International Journal of Clinical Pediatric Dentistry

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2018 | July-August | Volume 11 | Issue 4

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Mahima Gandhi, Garima Kalia, Khushboo Rathore

Comparative Evaluation of Mucosal Vibrator with Topical Anesthetic Gel to reduce Pain during Administration of Local Anesthesia in Pediatric Patients: An in vivo Study

[Year:2018] [Month:July-August] [Volume:11] [Number:4] [Pages:5] [Pages No:261 - 265]

Keywords: Facial pain rating scale, Lignocaine jelly, Pain scores, Sound, eye, motor scale

   DOI: 10.5005/jp-journals-10005-1523  |  Open Access |  How to cite  | 


Introduction: Usually discomfort and pain are associated with dental work, especially for young patients. Pain control can be achieved by using anesthesia. Sight of injection can terrify any patient and if the patient is a child it is really difficult to convince them for injections. Alternatives to injections have been explored. Pediatric dentists are using anesthesia in the form of jelly and patch. Recently, the concept of mucosal vibration has been put forward to enhance the effectiveness of local anesthesia. Aim: The aim of the present study was to compare and evaluate the effectiveness of lignocaine jelly and mucosal vibration in reducing pain during administration of local anesthesia in pediatric dental patients. Materials and methods: Thirty children in the age group 6 to 11 years who required bilateral anesthesia for dental treatment in mandible were selected for this study. Pain was compared using Wilcoxon signed-rank test at the time of injection using Sound, Eye, Motor (SEM) scale as objective criteria and facial pain rating (FPR) scale as subjective criteria after administration of injection by a trained assistant who was blinded to the procedure. Results: Local anesthetic injection along with mucosal vibration resulted in significantly less pain (p = 0.001) in comparison with the injections without the use of mucosal vibration. Conclusion: The result shows that mucosal vibration can be used as an effective means to reduce the intensity of pain during local anesthetic injection in dentistry.



Shefally Garg, Munish Goel, Shweta Verma, Nanika Mahajan, Bhawna Kaul, Vikas Garg

Use of “Surface Analyzer” to evaluate the Effect of Two Polishing Systems on Surface Texture of Four Newer Composites

[Year:2018] [Month:July-August] [Volume:11] [Number:4] [Pages:5] [Pages No:266 - 270]

Keywords: Composites, Light cure unit, Mylar strip, Polishing system, Profilometer

   DOI: 10.5005/jp-journals-10005-1524  |  Open Access |  How to cite  | 


Composites polymerized with a clear matrix on the surface will leave a resin-rich surface layer that is easily abraded in the oral environment, exposing unpolished, rough, inorganic filler material. The purpose of this study was to evaluate the polishing effect of two different polishing systems: One-step (PoGo) system and Sof-Lex (multistep) system on four different resin composites: Synergy D6, Clearfil APX Esthetics, Filtek Z 350 XT, Ceram X Mono. After polishing, the specimens were analyzed for average surface roughness using a twodimensional surface profilometer.



Mohit Sharma, Prasanna Kumar, Dempsy CM Mandanna

Validity and Reliability of the Hindi Version of the Modified Child Perceptions Questionnaire 11 to 14

[Year:2018] [Month:July-August] [Volume:11] [Number:4] [Pages:6] [Pages No:271 - 276]

Keywords: Child perceptions questionnaire, Hindi version of child perceptions questionnaire 11-14, Validity and reliability of child perceptions questionnaire 11-14

   DOI: 10.5005/jp-journals-10005-1525  |  Open Access |  How to cite  | 


Introduction: The study was conceived to formulate a tool to evaluate child perceptions related to oral health in 11- to 14-year-olds tailor-made for Indian children in Hindi. The original child perceptions questionnaire (CPQ11-14) was translated into Hindi and it was tested for validity and reliability. Materials and methods: The original CPQ11-14 was translated into Hindi and some questions were rephrased to suit the sociocultural situation in India. The domains of self-esteem and psychological well-being were added to the questionnaire to broaden the scope of parameters to thoroughly assess the impact on child perceptions toward oral health. The English and Hindi versions of the CPQ11-14 were administered during the first visit to test for validity and the children were recalled after 1 week and administered the Hindi questionnaire again after 1 week to check for reliability. Results: The results showed significant positive correlation between oral symptoms, decayed, missing and filled teeth (DMFT) functional limitation and malocclusion. The mean functional limitation score was found to be higher in subjects with malocclusion in both the English and Hindi questionnaires. The test–retest samples were evaluated using the paired t-test and showed no significant difference between the first and second administration which suggested good reliability. Conclusion: The translated and modified Hindi CPQ11-14 was found to be valid and highly reliable for use in India. The adaptation of the original questionnaire by modifying certain questions to suit the Indian condition was found to be culturally relevant.



Vanga V Narasimha Rao, Srinivas K Chandrabhatla, Vabbala R Rajasekhar

Comparative Evaluation of the Fracture Resistance of Two Different Fiber-reinforced Composite Restorations with Particulate Filler Composite Restorations

[Year:2018] [Month:July-August] [Volume:11] [Number:4] [Pages:6] [Pages No:277 - 282]

Keywords: Fracture resistance, Glass fiber-reinforced composites, Incisal fractures, Mesio-incisal fractures, Polyethylene fiber-reinforced composites

   DOI: 10.5005/jp-journals-10005-1526  |  Open Access |  How to cite  | 


Uncomplicated crown fractures are the most common form of traumatic dental injuries (TDIs) in children affecting their personal and social well-being. Aim: To evaluate the fracture resistance of fractured incisors restored with particulate filler composites, glass fiberreinforced composites, and Polyethylene fiber-reinforced composite restorations. Materials and methods: Standardized incisal and mesioincisal fractures with chamfer preparation were prepared on human maxillary central incisors. Test samples were restored using particulate filler composites (Filtek Z 250), glass fiber-reinforced composites (Fiber-Splint) and polyethylenereinforced composites (Ribbond). Static load was applied to the test samples using Universal testing machine at a crosshead speed of 1 mm/min. Data were tabulated and analyzed using analysis of variance (ANOVA) (p = 0.05). Results: Descriptive statistics of mean [standard deviation (SD)] peak failure load in incisal restorations for particular filler composite, glass fiber-reinforced composites, and polyethylene fiber-reinforced composites were 196.00 (± 67.46), 186.28 (± 66.44), and 246.71 (± 24.52) respectively, whereas for mesio-incisal restorations, mean (SD) peak failure loads were 169.28 (± 33.53), 218.57 (± 74.41), and 225.71 (± 57.52) respectively. Conclusion: Polyethylene-reinforced composites showed an improved load-bearing capacity in incisal and mesio-incisal restorations when compared with particulate filler composites and glass fiber-reinforced composites.



Manoj K Mallela, Harivinder R Konyala, Ajay R Mareddy, N Venugopal Reddy, Keerthi P Susheela

Clinical, Radiological, and Histological Assessment of Magnetic Nanoparticles as Pulpotomy Medicament in Primary Molars

[Year:2018] [Month:July-August] [Volume:11] [Number:4] [Pages:5] [Pages No:283 - 287]

Keywords: Magnetic nanoparticles, Pulpotomy, Scanning electron microscope

   DOI: 10.5005/jp-journals-10005-1527  |  Open Access |  How to cite  | 


Aim and objectives: Aim of the study was to evaluate the success of magnetic nanoparticles (MNPs) as pulpotomy medicament by clinical, radiologic, and histological assessment in primary molars. Materials and methods: The sample included 30 primary molars from 25 children aged between 3 and 9 years requiring pulpotomy treatment. Pulpotomy was carried out with MNPs. The teeth were evaluated after a period of 3, 6, and 12 months clinically and with the aid of radiographs. After 1 year, 10 teeth were extracted for histological evaluation under field emission scanning electron microscope (FE-SEM; ZEISS, Model No. Supra 55vp). Results: Of the samples, 98% showed clinical success rate with absence of pain, swelling, mobility, and abscess formation. After 3 months, 98% radiological success with absence of periodontal ligament widening, root resorption, and interradicular radiolucency was noted. Histological examination carried out under FE-SEM revealed a zone of odontoblastic proliferation at the interface between MNPs and odontoblastic layer of pulp and viable pulpal cells from the canal orifice till apical foramen. Conclusion: Magnetic nanoparticles can be recommended as an effective pulpotomy medicament with hard tissue barrier formation and preservation of vitality of remaining radicular pulp.



Veerakishore Kumar Reddy, Naveen K Kommineni, Prathyusha Padakandla, John P Indupalli, Swapna P Nanga

Evaluation of Chemokines in the Gingival Crevicular Fluid of Children with Down Syndrome

[Year:2018] [Month:July-August] [Volume:11] [Number:4] [Pages:6] [Pages No:288 - 293]

Keywords: Chemokines, Down syndrome, Gingival crevicular fluid, Inflammation, Macrophage inflammatory protein 1&alpha , Macrophage inflammatory protein 1â

   DOI: 10.5005/jp-journals-10005-1528  |  Open Access |  How to cite  | 


Aim: The goal of the study was to detect the presence of macrophage inflammatory protein (MIP)-1α and MIP-1β and to estimate their levels in gingival crevicular fluid (GCF) of children with Down syndrome. Materials and methods: MIP-1α and MIP-1β levels were estimated in GCF samples of 20 healthy and 20 Down syndrome individuals. Gingival status was assessed by measuring the gingival index (GI), plaque index (PI), clinical attachment level (CAL), and probing pocket depth (PPD). The GCF samples were obtained from the subjects and MIP-1α and MIP-1β levels were quantified by enzyme-linked immunosorbent assay (ELISA). Results: The mean MIP-1α concentrations in healthy and Down syndrome individuals were 209 and 1411 pg/μL respectively, and MIP-1α levels were 342 and 1404 pg/μL respectively. The levels of MIP-1α and MIP-1β in the GCF of subjects with Down syndrome were significantly higher than in the healthy individual, and statistically significant differences were present among the two groups. Conclusion: The GCF showed dynamic changes according to the severity of periodontal disease, and the levels of MIP-1α and MIP-1β had a strong relationship with clinical parameters. The MIP-1α and MIP-1β can therefore be considered as novel biomarkers in the biological mechanism underlying the pathogenesis of periodontal disease.



Gianluca Porcaro, Ernesto Amosso

Evaluation of Surgical Options for Supernumerary Teeth in the Anterior Maxilla

[Year:2018] [Month:July-August] [Volume:11] [Number:4] [Pages:5] [Pages No:294 - 298]

Keywords: Anterior maxilla, Impacted teeth, Mesiodens, Supernumerary teeth, Surgical extraction

   DOI: 10.5005/jp-journals-10005-1529  |  Open Access |  How to cite  | 


Aim: The purpose of this study was to evaluate the surgical options for supernumerary teeth (SNT) in the premaxillary region of children. Materials and methods: A total of 69 patients with 82 partially or completely formed SNT in the anterior maxillary region were identified over a 3-year period. All selected patients were assessed for the number, location, and family history of SNT, damage to adjacent roots, and associated symptoms. The surgical approaches used for removal were recorded. Postoperative clinical sequelae (loss of vitality, periodontal problems, pain, bleeding, and enanthema) were evaluated. Results: A total of 43, 30, and 9 SNT were extracted with palatal, buccal, and bicortical approaches respectively. Periodontal and vitality assessments revealed no problems in adjacent teeth at 6 months after surgery. Postoperative pain was within acceptable levels in all patients and subsided within 3 to 7 days. Mild postoperative bleeding occurred in eight patients. Enanthema subsided within 10 days in all patients. Conclusion: Our results suggest that early diagnosis and appropriate surgical treatment of SNT are important to decrease the risk of clinical complications.



Bharathi Padiyar

Comparative Evaluation of Effects of Triphala, Garlic Extracts, and Chlorhexidine Mouthwashes on Salivary Streptococcus mutans Counts and Oral Hygiene Status

[Year:2018] [Month:July-August] [Volume:11] [Number:4] [Pages:8] [Pages No:299 - 306]

Keywords: Chlorhexidine, Garlic, Mouthwash, Plaque, Streptococcus mutans, Triphala

   DOI: 10.5005/jp-journals-10005-1530  |  Open Access |  How to cite  | 


Aims and objectives: To determine and compare the effect of triphala, chlorhexidine gluconate, and garlic extract mouthwash on salivary Streptococcus mutans count and the oral hygiene status. Materials and methods: Sixty children aged 9 to 12 years were randomly allocated into the study groups of triphala mouthwash, chlorhexidine mouthwash, garlic extracts mouthwash, and distilled water mouthwash. Examination included decayed, missing, and filled teeth (dmft)/decayed, missing, filled surface (dmfs) and DMFT/DMFS, plaque index, and S. mutans count on days 1, 15, and 30. Results: The results were statistically analyzed using Friedman test, Wilcoxon signed rank, repeated-measures analysis of variance (ANOVA), paired t-test, one-way ANOVA, post hoc Tukey's honestly significant different (HSD), Kruskal–Wallis test, and Mann–Whitney test; all calculations were done by MEDCALC software 14.0.0 version. Discussion: Streptococcus mutans count had significant reductions using different mouthwashes at 15 days, but the chlorhexidine group showed significant difference from the remaining three groups. Intergroup comparison for plaque index scores of triphala, chlorhexidine, and garlic groups was similar in preventing plaque build-up during the 15 days of mouthwash use. Conclusion: All the three mouthwashes containing triphala, chlorhexidine gluconate, and garlic were comparably efficient in reducing the salivary S. mutans count as well as in limiting plaque score; however, chlorhexidine was the most effective in this aspect. In comparison of the two natural ingredients, Triphala is more effective in its antimicrobial effect.



Bhagyalakshmi Avinash, Basapura M Shivalinga, Somanthan Balasubramanian, Suma Shekar, Byalakere R Chandrashekar, Battalli S Avinash

Orthodontic Treatment Needs of 12-year-old Schoolgoing Children of Mysuru District, Karnataka, India: A Cross-sectional Study

[Year:2018] [Month:July-August] [Volume:11] [Number:4] [Pages:10] [Pages No:307 - 316]

Keywords: Awareness, Dental health component, Esthetic component, Index of orthodontic treatment need, Malocclusion

   DOI: 10.5005/jp-ijcpd-11-4-307  |  Open Access |  How to cite  | 


Health is the extent of functional or metabolic regulation of a living body. Many researchers have shown that oral health is directly related to the systemic condition of a person. The various researches done has shown that there is an increase in need for orthodontic treatment in most of the countries. Hence judicious planning of providing orthodontic services on a population basis is necessary to appraise the requirement of resources and manoeuvre for providing such a service.



Ayman Mourad, Elia Sfeir, Mona Gholmieh, Zouhair Skaf

Alveolar Bone and Epithelial Attachment Status following Two Different Closed-eruption Surgical Techniques for Impacted Maxillary Central Incisors

[Year:2018] [Month:July-August] [Volume:11] [Number:4] [Pages:6] [Pages No:317 - 322]

Keywords: Closed-eruption surgical technique, Discontinued traction, Impacted, Periodontal status, Upper central incisor

   DOI: 10.5005/jp-journals-10005-1532  |  Open Access |  How to cite  | 


Aim: Two eruption surgical techniques are commonly described for the treatment of upper impacted central incisors (ICIs): Open and closed. Currently, the closed-eruption surgical technique (CEST) is the most commonly used, as it allows for the best esthetic and periodontal results. The aim of this study was to determine the effect of traction discontinuation on maxillary central incisor sulcal depth and alveolar bone ridge levels compared with contralateral incisors, when CEST is used. Materials and methods: Our study involved 28 unilateral impacted maxillary central incisors treated by CEST. Thirteen teeth were subjected to traction interruption for a month at the time of emergence of the crown, while 15 teeth underwent continuous traction. One year after treatment, periapical digital X-rays, anterosuperior cone beam computerized tomography (CBCT) scanning, and periodontal probing of the ICIs and contralateral central incisors (CCIs) were performed. Student's t-test was used to study whether a statistically significant difference between continuous and interrupted tractions takes place while using the CCI measurements as reference. Results: There was a statistically significant difference between the two techniques only for the following measurements: Mesial probing (p-value 0.039352), labial bone level (p-value 2.58E-08), and palatal bone level (p-value 2.56E-06). Limitations: A larger sample size and longer term follow-up are needed to draw more robust conclusions. Conclusion: A temporary discontinuation during traction of the tooth appears to positively impact treatment outcome on ICIs. Clinical significance: • The CEST leads to the best periodontal status for ICIs. • The discontinuation of traction at the emergence of the tooth allows the supracrestal fibers to insert into the cement in a proper way.



Chandrashekar Yavagal, Attiguppe Prabhakar, Manjunath Lokeshwari

Efficacy of Caries Removal by Carie-Care and Erbiumdoped Yttrium Aluminum Garnet Laser in Primary Molars: A Scanning Electron Microscope Study

[Year:2018] [Month:July-August] [Volume:11] [Number:4] [Pages:7] [Pages No:323 - 329]

Keywords: Carie-Care, Caries excavation, Carious primary molars, Erbium-doped yttrium aluminum garnet laser, Light microscopy, Round tungsten carbide bur, Scanning electron microscope

   DOI: 10.5005/jp-journals-10005-1533  |  Open Access |  How to cite  | 


Aim: To compare and evaluate morphological changes and bacterial deposits in primary carious molars after caries excavation with Carie-Care, erbium-doped yttrium aluminum garnet (Er:YAG) laser, and round tungsten carbide bur. Materials and methods: Thirty human carious primary molars extracted for therapeutic reasons were sectioned mesiodistally. These sectioned samples were allocated into three groups (20 samples each): group I: Carie Care, group II: Er:YAG laser, and group III: round tungsten carbide bur. After caries excavation, all samples were processed and examined under conventional light microscope to examine for bacterial deposits. Representative samples from each group were processed and analyzed to examine the morphology of caries-excavated tissue by scanning electron microscope (SEM). Statistical analysis was done using Fisher's exact test, Kruskal–Wallis test, and Mann–Whitney U test. Results: The Er:YAG laser showed best results with no smear layer followed by chemomechanically excavated surfaces with Carie-Care. Amount of bacterial deposits was observed to be more in group I while least in group II (p-value < 0.001). Mann– Whitney U test and Fisher's exact test revealed that there was statistically significant difference among all the three groups. Conclusion: Among the three different methods of caries excavation, Er:YAG laser was found to be more effective compared with Carie-Care and round tungsten carbide bur. Clinical significance: Laser-induced caries excavation by Er:YAG laser and chemomechanical method of caries removal by Carie-Care can be considered as future of noninvasive pediatric and preventive dentistry.



Jampanapalli S Reddy, Konda Suhasini, Inguva H Chandrika, Dalavai Praveen

Time and Eruption Sequence of Permanent Teeth in Hyderabad Children: A Descriptive Cross-sectional Study

[Year:2018] [Month:July-August] [Volume:11] [Number:4] [Pages:8] [Pages No:330 - 337]

Keywords: Eruption sequence, Eruption time, Permanent dentition

   DOI: 10.5005/jp-journals-10005-1534  |  Open Access |  How to cite  | 


Context: Eruption of teeth is influenced by various factors. Very few studies were carried out in the past on the eruption time of teeth in the Indian population. Aim: The aim of the study is to determine the time and sequence, gender differences, pattern of symmetry in the eruption of permanent teeth in Hyderabad children. Materials and methods: In this cross-sectional study, 1654 schoolchildren (806 girls and 848 boys) in the age group of 5 to 15 years from Hyderabad were examined for the status of eruption of permanent teeth. Statistical analysis used: Results were subjected to probit's regression analysis. The average age at eruption of permanent teeth, excluding third molars, was given as the mean [± standard deviation (SD)] in months for each gender. A table of percentiles of the eruption time was also determined. Results: Unlike most of the earlier studies which showed that girls are ahead of boys in permanent teeth emergence, no such pattern was observed. No significant difference was found in the eruption of permanent teeth in right and left arches. Eruption of all the mandibular teeth, with the exception of right first premolar (44) in both the genders, was earlier than their maxillary counterparts. There was overall delay in the eruption of permanent teeth and significant delay in the eruption of lower canines in both genders. Conclusion: The significant delay in the eruption of permanent mandibular canines is relevant for orthodontic treatment planning.



Shanmugaavel K Arunachalam

Knowledge, Attitude, and Practice of Mothers regarding Oral Hygiene of Primary School children in Chennai, Tamil Nadu, India

[Year:2018] [Month:July-August] [Volume:11] [Number:4] [Pages:6] [Pages No:338 - 343]

Keywords: Attitude, Knowledge, Mothers, Practice, Primary schoolchildren

   DOI: 10.5005/jp-journals-10005-1535  |  Open Access |  How to cite  | 


Introduction: Children depend on their parents and caretakers for maintenance of their oral health. Parents play a major role in both preventive and treatment regime in these children. This study was conducted with the aim of evaluating the influence of parental education on knowledge, attitude, and practice of mothers regarding oral health of primary schoolchildren in Chennai. Materials and methods: A 15-item self-administered questionnaire was used among 465 parents of preschool children in Chennai, of which 432 mothers returned the filled questionnaire. The data collected were subjected to statistical analysis using frequency of responses and chi-square test (p < 0.01). Data were analyzed using statistical package. Results: Of the 432 mothers who participated in the study, 150 (35%) have studied up to school level and 282 (65%) have completed diploma/degree. The knowledge of mothers regarding the knowledge of importance of oral health for general health is appreciable, but the awareness of proper brushing habit, treatment of caries, and importance of dental visits is less in mothers who have school education when compared with graduate mothers. Conclusion: Mothers who are graduates are more aware of the importance of oral health in children, treatment of dental caries, and brushing technique than mothers with school education. Hence, it is essential that government and health care providers impart oral health knowledge to mothers, as they are the role-models for their children.



Elisabeth Roy, Assem Soueidan, Marc Fouassier

Multidisciplinary Clinical Management of a Localized Aggressive Periodontitis diagnosed in a Child with Glanzmann's Thrombasthenia

[Year:2018] [Month:July-August] [Volume:11] [Number:4] [Pages:5] [Pages No:344 - 348]

Keywords: Aggressive periodontitis, Glanzmann's thrombasthenia, Periodontal disease/therapy, Periodontopathogen

   DOI: 10.5005/jp-journals-10005-1536  |  Open Access |  How to cite  | 


Localized aggressive periodontitis (LAP) in child involving primary dentition is a rare disease. The main characteristics of LAP are deep periodontal pockets, bone loss, tooth mobility, and, sometimes, spontaneous tooth loss. The LAP involves only some specific teeth. Glanzmann's thrombasthenia (GT) is a rare autosomal recessive bleeding disorder. The paper's aim is to present the case of a 5-year-old girl with GT presenting LAP, and discuss her clinical management.



Madhusudhan R Madhireddy, A Jacob Prakash, Vijayalakshmi Mahanthi, K Venkata Chalapathi

Large Follicular Odontogenic Keratocyst affecting Maxillary Sinus mimicking Dentigerous Cyst in an 8-year-old Boy: A Case Report and Review

[Year:2018] [Month:July-August] [Volume:11] [Number:4] [Pages:3] [Pages No:349 - 351]

Keywords: Dentigerous cyst, Follicular odontogenic keratocyst, Keratocystic odontogenic tumor

   DOI: 10.5005/jp-journals-10005-1537  |  Open Access |  How to cite  | 


Cyst with relatively high recurrence and having nature to invade the underlying tissue is “odontogenic keratocyst (OKC).” Radiographically, OKC can appear as different varieties, such as follicular, replacemental, extraneous, envelopmental, and collateral. Each radiographic variety of OKC varies in biological behavior, prognosis, recurrence, and therapeutic approaches. Many studies done till date have not established any relationship between markers of proliferation and aggressiveness in regard to radiographic varieties of OKC. The present article reports a case of follicular OKC in an 8-year-old boy which was concluded as a dentigerous cyst by radiographic features.



Hytham N Fageeh

Papillon–Lefèvre Syndrome: A Rare Case Report of Two Brothers and Review of the Literature

[Year:2018] [Month:July-August] [Volume:11] [Number:4] [Pages:4] [Pages No:352 - 355]

Keywords: Palmar-plantar hyperkeratosis, Papillon–Lefèvre syndrome, Periodontitis

   DOI: 10.5005/jp-journals-10005-1538  |  Open Access |  How to cite  | 


Papillon–Lefèvre is an autosomal recessive syndrome that starts in early periods of childhood. Characteristic features include palmar plantar hyperkeratosis, aggressive periodontal disease, and a tendency for dry and chopped skin, thin and sparse hair. Patients show signs of premature tooth loss at the age of 2 to 4 years, which is then followed by the loss of permanent dentition during adolescence. The presence of both skin and oral lesions in this syndrome differentiates this unusual genodermatosis from other pathology of palmoplantar keratoderma (PPK). The etiopathogenesis of this syndrome is somewhat obscure; however, immunologic, genetic, and possible bacterial etiologies have been proposed. The dental practitioner is often the first to diagnose the disease, as there is a significant degree of periodontal breakdown that is involved at an early age. This report presents a clinical presentation of two brothers detected with Papillon–Lefèvre syndrome (PLS).


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