International Journal of Clinical Pediatric Dentistry

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2018 | November-December | Volume 11 | Issue 6

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Original Article

Vineet Dhar, Soe Mon, Mark D Macek

Evaluation of Nonproximal Caries as Predictor of Proximal Caries in Primary Molars

[Year:2018] [Month:November-December] [Volume:11] [Number:6] [Pages:5] [Pages No:457 - 461]

Keywords: Caries, Nonproximal lesions, Proximal lesions

   DOI: 10.5005/jp-journals-10005-1557  |  Open Access |  How to cite  | 


Background: Most caries prevalence studies are conducted in community-based settings, usually with no radiographs, therefore, it is questionable if visual examination alone captures the true extent of disease. Aim: Since it is relatively easy to diagnose occlusal and facial/ lingual surface (nonproximal caries) on visual examination, our aim was to evaluate for an association between nonproximal caries (NP) and proximal caries (P), which if present can provide a tool to help decision makers in estimating the true extent of the disease. Design: A cross-sectional retrospective chart audit was done using records of 106 children to determine the association between NP and P caries in the primary dentition. Results: Our mean dft for NP lesions only was 1.55. Based on our data, the mean dft considering all pit and fissure plus the proximal lesions was 2.54, which is a 63.2% increase from the dft based on NP caries only. We found a significant association between NP caries and radiographically detectable P caries. Proximal lesions were twice as likely to exist on primary molars when non-proximal/pit and fissure carious lesions were present. Conclusion: The results imply that proximal caries, and thus need for treatment, are being underestimated during visual exams.


Original Article

Subramanian EMG, Satish Vishawanathaiah

Assessment of Quality of Obturation, Instrumentation Time and Intensity of Pain with Pediatric Rotary File (Kedo-S) in Primary Anterior Teeth: A Randomized Controlled Clinical Trial

[Year:2018] [Month:November-December] [Volume:11] [Number:6] [Pages:6] [Pages No:462 - 467]

Keywords: Children, Pain, Primary anteriors, Pulpectomy, Rotary file

   DOI: 10.5005/jp-journals-10005-1558  |  Open Access |  How to cite  | 


Aim: The purpose of this study was to clinically compare and evaluate the efficiency of pediatric rotary file kedo-S with hand K files and ProTaper rotary files during root canal preparation of primary anterior teeth. Materials and methods: Forty-five children requiring pulpectomy in any one of the vital primary anterior teeth were included. The children were randomly assigned to one of the three groups (15 per group), where the instrumentation was done using hand files in group 1, ProTaper rotary files in group 2 and Kedo-S rotary files in group 3. The instrumentation time, pain perception and the quality of obturation was assessed, and the statistical analysis was done using statistical package for social sciences (SPSS) software. Results: Statistically decreased instrumentation time was observed with the use of Kedo-S rotary file system (p < 0.05) when compared to the other two file systems. The intensity of pain experienced during instrumentation was also lesser with Kedo-S rotary file (p < 0.05). No significant difference was noted in the obturation quality with the exclusive pediatric rotary file when compared with the other two groups (p > 0.05). Conclusion: Kedo-S rotary files decrease the instrumentation time and intensity of the pain perception during canal instrumentation which positively influences the cooperation of the children. Clinical significance: Use of exclusive pediatric rotary files (Kedo-S) for root canal preparation in primary teeth reduces the fatigue of both the children and the dentists. Also, influences the behavior of the children in a more positive way thereby instilling a positive dental attitude.


Original Article

Prabhakar A Ramasetty, Amrita P Tripathi, Sugandhan S, Saraswathi V Naik, Deepak BM

Nanotechnology in Dentin Disinfection: Can We Preserve the Bond?

[Year:2018] [Month:November-December] [Volume:11] [Number:6] [Pages:6] [Pages No:468 - 473]

Keywords: Ag-Au (silver-gold) nanoparticles, Chlorhexidine, Microleakage, Resin tag

   DOI: 10.5005/jp-journals-10005-1559  |  Open Access |  How to cite  | 


Aims: The aim of the present study is to evaluate the effect of cavity disinfection with 2% chlorhexidine (CHX) and Ag-Au nanoparticles on microleakage and resin tag penetrability of composite restoration under in vitro conditions. Materials and methods: Twenty-five human permanent molars extracted for therapeutic reasons were used in the study. Class V cavity of standard dimension was prepared on the buccal and lingual surfaces of the teeth. The teeth were randomly allocated into two groups based on the cavity disinfectant used; group I being 2% chlorhexidine gluconate (chlorhexidine FGM) and group II being cavity disinfectant containing Ag-Au nanoparticles (nanocare gold). In both the groups, the dentin was etched with 37% phosphoric acid and cavity disinfectants were applied following which dentine bonding agent and composite resin were applied and cured. The specimens were then viewed under stereomicroscope and scanning electron microscope for evaluation of microleakage and resin tag formation, respectively. Results: The results were statistically analyzed using independent ‘t’ test. No significant difference was seen between the two groups with respect to the microleakage and resin tag penetration values (p > 0.05). Conclusion: Cavity disinfectant containing Ag-Au nanoparticles had no effect on the sealing ability and resin tag penetrability of composite resin in permanent molars when compared with 2% CHX. Clinical significance: Use of Cavity disinfectant containing Ag-Au nanoparticles with etch and rinse system can be preferred as it satisfies the ideal property of a cavity disinfectant which includes excellent antimicrobial action and non-detrimental effect on the sealing ability and resin tag penetrability.


Original Article

Shital DP Kiran, Komal Ghiya, Disha Makwani, Megha Patel

Comparison of Plaque Removal Efficacy of a Novel Flossing Agent with the Conventional Floss: A Clinical Study

[Year:2018] [Month:November-December] [Volume:11] [Number:6] [Pages:5] [Pages No:474 - 478]

Keywords: Gingivitis, Gumchucks, Oral hygiene

   DOI: 10.5005/jp-journals-10005-1560  |  Open Access |  How to cite  | 


Introduction: The various methods for plaque control include mechanical plaque control methods which comprises use of toothbrushes, flosses, interdental brushes, and chemical plaque control which includes mouthwashes, dentrifices. The need for the study was to prove the efficacy of flossing in children using gumchucks. Materials and methods: A total sample size of 24 children age groups 6–12 years according to chronological age were selected. In 12 patients, flossing using gumchucks was done and in 12 patients flossing using unwaxed floss without handle was done. Proximal plaque index was taken at 0,2,4,6 weeks to assess the efficacy of both types of floss in removal of interproximal plaque. At the end of 6 weeks, patient's parents were asked to fill up the questionnaire. Results: In the intragroup comparison for gumchucks, significant plaque reductions were found at 4 and 6 weeks. In the intragroup comparison for unwaxed floss, significant reduction for plaque marginal index were recorded from baseline to 2 and 4 weeks. In the intergroup comparison, significant reduction in plaque index was recorded at 4 and 6 weeks. Conclusion: Gumchucks have the high efficacy of plaque removal as well as easy in use for children routinely. Also when surveyed majority of the patents preferred gumchucks if available in the stores.


Original Article

Ullal A Nayak, Damodhar Kappadi, Deepesh Prajapati, Kangkan J Roy

Visible Enamel Defects in Adolescents: How Do their Peers View Them?

[Year:2018] [Month:November-December] [Volume:11] [Number:6] [Pages:4] [Pages No:479 - 482]

Keywords: Dental appearance, Enamel defects, Judgements

   DOI: 10.5005/jp-journals-10005-1561  |  Open Access |  How to cite  | 


Aim: The present study was aimed to determine whether adolescents make social judgments about other children who have noticeable enamel imperfections. Materials and methods: Two schools with very different socioeconomic profiles were selected using a stratified random sampling method. Children aged 13–14 years (school class 9) and 15–16 (school class 11) were randomly selected from these schools totaling to a sample size of 200. Half the participants rated full-face photographs of a boy and girl without an enamel defect, and the other half-rated the same two photographs with the digitally modified incisors. The photographic subjects were rated on a four-point Likert's scale consisting of six positive and five negative descriptors. Results: Based on the gender of the photographic subject, the mean total attribute score was almost identical. However, it was lower for photographic subjects showing enamel defects as compared to those without. Conclusion: The dental appearance can influence value judgments in children. Clinical significance: It is important to treat the enamel lesions and various developmental defects of the enamel as it may lead to a negative social judgment by peers.



Divyata Kohli, Chandrashekhar M Badakar, Prachi J Thakkar

An In Vivo Comparative Evaluation of Dental Anxiety Level and Clinical Success Rate of Composite and Multicolored Compomers in 6 to 12 years of Children

[Year:2018] [Month:November-December] [Volume:11] [Number:6] [Pages:7] [Pages No:483 - 489]

Keywords: Anxiety, Children, Coloured compomers, Composites

   DOI: 10.5005/jp-journals-10005-1562  |  Open Access |  How to cite  | 


Background: Pediatric dentistry is not just about treating the tooth, but it also involves giving an overall comprehensive treatment to the child. Children like different colors and when the child is allowed to select the color of the restoration, it will positively motivate the child to accept dental treatment. Aim: The aim of our study was to evaluate and compare the clinical success rate of composite and multicolored compomer restorations and dental anxiety level in children. Materials and methods: A total of 60 samples equally divided into two study groups by of split-mouth design. In the control group, subjects received composites and in experimental group, they received colored compomers. The dental behavior was assessed using the Frankl behavior rating scale for both the groups. Dental anxiety was checked in the patients using visual analogue scale (VAS) before and after the treatment for both the groups. Children were recalled for follow up at 1, 3 and 6 months to evaluate clinical success rate amongst control and experimental group and results were subjected to statistical analysis. Results: Colored compomer proved to reduce the anxiety in the child and had a better behavioral response and positive attitude. Both restorative materials had comparable clinical success rates. Conclusion: At 6 months follow-up evaluation colored compomer restorative material showing promising with similar properties like that of composites with the added advantage of multicolors and can be considered as the new restorative material in the child dentistry. Clinical significance: Colored compomers are known to be excellent alternative restorative materials for restoration of teeth in children as they aid in behavior modification and good compliance from the patient.



Amitabha Chakraborty, Bibhas Dey, Sinjana Jana

A Nonconventional Approach to Formocresol Pulpotomy

[Year:2018] [Month:November-December] [Volume:11] [Number:6] [Pages:6] [Pages No:490 - 495]

Keywords: Access cavity, Formocresol, Pulpotomy

   DOI: 10.5005/jp-journals-10005-1563  |  Open Access |  How to cite  | 


A different concept of formocresol pulpotomy procedure has been proposed where the formocresol pulpotomy is done with smaller access to the pulp chamber. In our study formocresol pulpotomy was carried out in 128 primary molar teeth with a limited amount of access opening, saving a bit of more tooth structure, which excludes the requirement of placement of a stainless steel crown (SSC). In 2 years follow-up period, no crown fracture was reported. One hundred fifteen teeth remain vital at the end of 2 years period of observation with the periodic clinical and radiographic review. The result shows 89.4% clinical and radiographic success of this nonconventional pulpotomy procedure that corroborates with several studies of the conventional formocresol pulpotomy procedure.



Hitaf Nasrallah, Balsam El Noueiri, Charles Pilipili, Fouad Ayoub

Clinical and Radiographic Evaluations of Biodentine™ Pulpotomies in Mature Primary Molars (Stage 2)

[Year:2018] [Month:November-December] [Volume:11] [Number:6] [Pages:9] [Pages No:496 - 504]

Keywords: Biodentine, Complete root formation, Primary molars, Pulp canal obliteration, Pulpotomy

   DOI: 10.5005/jp-journals-10005-1564  |  Open Access |  How to cite  | 


Introduction: The preservation of the integrity and health of primary teeth and their supporting tissues is of great importance in maintaining arch length space, mastication, speech, and esthetics. A pulpotomy is a common therapy performed on a primary tooth presenting reversible pulpitis or a traumatic pulp exposure, allowing its conservation on the arch until its loss. Aim: The study aims to clinically and radiographically evaluate the rates of success and efficacy of Biodentine™ as pulpotomy medicament exclusively on deciduous molars with complete roots formation (stage 2). Materials and methods: A total number of 75 primary molars in stage 2 of formation were selected to undergo pulpotomy treatment. All teeth were restored with a stainless-steel crown. The clinical success was evaluated at 1, 3, 6 and 12-month intervals. The radiographic follow-up evaluations were at 6 and 12 months. The resulting data were tabulated and statistically analyzed. Results: Among the 75 teeth treated with Biodentine™, one tooth revealed abnormal mobility and tenderness to percussion at the end of the 1st month. PLS widening and the bone lesion was not seen in any of the 74 remaining cases. Forty teeth (54.1%) showed pulp canal obliteration (PCO), and none of the cases developed a draining sinus or had increased mobility. At the end of the 1-year follow-up, the clinical and radiographic success rates were 98.7% and 100%, respectively. Conclusion: Pulpotomies performed with Biodentine™ on stage 2 primary molars were generally very satisfactory and fulfilled all requirements, covering all needs. This innovative bioactive medicament seems to be a “heroic” material. The excellent outcomes of the present study are indicative that Biodentine™ is a promising biomaterial to promote pulp repair after pulpotomy in clinical practice.



Shikha Mali, Ankit Gautam, Babita Niranjan

Efficacy of Myristica fragrans and Terminalia chebula as Pulpotomy Agents in Primary Teeth: A Clinical Study

[Year:2018] [Month:November-December] [Volume:11] [Number:6] [Pages:5] [Pages No:505 - 509]

Keywords: Formocresol, Myristica fragrans, Pulpotomy, Primary teeth, Terminalia chebula

   DOI: 10.5005/jp-journals-10005-1565  |  Open Access |  How to cite  | 


Background: Pulpotomy is the treatment for cariously exposed vital primary molars. Using Formocresol as a pulpotomy agent is been in controversy, which has triggered the search for better alternatives. The product like ‘Myristica fragrans (MF)–Nutmeg gel, Terminalia chebula (TC)–Myrobolan gel is gaining popularity as herbal pulpotomy agents. Aim: To evaluate and compare clinical and radiographical success of herbal gels Myristica fragrans (MF)–Nutmeg, and Terminalia chebula (TC)–Myrobolan as pulpotomy medicaments in primary teeth. Materials and methods: Twenty participants (n = 20), each with at least two primary molars requiring pulpotomy, were selected and divided into two test groups. In 10 children Terminalia chebula gel was placed in one side and Formocresol on another side. Rest 10 children were treated with Myristica fragrans gel on one side and another side with formocresol. The treated teeth selected for clinical and radiographic evaluation were monitored periodically for 3, 6 and 12 months. Results: With the follow-up of 12 months there was no significant difference in efficacy of all three pulpotomy medicaments, i.e. Nutmeg, Myrobolan, and Formocresol, respectively was found Conclusion: Herbal gels have a promising role in dentistry having the proper knowledge, and their effects on teeth would prove them as a successful dental therapeutic agent.



Fernanda Hecksher, Bruno Vidigal, Patricia Coelho, Diassanam Otoni, Christiano Alvarenga, Eduardo Nunes

Endodontic Treatment in Artificial Deciduous Teeth by Manual and Mechanical Instrumentation: A Pilot Study

[Year:2018] [Month:November-December] [Volume:11] [Number:6] [Pages:3] [Pages No:510 - 512]

Keywords: Deciduous teeth, Endodontics, Instrumentation

   DOI: 10.5005/jp-journals-10005-1566  |  Open Access |  How to cite  | 


Introduction: “In vitro” studies seek to simulate actual biological conditions in the laboratory and providing principles to be studied later, to facilitate the development of new techniques of root instrumentation in primary teeth and to ensure the integrity and function of the element. Aim: This study aimed to demonstrate the technological advances in endodontics by endodontic treatment performed on artificial primary teeth using a rotary instrumentation system and reciprocation. Materials and methods: Instrumentation of the root canal was performed via a manual, rotatory and Reciproc system. Results: The rotatory systems can facilitate endodontic treatment in one session. Conclusion: These procedures become increasingly easy and rapid with the help of technological advances in dentistry.



Saima Y Khan

An Exploratory Study of Consanguinity and Dental Developmental Anomalies

[Year:2018] [Month:November-December] [Volume:11] [Number:6] [Pages:6] [Pages No:513 - 518]

Keywords: Consanguinity, Fusion, Microdontia, Nonsyndromic supernumerary teeth

   DOI: 10.5005/jp-journals-10005-1567  |  Open Access |  How to cite  | 


Background: Consanguinity is known to alter the population structure but the available literature is almost silent on the association of dental conditions with consanguinity. Aim: The purpose was to assess the various dental developmental anomalies in 6–9 year old children born out of consanguineous and non-consanguineous marriages and its association with their parents. Design: A cross sectional house–hold survey with a sample size of 2,000 (1,600 non-consanguineous and 400 consanguineous respondents and their parents) using systematic random sampling was planned. Six to nine-year-old children and their parents living in 1,597 households were examined and the information recorded on a pretested self prepared questionnaire. The questionnaire had questions pertaining to personal details, type of consanguineous marriages, history of trauma and examination of dental developmental anomalies. Results: Multivariate logistic regression showed that non syndromic supernumerary teeth in fathers (p =.009); fusion in mothers (p = 0.002); fusion (p <0.001), nonsyndromic supernumerary teeth (p < 0.001), and microdontia (p = 0.002) in respondents were significantly associated with consanguinity. Conclusion: A significant association of developmental anomalies in parents with consanguineous marriages and their respondents was observed.



Munish Reddy, Shalu Jain, Pradeep Raghav, Stuti Mohan, Ashutosh Wadhawan

Sequential Utilization of E-space for Correction of Moderate Crowding: A Case Report

[Year:2018] [Month:November-December] [Volume:11] [Number:6] [Pages:7] [Pages No:519 - 525]

Keywords: E-space utilization, Late mixed dentition, Orthodontics, Tooth movement

   DOI: 10.5005/jp-journals-10005-1568  |  Open Access |  How to cite  | 


Leeway space and E-space plays a crucial role in the late transition phase from primary dentition to permanent dentition. Leeway space is normally 0.9 mm and 1.5 mm in upper and lower arch respectively. E-space is the difference in the mesiodistal width of deciduous second molar and permanent second premolar which is 2.3 in upper arch 2.5 mm in lower arch 1. E-space and leeway space are normally utilized by permanent first molars to establish class I molar relation in permanent dentition. We can also utilize this E-space during fixed orthodontic treatment for reliving of crowding in late mixed dentition. Thus, here in this article, we are presenting clinical technique along with case series of sequential utilization of E-space for correction of anterior crowding without extractions.



Naga Sreebala, Basavaraj , Farheena Sindgi

Laser Excision of Focal Epithelial Hyperplasia (Heck's Disease): A Rare Case Report

[Year:2018] [Month:November-December] [Volume:11] [Number:6] [Pages:3] [Pages No:526 - 528]

Keywords: Focal epithelial hyperplasia, Heck's disease, Human papilloma virus

   DOI: 10.5005/jp-journals-10005-1569  |  Open Access |  How to cite  | 


Heck's disease or focal epithelial hyperplasia is a rare, benign and asymptomatic lesion of oral mucosa that is characterized by the presence of soft, sessile papules, white to pinkish in colour that occur diffusely in oral cavity. Prevalence rate of this disease greatly varies from one geographic region to another. It is found to be closely associated with human papilloma virus (HPV). This paper reports an Indian case of focal epithelial hyperplasia in a 5-year-old boy that is diagnosed according to both clinical and histopathological features, where human poillomavirus (HPV) subtype 32 was found associated with disease through polymerase chain reaction analyses. A dental practitioner should be aware of this disease and must perform a careful evaluation both clinically and histopathologically for setting the diagnosis with other diseases.



Jeswin Thomas, Anoop Harris, Sundeep Hedge, Gen Morgan, Esai A Prabha, Rinu p

Alternative Management of Impacted Permanent Central Incisor

[Year:2018] [Month:November-December] [Volume:11] [Number:6] [Pages:3] [Pages No:529 - 531]

Keywords: Impacted permanent central incisor, Supernumerary tooth, Treatment

   DOI: 10.5005/jp-journals-10005-1570  |  Open Access |  How to cite  | 


Aim: To discuss about the possible treatment modalities of supernumerary tooth in place of a impacted permanent tooth Background: Numerical anomaly with an excessive number of teeth are termed as supernumerary teeth. Case description: This paper describes a case with erupted supernumerary tooth in the place of missing left maxillary central incisor. Radiographically the left maxillary central incisor was impacted below the root of the supernumerary tooth with an additional impacted supernumerary tooth in relation to the right maxillary central incisor. Conclusion: A multidisciplinary approach is required in managing the supernumerary teeth. When orthodontic extrusion of the impacted permanent tooth is not possible the possibilities of retaining the supernumerary tooth should be considered. Clinical significance: This paper describes about the treatment of supernumerary tooth erupted in the place of missing left maxillary central incisor not amenable for orthodontic extrusion.



Gagandeep Kaur, Mitul Joshi

Recurrent Kawasaki Disease Presenting to Dentists: “Think Beyond Dentition”

[Year:2018] [Month:November-December] [Volume:11] [Number:6] [Pages:1] [Pages No:535 - 535]

Keywords: Kawasaki disease, Orofacial features, Recurrent

   DOI: 10.5005/jp-journals-10005-1571  |  Open Access |  How to cite  | 


Aim: To create awareness of Kawasaki disease in the dental community as it is a rare disease and some cases might go unnoticed due to lack of knowledge of the treating dentist. Thus proper knowledge helps in the timely diagnosis of the disease and decrease the mortality rate in these patients. Children who show the oral features of this disease should be treated seriously by the dentist. Background: Kawasaki disease is a rare acute systemic vasculitis disorder reported in the dental literature. Clinical features include high fever, redness of palms and soles of the feet, conjunctivitis, oropharyngeal mucositis and lymphadenopathy. The cardiac involvement in the form of myocarditis, aneurysms, pericarditis is also seen and is caused by inflammation of vessels of the heart. Case description: Here we present a rare case of an 8-yearold girl who presented to the department of Pediatric Dentistry with the chief complaint of recurrent painless swelling of the lower lip. This rare presentation of lower lip swelling has not been cited in the oral manifestation of Kawasaki disease before. Clinical significance: The disease has high mortality and morbidity rate if not treated early, and hence an early diagnosis and treatment are important in managing this condition. The oral findings are a characteristic feature of this serious disease, hence, many cases might first report to the dental clinician only. Dentists should always remain alert in handling patients having a history of Kawasaki disease because of the possibility of recurrence of the disease. As these patients have valvular heart defects, they might require prophylactic antibiotic treatment before the needed dental procedure. Conclusion: Despite this, there seems to be less aware of this disease among the dentist, hence this condition goes unnoticed leading to few citations of this disease in the dental literature.



Anshul Arora, Ashtha Arya, Latika Chauhan, Gaurav Thapak

Radix Entomolaris: Case Report with Clinical Implication

[Year:2018] [Month:November-December] [Volume:11] [Number:6] [Pages:3] [Pages No:536 - 538]

Keywords: Anatomical variation, Endodontic treatment, Mandibular molar, Radix entomolaris

   DOI: 10.5005/jp-journals-10005-1572  |  Open Access |  How to cite  | 


Usually first mandibular molars have one mesial and distal root but in some cases there are anatomical variations wherein the number of roots and root canals vary. Presence of an additional lingual root distally in mandibular molars is called radix entomolaris (RE). Appropriate diagnosis is must before starting with root canal procedure in these teeth to ensure successful treatment outcome. The report describes the endodontic management of mandibular molar with RE.


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