International Journal of Clinical Pediatric Dentistry

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2019 | July-August | Volume 12 | Issue 4

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Original Article

Soumya Rajan, Sobha Kuriakose, Bobby J Varghese, Firoz Asharaf, Athira Sreedevi

Knowledge, Attitude, and Practices of Dental Practitioners in Thiruvananthapuram on Oral Health Care for Children with Special Needs

[Year:2019] [Month:July-August] [Volume:12] [Number:4] [Pages:4] [Pages No:251 - 254]

Keywords: Barriers, Special care dentistry, SHCN

   DOI: 10.5005/jp-journals-10005-1631  |  Open Access |  How to cite  | 


The objective of this study was to investigate knowledge, attitude, and practices of dental practitioners in Thiruvananthapuram, India regarding dental management of children with special healthcare needs (CSHCN). Materials and methods: A structured questionnaire was given to 400 dental practitioners. The data were analyzed using SPSS software (version 23.0) and Chi-square test was used. Results: The response rate was 94%. An estimated 73.8% treated children, 66.5% showed willingness to treat CSHCN, and 70.8% had attended CSHCN in their practice. A partial knowledge in dental management of CSHCN was reported by 67.5%. An estimated 36% had undergone training in special care dentistry (SCD) but 45% were not sure whether they can provide dental care with the graduate-level training. Knowledge regarding guidelines for CSHCN was known to 19.5% and that regarding timing of the first dental visit was known to 69% of participants. Tooth extraction (43.1%) and a subsequent caries treatment (39.1%) were the most frequently done procedures, and nonpharmacological management (46.5%) was the mostly used behavior management technique. Among the barriers faced by dentists in treating CSHCN, time consumption (55.6%) and lack of training (55.1%) were commonly enlisted. Further training and improved facilities would motivate the respondents in providing better care to CSHCN. Conclusion: This study suggests that majority of the dentists participated had a partial knowledge on SCD and were willing to treat CSHCN. Insufficient training in the field of SCD was a major drawback, which prevented most general dentists from effectively managing CSHCN. Additional training and improving facilities can improve dental care to CSHCN.


Original Article

Raghavendra M Shetty, Shailja Hanumanta

RMS-MP3 Classification: A Newly Proposed Digital MP3 Classification in Assessing Skeletal Maturity

[Year:2019] [Month:July-August] [Volume:12] [Number:4] [Pages:6] [Pages No:255 - 260]

Keywords: Growth prediction, MP3 classification, RMS-MP3 classification reliability, Skeletal maturity

   DOI: 10.5005/jp-journals-10005-1632  |  Open Access |  How to cite  | 


Background: Growth is a crucial inconsistent parameter, which is a primary requisite in diagnosing and planning orthodontic and orthopedic treatment. The use of the epiphyseal development of the middle phalanx of the third finger (MP3) radiograph is advisable instead of hand and wrist radiographs for growth assessment. Aim: (1) To propose a simple, precise, and reliable classification system of MP3 staging—RMS MP3 classification and (2) to check the reliability of newly proposed RMS-MP3 classification in assessing the skeletal maturity. Materials and methods: Standardized MP3 digital radiographs of 276 children between 5 years and 13 years of age were included in the study. The epiphysis and diaphysis were measured, and the percentage of epiphysis formed when compared to diaphysis was obtained using our formula. A new classification was designed and proposed. The assessment of the MP3 developmental stages was carried out by all the four investigators (two pedodontists and two nonpedodontists) according to the older classification by Liete et al. and the newly proposed RMS-MP3 classification. Results: Among nonpedodontists, there was 51% perfect agreement of maturity stages according to old classification and 90% perfect agreement according to newly proposed classification. Among pedodontists, there was 90% perfect agreement of maturity stages according to old classification and 99% perfect agreement according to the newly proposed classification. An estimated 89% of agreement was seen in RMS-MP3 classification among all the four observers when compared to 38% of agreement in the old classification. Conclusion: The newly proposed RMS-MP3 classification can be an alternative and perfect aid in assessing growth with accuracy, precision, ease, and an increased reliability.


Original Article

Isabella LA Ribeiro, Eufrásio de Andrade Lima Neto, Ana MG Valença

Chemotherapy in Pediatric Oncology Patients and the Occurrence of Oral Mucositis

[Year:2019] [Month:July-August] [Volume:12] [Number:4] [Pages:7] [Pages No:261 - 267]

Keywords: Chemotherapy, Dentistry, Oncology, Pediatric, Severe oral mucositis

   DOI: 10.5005/jp-journals-10005-1633  |  Open Access |  How to cite  | 


Background: It is known that chemotherapeutic agents are not equally stomatotoxic and oral cavity lesions are the most frequent complications encountered in antineoplastic chemotherapy. Aims: The objective of this study was to evaluate the occurrence of severe oral mucositis during a chemotherapy treatment and to identify its relationship with the chemotherapeutic class used. Materials and methods: This is a longitudinal, prospective, and observational study that used an intensive direct observation technique for assessing the oral clinical conditions and the chemotherapy treatment administered to 105 patients (both children and adolescents). Results: Severe oral mucositis occurred in all the 10 weeks of evaluation (ranging from 16.2 to 31.4%) and the association between the type of chemotherapy and the occurrence of severe oral mucositis is recorded only in the 6th week, with the chance to develop severe oral mucositis being 3.07 (3.85–2.29) times higher in patients underwent chemotherapy with antimetabolites than in those who have not used chemotherapy (p = 0.012). Conclusion: It was concluded that the chemotherapeutic agents most related to severe oral mucositis and to the interruption in chemotherapy are those of the class of antimetabolites, especially the methotrexate and the Ara C.


Original Article

Sunu Alice Cherian, Elizabeth Joseph, S Rupesh, Gibi Syriac, John Philip

Empowerment of Anganwadi Workers in Oral Health Care: A Kerala Experience

[Year:2019] [Month:July-August] [Volume:12] [Number:4] [Pages:5] [Pages No:268 - 272]

Keywords: Anganwadi workers, Knowledge, Oral health education, Practice, Preexperimental study

   DOI: 10.5005/jp-journals-10005-1636  |  Open Access |  How to cite  | 


Introduction: Oral diseases are a serious public health problem, which affects the overall health of a person. The lack of available and affordable oral health services, especially in a developing country like India, not only results in aggravation of the disease, but also enhances the cost of treatment and care. Education and involvement of community workers like Anganwadi workers aid to remove stigma, discrimination and provide better atmosphere conducive for patients with various diseases. Aim: To assess the knowledge and practice of oral health care among the AWWs of the Pulikeezh block Panchayath before and after an oral health education training. Materials and methods: A self-administered questionnaire was distributed to anganwadi workers of the Pulikeezh block Panchayath, Thiruvalla, Kerala before and after an oral health education training within a period of 3 months. Result: The mean knowledge and practice scores in the pretest were found to be 9.6 + 2.2 and 5.0 + 1.0 respectively. The posttest conducted after a 3-month period showed an increase in the knowledge and practice score with a mean of 10.9 + 2.2 and 5.7 + 0.6 respectively. The increase in knowledge and practice was statistically significant (p < 0.0001). Conclusion: Empowered women are recognizably key agents in the change process who can play an effective role for health promotion. AWWs can function as oral health guides who can create awareness and help in prevention oral diseases. Clinical significance: As the oral health of an individual is set in the preschool period and more than 90% of dental diseases are preventable; preventive factors established around this age will determine the person's dental health for many years to come. The inclusion of oral health education in Anganwadi centers can be helpful in prevention of dental diseases.


Original Article

Gopalakrishnan Anjana, Indu Raghavan

Evaluation of Antimicrobial Efficacy and Penetration Depth of Various Irrigants into the Dentinal Tubules with and without Lasers: A Stereomicroscopic Study

[Year:2019] [Month:July-August] [Volume:12] [Number:4] [Pages:7] [Pages No:273 - 279]

Keywords: Diode laser, Erbium, Chromium:yttrium scandium gallium garnet laser, Experimental study, Penetration depth

   DOI: 10.5005/jp-journals-10005-1647  |  Open Access |  How to cite  | 


Aim: To evaluate and compare the antibacterial efficacy and horizontal depth of penetration of various irrigants into the dentinal tubules when used alone and when combined with lasers. Materials and methods: An experimental study was done on 42 single-rooted teeth. Access cavity preparation was done and the canals were enlarged up to a ProTaper file size F2 of length 25 mm. They were inoculated with 0.1 mL of Enterococcus faecalis and the samples were randomly assigned into six different groups of seven teeth each. The following irrigation systems were used individually and in combinations—normal saline, sodium hypochlorite, chlorhexidine gluconate, diode laser and erbium, chromium:ytrrium scandium gallium garnet laser (Er,Cr:YSGG laser). The colony-forming units (CFU) of bacteria before and after disinfection and the penetration depth of different groups were determined. Statistical analysis was done by an ANOVA test. Results: The highest number of CFU of bacteria was shown by the group where saline was used and it also showed the least penetration depth compared to that of the Er,Cr:YSGG laser group. Conclusion: Er,Cr:YSGG laser when used along with sodium hypochlorite and chlorhexidine gluconate showed the highest reduction in the CFU of bacteria and the greatest penetration depth when observed under a stereomicroscope. Clinical significance: Laser-assisted irrigation regimes have a high antibacterial efficacy and more penetration depth into the dentinal tubules.


Original Article

Mimoza Canga, Vito A Malagnino, Irene Malagnino, Giulia Malagnino

Effectiveness of Fluoridation Depending on Periodicity in 6–10-year-old Children

[Year:2019] [Month:July-August] [Volume:12] [Number:4] [Pages:3] [Pages No:280 - 282]

Keywords: Caries, Caries risk, Dentition, Topical fluoride

   DOI: 10.5005/jp-journals-10005-1648  |  Open Access |  How to cite  | 


Background: The cost-effectiveness of this study was achieved in the group that was treated every three months with periodic intervals, which had a reduction of caries with 62%. The relative effectiveness of our study is the application of fluoride treatment every 3 months compared with treatments done every 4 and 6 months, respectively. Objective: To evaluate the reduction of caries disease depending on the time period of fluoride gel application. The sample was chosen randomly. Main hypothesis: The frequency of fluoride gel application every 3 months has positive impacts on reducing dental caries. Basic design: This is a cross-sectional study with a controlled sample for a period of 24 months. Durashield fluoride fluid (5% sodium fluoride) was used for the treatment of permanent dentition of the 6–10-year-old children. Clinical setting: This study proves that fuoride application every 3 months significantly reduces caries morbidity. Participants: Our study included 400 children, who were divided into 4 groups, 100 children in each group. Intervention: The first group did not undergo any treatment and it is called the control group. The second group was under fluoride treatment every 4 months. The third group was treated with fluoride every 3 months, and the fourth group was treated every 6 months. Results: The data collected from the control group showed that there is an increase in 24% of the caries incidence. In the group treated with fluoride every 4 months, caries incidence decreased to 30%. The group treated every 3 months with periodic intervals had a reduction of caries with 62%, while the group treated every 6 months had a reduction of 40%. Based on the analysis of variance (ANOVA) test, the fluoridation application every 3 months is significant for p = 0.000. Conclusion: The best results were achieved in the treatment with fluoride in a 3-month periodic interval.


Original Article

Fatemah AAM Husain, Abrar N Alanzi

Caries Experience and Oral Health-related Factors of Kuwaiti Preschool Children and their Mothers: A Pilot Study

[Year:2019] [Month:July-August] [Volume:12] [Number:4] [Pages:5] [Pages No:283 - 287]

Keywords: Dental caries, Oral health, Preschool children

   DOI: 10.5005/jp-journals-10005-1652  |  Open Access |  How to cite  | 


Aim: The objective of this study was to investigate the association between the caries experience and oral-health-related behavior of Kuwaiti preschool children and their mothers. Materials and methods: A convenience sample of 84 participants (42 child–mother pairs) was selected. Data regarding children's and mothers’ demographics, oral hygiene practices, and dietary habits were obtained by questionnaires. Oral clinical examinations were carried out on the participant children and mothers to determine their caries experience (decayed, missing, and filled teeth index-dmft/DMFT). Results: An estimated 19% of children were caries-free and 66% of mothers have untreated caries. The mean dmft index of the preschool children was 3.90 ± 2.9, and the mean DMFT index of their mothers was 12.38 ± 5.4. Mothers’ untreated caries was significantly associated with their children's untreated caries (r = 0.183, p < 0.05). No correlation was found between the brushing frequencies of children and their mothers (p = 0.582). High consumption of sugary snacks and sugary beverages was detected among the children and mothers with a significant association (p < 0.05). The mean dmft of the children was found to be significantly lower among the young mothers, less than 30 years, (2.4 ± 2.1) compared to that among the mothers older than 30 years (4.3 ± 2.9, p < 0.05). Conclusion: There was a high prevalence of early childhood caries in the preschool children studied. A positive correlation was found between the dental caries experience and sugar consumption of the Kuwaiti preschool children and those of their mothers. Clinical significance: The oral health status and dietary habits of mothers are potentially significant risk factors for the development of early childhood caries in their children. Pediatric dentists need to identify the main caries risk factors in their community in order to implement appropriate preventive dental care and educational programs.


Original Article

Moez I Khakiani, Hemal V Pandya, Tousif I Nathani, Priya Verma

Effect of Immediate Dentin Sealing on Polymerization of Elastomeric Materials: An Ex Vivo Randomized Controlled Trial

[Year:2019] [Month:July-August] [Volume:12] [Number:4] [Pages:5] [Pages No:288 - 292]

Keywords: Dentin bonding agent, Elastomers, Immediate dentin sealing, Oxygen inhibition layer

   DOI: 10.5005/jp-journals-10005-1657  |  Open Access |  How to cite  | 


Statement of problem: Interactions are suspected between resin coating and elastomeric impression material. Purpose: The purpose of this study was to identify possible interactions between two impression materials and resin-coated tooth surfaces. Materials and methods: Extracted molars (n = 10) underwent 1 of the 4 procedures: control group (unsealed tooth surface/impression); IDS group (immediate dentin sealing/impression); IDS/AB group (immediate dentin sealing/air blocking/impression); IDS/AB-P group (immediate dentin sealing/air blocking/pumicing/impression). Dentin bonding agents used were Adper single bond 2 and Clearfil SE bond. Impression materials used were Impregum Soft (polyether) and Aquasil (A silicone). A stereomicroscope was used to detect any residual impression material on the bonded tooth surface. Results: The IDS group showed 100% faulty impressions. Air blocking the resin coating did not completely eliminate the oxygen-inhibited layer of Adper single bond 2. Clearfil SE Bond along with Aquasil generated ideal impressions in group IDS/AB, while all other combinations resulted in faulty impressions. The IDS/AB-P group yielded ideal impressions with Aquasil but generated faulty impressions with Impregum soft in most specimens. Conclusion: Immediate dentin sealing should be followed by air blocking and pumicing to generate ideal impressions with Aquasil (A silicone). Impregum Soft (polyether) is not recommended in combination with immediate dentin sealing.


Original Article

Katia Vasconcelos, Silvane Evangelista, Raquel AB Silva, Sara Oliveira, Andre Dutra, Adriana Santos, Ananda Noronha, Leandro Belem, Lea Silva, Paulo Nelson-Filho, Erika Calvano Küchler

Assessing the Association between Dental Caries and Nutritional Status in Children from the Brazilian State of Amazonas

[Year:2019] [Month:July-August] [Volume:12] [Number:4] [Pages:4] [Pages No:293 - 296]

Keywords: Children, Dental caries, Obesity

   DOI: 10.5005/jp-journals-10005-1638  |  Open Access |  How to cite  | 


Aim: To evaluate the association between dental caries and nutritional status in a group of Brazilian schoolchildren, from Manaus. The studied population consisted of 197 students (10–12-year-olds) from public schools at Manaus, Amazonas, Brazil. Materials and methods: A clinical examination was carried out and the decay-missing-filled-teeth index for primary and permanent teeth (dmft and DMFT) was used to evaluate dental caries. Body mass index Z-score was calculated using variables such as individual height, weight, age, and gender. The nutritional status was classified as underweight, eutrophic, overweight, and obese. One-way ANOVA and Tukeys posttests were used for means comparison between groups. The established alpha was 5%. Results: Eighty-one (41.1%) children were caries-free. Five (2.5%) children were underweight; 127 (64.5%) were eutrophic; 49 (24.9%) were overweight; and 16 (8.1%) were obese. The mean dmft/DMFT index was 1.67 (2.05). Obese children had more caries experience than eutrophic and overweight children (p < 0.05). Conclusion: Our study demonstrated that dental caries is associated with obesity in school children from Manaus.



Paloni Koticha, Farhin Katge, Shilpa Shetty

Effectiveness of Virtual Reality Eyeglasses as a Distraction Aid to Reduce Anxiety among 6–10-year-old Children Undergoing Dental Extraction Procedure

[Year:2019] [Month:July-August] [Volume:12] [Number:4] [Pages:6] [Pages No:297 - 302]

Keywords: Audiovisual, Distraction, Oxygen saturation, Pulse rate, Venham picture test, Virtual reality eyeglasses

   DOI: 10.5005/jp-journals-10005-1640  |  Open Access |  How to cite  | 


Introduction: Distraction is commonly used nonpharmacologic pain management technique by pedodontists to manage pain and anxiety. There are some new techniques which uses audiovideo stimulation and distract the patient by exposing him or her to three-dimensional videos. These techniques are referred to as virtual reality audiovisual systems. The aim is to evaluate the effectiveness of virtual reality eyeglasses as a distraction aid to reduce anxiety of children undergoing extraction procedure. Objective: The aim of this study is to evaluate the effectiveness of virtual reality eyeglasses as a distraction aid to reduce anxiety of children undergoing dental extraction procedure. Materials and methods: Thirty children of age 6–10 years (n = 60) with bilateral carious primary molars indicated for extraction were randomly selected and divided into two groups of 30 each. The first one was group I (VR group) (n = 30) and group II (control group) (n = 30). Anxiety was measured by using Venham's picture test, pulse rate and oxygen saturation. Anxiety level between group I and group II was assessed using paired “t” test. Results: The mean pulse rate values after extraction procedure in group I were 107.833 ± 1.356 and group II were 108.4 ± 0.927 respectively. The pulse rate values in intergroup comparison were found statistically significant p = 0.03. Conclusion: The virtual reality used as a distraction technique improves the physiologic parameters of children aged 6–10 years but does not reduce the patient's self-reported anxiety according to Venham's picture test used.



Eddula R Reddy, Merum Kiranmai, Saraswathi Srikanth, Suman Jain

Comparative Evaluation of BMI, Dental Age, Salivary Alkaline Phosphatase Levels, and Oral Health Status in Children with β Thalassemia Major

[Year:2019] [Month:July-August] [Volume:12] [Number:4] [Pages:4] [Pages No:303 - 306]

Keywords: β thalassemia major, Body mass index, Intervention urgency index, Oral health status, Salivary alkaline phosphatase

   DOI: 10.5005/jp-journals-10005-1641  |  Open Access |  How to cite  | 


Purpose: Thalassemia poses clear systemic and oral health problems. Clinicians must be aware of various dental treatment needs in these patients. This study was undertaken to assess body mass index (BMI), dental age, salivary alkaline phosphatase levels, malocclusion, and treatment needs in children with β thalassemia major. Materials and methods: A total of 100 children within the age group of 2–15 years (50 thalassemic and 50 healthy controls) were included. Dental age, oral health status, malocclusion, and intervention urgency index was recorded. Unstimulated whole saliva samples were collected to assess the salivary alkaline phosphatase levels. The recorded data were statistically analyzed. Results: A significantly greater number of thalassemia children were found to be in the underweight category. A significantly high OHI-S scores and low gingival index scores were observed in thalassemia children. Salivary alkaline phosphatase levels were significantly low in thalassemia children compared to the control group. Intervention urgency index scores were significantly high in thalassemia group of children. Conclusion: Thalassemia children had low BMI, gingival index scores, salivary alkaline phosphatase levels and higher prevalence of malocclusion, and high OHI-S index scores compared to the healthy control group. Intervention urgency index scores revealed greater dental treatment needs in children with thalassemia.



Sunaina Pamnani, Murali K Dindukurthi, Sindura Allani

Rugoscopy as a Gender Determination Tool and its Appositeness in Malocclusion among Adolescents Aged 13–18 Years

[Year:2019] [Month:July-August] [Volume:12] [Number:4] [Pages:5] [Pages No:307 - 311]

Keywords: Palatal rugae, Rugoscopy, Sagittal skeletal jaw relation, Skeletal malocclusion

   DOI: 10.5005/jp-journals-10005-1642  |  Open Access |  How to cite  | 


Aim: The aim of the study was to determine the relationship between malocclusion and palatal rugae patterns and its reliability in gender determination of adolescents aged 13–18 years. Materials and methods: A total of 90 children with 30 in each of skeletal class I, II and III groups respectively were included in the study. The lateral cephalograms of the study samples were analyzed cephalometrically using ANB angle, WITS appraisal and beta angle and categorized as skeletal class I, class II or class III sagittal skeletal jaw relation. Sassouni's Archial analysis was used to reconfirm skeletal jaw relation and also to assess treatment needs. Palatal rugae of each sample were recorded to study the patterns. Thomas and Kotze classification was followed for rugae pattern analysis. Results: No definite rugae print pattern could be associated with any particular sagittal skeletal jaw relation in the present study. Female population of class II skeletal malocclusion showed a significant difference for number of rugae on the right and left sides of mid palatine raphe. Discriminant function analysis showed no significance when the number of rugae were compared among males and females for gender determination. Conclusion: As rugoscopy was neither found to provide absolute conclusive evidence in identification of any particular jaw relationship nor gender determination, combination with more reliable forensic methods would help in better personal identification. Clinical significance: Palatal rugae and craniofacial skeleton develop at the same embryonic period. Developmental factors that cause malocclusions should also reflect in the palatal rugae patterns. There exists a deficiency in studies in samples of younger age group and hence the need of the study.



Lata K Mehta, Amitha Hegde, Ann Thomas, Mandeep Singh Virdi

Acidogenic Potential of Packaged Fruit Juices and its Effect on Plaque and Salivary pH

[Year:2019] [Month:July-August] [Volume:12] [Number:4] [Pages:6] [Pages No:312 - 317]

Keywords: Acidogenic potential, Fruit juices, Plaque pH, Randomized clinical trial, Salivary pH

   DOI: 10.5005/jp-journals-10005-1644  |  Open Access |  How to cite  | 


Aim: The aim of this study was to analyze the acidogenic potential of the various commercially available fruit juices and to evaluate the salivary and plaque pH changes before and after consumption of the fruit juices that were kept at various temperatures. Materials and methods: Baseline plaque and salivary pH were measured for 30 volunteers, and the test was conducted for 4 consecutive days on which juices with a known pH was consumed, which were kept at varying temperatures. The resulting changes in the plaque and salivary pH were measured after 1, 5, 15, and 30 minutes of the consumption of the fruit juices using a portable standard digital pH meter. Results: Among the three juices compared, grape juice was found to be more acidic compared to the orange juice and pineapple juice. The pH fall was maximum after consumption of grape juice followed by orange and pineapple juice, respectively. The consumption of ice candy caused a greater fall in pH followed by the refrigerated juice and the juices that were kept at room temperature, respectively. Conclusion: Parents are unaware of the harmful effects of endogenous acids in the fruit juices and their effect on the teeth. We, as primary dental care providers, should take initiatives to provide adequate knowledge and information regarding this new trend of consuming frozen fruit juices and must strongly discourage this form of consumption as a frequent habit. Clinical significance: Though many presume that the readily available fruit juices are healthy, frequent consumption of these fruit juices causes acid dissolution of enamel as most of these juices have a pH below the critical level. Hence the present study was conducted to evaluate the erosive potential of the various commercial fruit juices. As with increased awareness by both the dentists and the parents, the problem of fruit-juice-induced tooth loss may be reduced.



Rita Zarina, Sobha Kuriakose, Jaini Lalithamma, Anna D Souza, Bharathiammal Padmakumari, Puthiyapurayil Jeeva

Evaluation of Inter-pair Differences in Caries among South Indian Monozygotic Twins: A Cross-sectional Study

[Year:2019] [Month:July-August] [Volume:12] [Number:4] [Pages:7] [Pages No:318 - 324]

Keywords: Breastfeeding, Caries prevalence, Cross-sectional study, Frequency of brushing, Monozygotic twins, Oral habits, Socioeconomic status, South Indian, Sweet intake

   DOI: 10.5005/jp-journals-10005-1645  |  Open Access |  How to cite  | 


Introduction: Assessment of difference in caries prevalence among twins may help determine the character and the extent of the influence exercised by the environment, as a complement of the genetic constitution. Aim: To investigate the inter-pair differences in caries prevalence among South Indian monozygotic twins in relation to birth weight, birth order, and gender. Possible correlation among other attributes such as breastfeeding, socioeconomic status, oral habits, frequency of brushing, and sweet intake were also assessed. Materials and methods: A sample of 40 monozygotic children between the age group of 6 and 12 was selected. The parents were asked to complete the questionnaire and report with their children. Then dental examinations were carried out and the prevalence of dental caries among the twins were assessed. Results: Among the total samples, 61.5% exhibited caries. Lower birth weight twins showed an increased chance of caries (72.22%), compared to higher birth weight twins (68.18%). Second of the twins had an increased risk of dental caries (70%) compared to the first (60%). 90% of the male twins and 45% of the female twins had caries. The association between dental caries and other variables were also assessed; those who were exclusively breastfed had an increased risk (70%) of caries. Evaluation of socioeconomic status and caries revealed a risk of for the high (65%), middle (62.5%), and lower groups (58.33%). Children without oral habits showed a higher prevalence (73.3%) of caries when compared to those without any habits (50%). It was noticed that the brushing frequency is not related to the severity of caries. The strongest association was noticed between excessive sweet liking and prevalence of dental caries. Conclusion: The study revealed difference in caries prevalence among monozygotic twins in relation to birth weight, birth order, and gender. It was found that variations in caries prevalence existed with other attributes also.



Vimala Devi Popuri, Sreekanth Kumar Mallineni

In Vivo Comparative Enactment of CarieScanPRO™ with Conventional Methods to Detect Occlusal Carious Lesions in the Mandibular Primary Molars

[Year:2019] [Month:July-August] [Volume:12] [Number:4] [Pages:7] [Pages No:325 - 331]

Keywords: Caries detection, CarieScanPRO™, Occlusal caries, Radiovisiography, Visual International caries detection and assessment system II

   DOI: 10.5005/jp-journals-10005-1649  |  Open Access |  How to cite  | 


Aim: To assess the performance of CarieScanPRO™ with radiovisiography (RVG) and international caries detection and assessment system II (ICDAS-II) to detect the occlusal carious lesions in the mandibular primary molars. Methods: Fifty healthy children of age 5–7 years were involved and evaluated for caries using visual ICDAS-II, RVG, and CarieScanPRO™. Operative intervention pit and fissure opening served as a gold standard for comparison of the three methods of examination. The sensitivity, specificity, accuracy, and area under the receiver operating characteristic (ROC) curve (Az) of the methods were calculated at enamel (D1), dentinoenamel junction (DEJ) (D2), and dentine (D3, D4). Results: At D1 threshold, CarieScanPRO™ showed higher values of sensitivity and accuracy (0.97 and 0.88) and RVG specificity (0.92). At D2 threshold, visual examination showed higher values of sensitivity (0.80) whereas CarieScanPRO™ showed specificity and accuracy of 0.98 and 0.87. At D3, D4 threshold, CarieScanPRO™ showed higher values of sensitivity, specificity, and accuracy (0.1, 0.98, and 0.99). Higher positive predictive value (PPV), negative predictive value (NPV) and lower false discovery rate (FDR), false-positive rate (FPR) were shown by CarieScanPRO™. The intraexaminer repeatability for CarieScanPRO™ was good with kappa at D1 (0.77) and D3, D4 (0.98). Conclusion: CarieScanPRO™ showed higher reproducibility compared to visual examination and RVG for the detection of enamel and dentinal caries. Higher accuracy of CarieScanPRO™ can be used for longitudinal monitoring of occlusal caries in primary teeth with low sensitivity at DEJ.



Regenerative Endodontic Treatment of Bilateral Necrotic Immature Permanent Maxillary Central Incisors with Platelet-rich Plasma versus Blood Clot: A Split Mouth Double-blinded Randomized Controlled Trial

[Year:2019] [Month:July-August] [Volume:12] [Number:4] [Pages:8] [Pages No:332 - 339]

Keywords: Blood clot, Immature permanent necrotic maxillary bilateral central incisors, Platelet-rich plasma, Regenerative endodontic treatment

   DOI: 10.5005/jp-journals-10005-1656  |  Open Access |  How to cite  | 


Aim: Clinical and radiographic assessment of the regenerative potential of bilateral immature permanent maxillary central incisors with necrotic pulps using blood clot (BC) and platelet-rich plasma (PRP) scaffolds. Trial design: This is a split mouth double-blinded parallel randomized controlled clinical trial. Subjects and methods: Randomization and blinding: the study started with 15 patients with bilateral maxillary immature permanent central incisors with necrotic pulp. The two upper bilateral central incisors were randomly assigned to either the control (BC scaffold) group I or examined (PRP scaffold) group II. Participant: 13 patients aged 8–14 years fulfilled the study requirements. A follow-up was done for 3, 6, 9, and 12 months. Standardized radiographs were collected during the follow-up period, and radiographic changes were measured using Image J software. Primary outcome measured were clinical: pain, mobility, swelling, and sinus/fistula. Radiographic outcome included increased root length and increase in root thickness. Secondary outcomes were clinical: discoloration and sensibility test. Radiographic outcome included an increase in bone density measurements and a decrease in apical diameter. Standardized radiographs were collected during the follow-up period, and radiographic changes were measured using Image J software. Results: All 26 treated teeth survived during the 12-month follow-up period with 100% success rate. PRP-treated teeth showed a statistically significant increase in radiographic root length, width, periapical bone density, and a decrease in apical diameter when compared with BC. At the end of 12 months, all treated teeth did not respond to the sensibility test. BC displayed a significantly higher amount of crown discoloration compared to the PRP group. Conclusion: For necrotic immature teeth, regenerative endodontic treatment using PRP is a desirable alternative to BC and shows excellent 12-months prognosis.



Subramanian MG Erulappan

Comparison between the Effectiveness of Rotary and Manual Instrumentation in Primary Teeth: A Systematic Review

[Year:2019] [Month:July-August] [Volume:12] [Number:4] [Pages:7] [Pages No:340 - 346]

Keywords: Cleaning efficiency, Debris, K-files, Rotary files, Smear layer

   DOI: 10.5005/jp-journals-10005-1637  |  Open Access |  How to cite  | 


Aim: To develop a scientifically current and evidence based protocol on the efficacy of rotary and hand root canal instrumentation in primary teeth. Materials and methods: Previous randomized control trials were used for the current review. Hand search and online search engines of PUBMED and Google Scholar were used to search English language articles with human subjects published up to December 2016. Results: After screening of the abstracts and articles, based on the inclusion and exclusion criteria a total of 13 articles were included in the systematic review. Conclusion: Rotary instrumentation shows equivalent cleaning efficiency than hand files depending on the system of instrumentation and techniques used. However, use of rotary in primary teeth leads to improved shaping of canals providing better quality of treatment in less time.



Ashkenazi Malka, Gotler Maya

Pain-related Disruptive Behavior during Dental Treatment Interpreted as Uncooperative Behavior—Small Case Series

[Year:2019] [Month:July-August] [Volume:12] [Number:4] [Pages:5] [Pages No:347 - 351]

Keywords: Case series study, Ineffective anesthesia, Lidocaine, Local anesthesia

   DOI: 10.5005/jp-journals-10005-1618  |  Open Access |  How to cite  | 


Aim: To describe a small series of six cases of children who were diagnosed as uncooperative and referred to general anesthesia to complete their dental treatment. These children were actually exhibiting pain-related disruptive behaviors during previous dental treatments; we determined the reasons for ineffective anesthesia. Background: One of the most common reasons for disruptive behaviors in children during operative dental treatment is the experiencing of pain during treatment. Disruptive behavior may lead to treatment under general anesthesia. Case description: Parents of six uncooperative children referred to general anesthesia for dental treatment, arrived at our clinic, because they wanted a second opinion. The children were found to be nonresponsive to the common anesthetic technique and were treated by several approaches to increase the effectiveness of anesthesia. These included supplementary anesthesia to accessory innervation (in three cases), changing brands of anesthetic (in two cases), injecting the maximal dose at once to prevent tachyphylaxis, and waiting 5 minutes to achieve effectiveness of anesthesia (in one case). After achieving effective anesthesia, all the children fully cooperated during the operative treatment. Conclusion: Ineffective anesthesia can lead to severe disruptive behavior when continuing the treatment irrespective to the sensation of pain. Several approaches were used to increase the effectiveness of anesthesia resulting in cooperation of the pediatric patients. Clinical significance: Behavioral response to ineffective anesthesia may be diagnosed as uncooperativeness. Effort should be put to differentiate between ineffective anesthesia and uncooperative patient.



Chamarthi Vishnurekha, Dhanraj Kalaivanan, Santham Krishnamoorthy, Shanthipriya Manoharan, Vijayaprabha Kalyanaraman, Sobiha Selvaraj

Cleidocranial Dysplasia in a 10-year-old Child: A Case Report

[Year:2019] [Month:July-August] [Volume:12] [Number:4] [Pages:4] [Pages No:352 - 355]

Keywords: Cleidocranial dysplasia, Fontanels, Supernumerary teeth

   DOI: 10.5005/jp-journals-10005-1634  |  Open Access |  How to cite  | 


Cleidocranial dysplasia is a rare congenital anomaly characterized by multiple skeletal defects of which partial or complete absence of clavicles, delayed closure of fontanels with presence of open sutures and multiple wornian bones forms a striking feature. The oral manifestations are delayed exfoliation, delayed or failing eruption of the permanent dentition with multiple supernumerary teeth, protruding mandible and mid face retrusion. It is also known as Marie and Sainton's disease, mutational dystosis or cleidocranial dysostosis. A 10-year-old female patient reported to the Department of Pedodontics and Preventive Dentistry, Sathyabama University, Dental College and General Hospital, Chennai, Tamil Nadu with the chief complaint of unerupted permanent teeth. Radiological investigations confirmed the diagnosis of cleido cranial dysplasia and various treatment options are discussed in this article.



Atul Sharma, Geetanjali Gandhi, Kanwaldeep S Soodan, Deepika Patidar

Mandibular Fracture in Children: A New Approach for Management and Review of Literature

[Year:2019] [Month:July-August] [Volume:12] [Number:4] [Pages:4] [Pages No:356 - 359]

Keywords: Bridle wiring, Orthodontic ligature wire, Pediatric facial fracture

   DOI: 10.5005/jp-journals-10005-1643  |  Open Access |  How to cite  | 


Maxillofacial fractures in the pediatric population consist of less than 15% of all facial fractures. Road traffic accidents, sport-related injury, and fall constitutes most common causes for the facial injury. Incidence of the facial fractures is comparatively higher in boys than in girls. In the management of the maxillofacial fractures in pediatric patients, we have to take into consideration the variation in anatomy and physiology between children and adults, as well as the particular stage of growth and dental development. Treatment options can vary from closed reduction to open reduction and internal fixation. In this article, the authors successfully managed the pediatric mandibular fractures by performing bridle wiring with the help of an orthodontic ligature wire.



Ganiga C Shivakumar, Adit Srivastava, Sahana Shivakumar

Primary Failure of Eruption: A Cause of Posterior Open Bite

[Year:2019] [Month:July-August] [Volume:12] [Number:4] [Pages:2] [Pages No:360 - 361]

Keywords: Anterior deep bite, Posterior open bite, Primary eruption failure, Retained deciduous teeth

   DOI: 10.5005/jp-journals-10005-1646  |  Open Access |  How to cite  | 


Primary eruption failure is a poorly understood condition in which the teeth fail to erupt in oral cavity in absence of any local or systemic factors. First and second molars are most commonly affected but one or more number of teeth, primary or permanent can be partially or completely affected. The orthodontic or surgical methods to get such teeth in occlusion have failed miserably. The early diagnosis of primary eruption failure (PEF) will allow the dentist to accurately rehabilitate the patient without wasting any time on treatments which are bound to fail.



Wed M Kassar

Dental Rehabilitation of a Child with Ectodermal Dysplasia: A Case Report

[Year:2019] [Month:July-August] [Volume:12] [Number:4] [Pages:4] [Pages No:362 - 365]

Keywords: Ectodermal dysplasia, Hypodontia, Oligodontia, Stainless steel crowns

   DOI: 10.5005/jp-journals-10005-1651  |  Open Access |  How to cite  | 


A nine-year-old girl was presented to the dental clinic at King Abdulaziz Medical City in Jeddah with carious posterior primary teeth and discolored teeth. She was referred to a pediatric geneticist to rule out any medical conditions. She was suspected to have ectodermal dysplasia (ED). DNA testing was requested and sent to Germany to confirm the clinical findings. Afterward, full-mouth rehabilitation was done including prophy and fluoride application, composite restorations, stainless steel crowns, and pulp therapy. The treatment was planned to be carried out under local anesthesia due to the cooperative behavior of the child and the parents’ request. Treatment objectives were oriented to achieve esthetic and functional rehabilitation of all carious teeth, maintain occlusion, in addition to maintaining spaces for the missing permanent teeth for future replacement. The patient became caries-free. Oral hygiene was improved which resulted in gingival inflammation resolution. Spaces were maintained and the behavior of the child was improved during recall visits from positive to definitely positive. Multidisciplinary approach in the management of oral and dental manifestations associated with ED including pediatric dentists, prosthodontists, and orthodontists is of paramount importance.



Ashish Katiyar, Sukriti Gupta, Kirtija Gupta, Mansi Pandey

Trauma to Tumor: A Hunt of Adenomatoid Odontogenic Tumor–A Rare Case Report

[Year:2019] [Month:July-August] [Volume:12] [Number:4] [Pages:4] [Pages No:366 - 369]

Keywords: Enucleation, Hamartoma, Odontogenic tumor, Trauma

   DOI: 10.5005/jp-journals-10005-1655  |  Open Access |  How to cite  | 


Tumors and tumor-like growths arising from odontogenic tissues constitute a heterogeneous group of interesting lesions, as they display the various inductive interactions that normally occur among the embryologic components of the developing tooth germ. Adenomatoid odontogenic tumor is a benign tumor, most common in the maxilla, characterized by slow, progressive, painless growth of firm consistency, the size of which usually does not reach large proportions. They are of three types: extrafollicular, follicular, and peripheral. It usually develops around or overlaps adjacent teeth.


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