Background: Over the last few decades, fluoride in various forms has been proved to reduce caries and dentinal hypersensitivity in both the primary and permanent dentitions. Recently, newer materials containing calcium and phosphate ions, tricalcium phosphate, and hydroxyapatite has received much attention. Aim: The aim of the study was to compare CPP–ACP, tricalcium phosphate, and hydroxyapatite in relation to the assessment of dentine tubule occlusion on primary enamel using scanning electron microscope (SEM). Materials and methods: Forty freshly extracted noncarious primary molars were randomly divided into 4 groups (I–IV) with 10 sections in each group—group I: negative control, group II: CPP–ACP, group III: tricalcium phosphate, group IV: hydroxyapatite. To assess tubule occlusion, twenty dentin sections of 2-mm thickness were obtained from the cervical third of sound primary molars. Each section was processed to simulate the hypersensitive dentin and the test agents were brushed over the sections with an electric toothbrush and observed under a SEM for calculation of the percentage of occluded tubules. Results: Groups II and IV showed a greater percentage of tubule occlusion than group III. An intergroup comparison of tubule occlusion potential of groups II and IV was not significant. Conclusion: Hydroxyapatite showed significantly higher dentinal tubule occlusion when compared to CPP–ACP and tricalcium phosphate.

Introduction: The foundation for healthy permanent teeth in children and teenagers is laid during the first few years of life. Toothbrushing should be presented as a habit. A wide array of toothbrushes is available in the market, which differ in size, design, length, hardness, arrangement of bristles. This present clinical study is undertaken to evaluate the effectiveness of ionic toothbrush on oral hygiene status and plaque removal. Materials and methods: A total of 30 children aged 6 years to 12 years were selected in this study. The children were divided into two groups, 15 children were given HyG ionic toothbrush, were instructed how to use product according to manufacturer's instructions, 15 children were assigned to use manual toothbrush, instructed to brush their teeth in usual manner. All subjects used the same commercially available dentifrice throughout the study. Results: The results were evaluated at each visit day 0, day 15 and day 30 following 12–18 hours of no oral hygiene. The subjects brushed their teeth twice daily for 1 minute under supervision. The result showed that there was significant difference in all the mean values in all the parameters. It may be concluded from the present study that though the ionic toothbrush was insignificantly superior to the manual toothbrush, both the toothbrushes are clinically effective in removing plaque and improving the gingival conditions.

Introduction: Dental treatment is known to trigger anxiety and fear even in fully grown adults, especially if administration of local anesthesia with a syringe is indicated. This study is aimed to evaluate whether procedures like an extraction and pulpectomy could trigger fear and anxiety in a pediatric patient and also the response of pediatric patients to other treatment modalities. Their perception toward receiving dental treatment as a whole is also evaluated. The effect of conditioning of the environment and the dentist (extractions done in second or third appointments) and its effect in decreasing the anxiety is also evaluated. The aim of the study is to evaluate the behavior of pediatric patients aged 7–17 years in response to various treatment procedures at Saveetha Dental College. Materials and methods: The behavior of 50 children reporting to Saveetha Dental College, categorized according to the Frankl's behavior rating scale, was recorded before, during, and posttreatment. Results: Children undergoing extractions and pulpectomies showed the most uncooperative behavior. Sixty percent of patients undergoing extraction and 45% of patients undergoing the pulp therapy showed negative behavior (rating 2) during treatment. Conclusion: Invasive procedures like extractions and pulpectomies were procedures that brought out negative behavior in pediatric patients, especially during treatment.

Aim and objective: This study aimed to compare the plaque removal efficacy of different toothbrushes and to ascertain the most efficient mechanical mean for daily plaque removal so as to maintain oral health in a preeminent way. Study design: It was a randomized controlled clinical trial consisting of 60 subjects divided into three groups (group I ultrasonic and sonic toothbrush, group II multidirectional toothbrush, and group III manual toothbrush) with 20 in each group. Prebrushing and postbrushing plaque scores were recorded at weekly intervals for four weeks using Turesky modification of Quigley and Hein plaque index. Results: Statistically significant differences (p < 0.001) existed in mean percent reduction of pre-day 1 to pre-day 28 mean percent reduction in plaque values of the ultrasonic toothbrush group (111.92 ± 25.20), the multidirectional toothbrush group (189.06 ± 52.70), and the manual toothbrush group (42.34 ± 14.77). Similar results were found in post-day 1 to post-day 28 mean percent reduction in plaque values. Conclusion: Group II (i.e., multidirectional toothbrush) showed maximum mean percent reduction in prebrushing and postbrushing plaque scores at the end of four weeks when compared with the baseline values followed by ultrasonic toothbrush and manual toothbrush.

Aim: The aim of this study is to verify if the thickness of soft tissues and inclination of the incisors have some relation with profile, to analyze its relevance considering these two parameters separately and to screen how the combination of different inclinations and different thickness can generate different facial patterns. Materials and methods: The study was performed on 47 Caucasian patients aged between 6 years and 16 years of divided into 24 males and 23 females. None of the patients presented craniofacial changes of syndromic nature. All patients presented a value of SNA in between 80° and 84°. The inclination of the upper incisor related to the bispinal plane was between 104° and 116°. Each radiograph has been digitized or analyzed directly in digital format. To analyze the relationships between soft tissues and position of the incisors using various cephalometric measures and statistical methodology were used. Results: Analysing the general correlation between all the cephalometric parameters considered, the results found show that the thickness of the tissues had an effect in modifying the aesthetic profile with respect to the position of the incisors. The cephalometric parameters related to the esthetic profile of the maxilla are all linked by strong correlations, especially correlation between SU, ULA and LS were very high. The differences between the means were statistically significant for different groups. Using the values of Mx1 and thickness of the lip as independent variables, while the LS, SU, ULA and NLA values as dependent variables all results are significant with respect to the prediction p < 0.05. Conclusion: Thickness of the soft tissues showed a significant influence on the profile with respect to the position of the incisors. Clinical significance: Data obtained highlighted that thickness of the soft tissues must be taken into account before starting an orthodontic treatment in order to obtain best aesthetic results.

Aim: This study aimed to evaluate and compare the antimicrobial efficacy of root canal sealers of different bases when mixed with herbal extracts. Materials and methods: An evaluation of three sealers (Endomethasone, AH plus, Apexit plus) mixed with three herbal extracts [Emblica officinalis (Amla), Myristica fragrans (Nutmeg) and Salvadora persica (Miswak)] was done against nine strains of bacteria at various time intervals using the agar diffusion test. Moreover, measurement of the mean zones of inhibition was done. Results: The largest zones of bacterial growth inhibition were observed with Endomethasone mixed with Myristica fragrans (Nutmeg) followed in the descending order by AH plus mixed with Salvadora persica (Miswak) and Apexit plus mixed with Salvadora persica (Miswak) respectively. The differences between zones of inhibition among different groups were found to be statistically significant. Conclusion: Zinc-oxide-eugenol-based sealer (Endomethasone) mixed with herbal extracts produced the largest inhibitory zones followed in the descending order by resin-based sealer (AH plus) and calcium-hydroxide-based sealer (Apexit plus), respectively. Clinical significance: Herbal plants such as [Emblica officinalis (Amla), Myristica fragrans (Nutmeg) and Salvadora persica (Miswak)] are rich sources of bioactive compounds that possess antimicrobial properties. Mixing their extracts with endodontic sealers can produce additive antimicrobial effect against microbes found in inflamed pulp.

Aim: Placement of fixed space maintainer (FSM) and removable space maintainer (RSM) may increase the risk of gingivitis in children. This study aimed to assess the effect of using FSMs and RSMs on periodontal parameters in 6–12-year olds. Materials and methods: This interventional prospective study was conducted on systemically healthy 6–12-year olds (mean age of 8 years) presenting at the Department of Pediatrics, Tehran University requiring space maintainers. The probing pocket depth (PPD), bleeding on probing (BOP), and gingival index (GI) were recorded at the baseline and 6 months after using space maintainers in the abutment teeth in patients with fixed space maintainers and in the tooth with the Adams clasp in children with removable space maintainers as well as the same teeth in the opposing jaw/quadrant as controls. Results: A significant increase in PPD was noted in distolingual and mesiolingual sites at 6 months after placement of FSM (p < 0.05). This increase was not significant for RSM at any site. A significant increase in GI and BOP was also noted at 6 months after placement of FSM and RSM (p < 0.05). Caries index did not show a significant change in FSM but caries index significantly increased following the use of RSM. Conclusion: BOP and GI increase following placement of FSM and RSM, and PPD increases in distolingual and mesiolingual areas of the banded tooth.

Aim and objectives: To evaluate and compare the dentinal microcrack formation after obturation using CPoint and gutta percha as root canal filling materials. Materials and methods: Forty orthodontically extracted single-rooted premolars were selected. The teeth were decoronated and were then divided into four groups (n = 10). In group I, samples were left unprepared and unfilled (negative control), in group II, samples were prepared and left unobturated (positive control), in group III, samples were prepared and obturation was done with Cpoint (F3) and endosequence bioceramic sealer, and in group IV, samples were prepared and obturation was done with Protaper gutta percha (F3) and endosequence bioceramic sealer. Then, the samples were kept for 1 week at 37°C and 100% humidity. All roots were then sectioned at 2 mm from the apex. Additional cross sections at a 4 mm level were made in groups III and IV. Then, the sections were observed under a scanning electron microscope and the presence of dentinal microcracks was checked. Results: There was statistically nonsignificant difference for a mean number of microcracks in the samples after obturation with CPoint and gutta percha. Conclusion: CPoint can be used as an alternative to gutta percha as it provides better seal because of its lateral hygroscopic expansion without causing significant damage to the dentinal microstructure. Clinical significance: In spite of gutta percha being the gold standard in obturating material, still the desired hermetic seal could not be achieved. To achieve this attainable goal, a new material CPoint had been introduced, which has the ability to undergo hygroscopic expansion within the root canal.

Objectives: To assess the association between different factors in saliva and dental caries experience in children with bronchial asthma. Materials and methods: A total of 60 asthmatic children and 60 healthy controls of both genders with age ranging from 4- to 12-year-old. The asthmatics were grouped according to disease severity into mild, moderate, or severe asthma. All the children were clinically examined to assess their dental caries experience (deft/DMFT), and stimulated saliva samples were collected to measure the saliva pH, flow rate, ά-amylase, and secretory immunoglobulin A (sIgA)-level changes. The data were statistically analyzed using the SPSS program (v. 23) to test for significance at p ≤ 0.05. Results: Asthmatic children presented significantly higher deft mean value (6.77 ± 1.69), as well as significantly reduced stimulated saliva flow (0.82 ± 0.2) and sIgA (29.42 ± 6.31) when compared to healthy control. The sIgA of asthmatics showed statistically significant negative correlation with deft and DMFT. Severe asthmatics presented significantly the lowest sIgA mean level (23.61 ± 5.33) and the most reduced saliva flow rate (0.64 ± 0.20). Conclusion: The reduction in saliva flow rate and secretory immunoglobulin A render asthmatic children more prone to increased dental caries progression mainly of primary dentition.

Background: Children with high level of preoperative anxiety during their visit to dental office are more likely to develop maladaptive behavior postoperatively. First dental experience is always critical in molding child's attitude toward dentistry. Various behavior management methods are being employed during dental treatment to complete anticipated treatment in children. Aim: The aim of the study was to evaluate the effectiveness of cognitive behavioral play therapy and audiovisual distraction for management of preoperative anxiety in children. Materials and methods: A total of 45 children of age 6–10 years with moderate-to-severe anxiety were allocated into three groups: group I—cognitive behavioral play therapy (CBT), group II—audiovisual (AV) distraction, and group III—tell-show-do technique (control group). Children in the CBT group were allowed to play with building blocks, asked to draw a picture and then showed a modeling video of co-operative child undergoing dental treatment. Children in group II were subjected to passive distraction with audiovisual aids, whereas group III (control) children were managed with the conventional TSD technique. Baseline and postintervention objective and subjective anxiety scores were measured with a pulse oximeter and facial image scale (FIS), respectively. Results: A statistically significant reduction in the subjective and objective anxiety scores is observed in all the three groups (p = 0.001) in both intragroup and intergroup comparisons. On intergroup comparison, the reduction in subjective and objective anxiety scores was higher in CBT (p = 0.0) than in AV distraction and TSD groups (p = 0.05). Conclusion: Active distraction with cognitive behavioral play therapy is found to be more effective in reducing the preoperative anxiety in children compared to audiovisual distraction and tell-show-do technique. Clinical significance: Identification and management of preoperative anxiety in children is most critical for successful dental treatment. Active distraction is an effective psychological approach for behavior management in anxious children.

Aim: The purpose of this research was to determine the prevalence, severity, and pattern of dental decay in 6–7-year-old youngsters in military elementary schools in Jeddah, Kingdom of Saudi Arabia. Materials and methods: The study included 312 youngsters randomly selected from eight elementary schools. Dental decay prevalence was determined by using dmft/dmfs/DMFT/DMFS indices according to the “British Association for the Study of Community Dentistry” diagnostic specifications. Results: There was no statistically notable difference in the prevalence of decay between boys and girls (p = 0.54). There was a notable difference between the mean dmft and dmfs in primary teeth (p = 0.000). There was a notable increase in the prevalence of decay for permanent teeth in males when compared to females (p = 0.011). The mean DMFT in boys was notably higher than that in girls (p = 0.035). No notable difference was found between males and females in mean DMFS (p = 0.54). Conclusion: The prevalence of dental decay was high among the study sample. There is a vast need to reduce dental decay by increasing dental awareness for youngsters and their parents. Clinical significance: Age has an important role in evaluating decay prevalence and dmft/dmfs/DMFT/DMFS indices. On the basis of age, caries is prevalent in 6–7-year-old youngsters and the dmft/dmfs/DMFT/DMFS indices resulted in high values.

Background: Many studies were conducted to assess the benefit/risk of equimolar mixture of oxygen and nitrous oxide (EMONO), but evaluating the appetite associated to its use is now getting very little attention in the literature. The purpose of this study was to investigate the effects present, felt, and sought during care by the child related with the 50% nitrous oxide/oxygen (EMONO) sedation used in pediatric dentistry. Materials and methods: All patients in consultation with the Dental Service of Nantes hospital and in need of EMONO were included in the study. In this prospective single-center study, the effects present, felt, and sought during care by the child and the assessment of EMONO appreciation were recorded. The presence of clear signs that the child was trying to extend the duration of the EMONO use was also sought. Results: Only 62% of the patients were presented with an anxiolytic effect, and 40% relative analgesia. Both effects were associated in 33% of children. Over the 76 patients assessed, 12 attempted to extend the duration of the EMONO use (16%). After a bivariate statistical analysis, none of the variables appeared significantly associated with the extension of the EMONO use duration. Conclusion: The significant proportion of patients who have prolonged the EMONO use seems to indicate a real attraction for nitrous oxide. This is the first study to evaluate nitrous oxide appreciation on a child.

Aim: To extract and systematically identify the existing literature on the “Clinical and radiographic outcome of calcium hydroxide vs other agents in indirect pulp capping of primary teeth”. Objective: To compare the clinical and radiographic outcome of calcium hydroxide and other agents in indirect pulp capping of primary teeth. Search strategy: The following databases were searched: PubMed Central, Cochrane Database of Systematic Reviews, Lilacs, Science Direct, Sigle. Bibliographies of clinical studies identified in the electronic search were analyzed for studies published outside the electronically searched journals. Selection criteria: Studies comparing the clinical and radiographic success rate of one or more indirect pulp capping agents with calcium hydroxide in primary molars were included. Results: The initial search revealed 243 of which only 9 met the inclusion criteria and 234 were excluded based on the exclusion criteria. All the 9 included studies analysed the clinical and radiographic outcome of calcium hydroxide in comparison with other agents in indirect pulp capping of primary teeth. Conclusion: There is a very limited good quality studies estimating the clinical and radiographic outcome of calcium hydroxide in comparison with other agents in indirect pulp capping of primary teeth. The review identified the need for more studies on the clinical and radiographic outcome of calcium hydroxide in comparison with other agents in indirect pulp capping of primary teeth.

Aim: The objective of the present systematic review was to assess the outcomes of Hall technique (HT) on primary carious molars and compared it with the conventional dental restorations. Materials and methods: The systematic review was registered with Prospero registry (CRD42015020445) to answer the following research question: Is HT a better restorative option compared to other techniques for restoration of carious primary molars? In addition to exploring various health sciences databases, hand search was also done using following key terms in different permutations: (Hall technique OR Hall's technique OR preformed metal crown OR stainless steel crown) AND (caries OR carious molar OR deciduous tooth OR baby tooth OR milk tooth OR primary tooth). The outcome of interest was success of the restoration achieved with either method. Results: Five studies were included (two RCTs, one quasi-experimental trial, and two retrospective). A total of 1775 teeth were assessed, of which 1325 teeth were restored using HT. The retrospective studies showed no difference between HT and other methods whereas the RCTs and quasi-experimental favored HT over other treatment modalities. Meta-analysis significantly favored HT over conventional restorations [risk ratio 5.55 (3.31–9.30)] (p value ≤ 0.001). Conclusion: HT appeared demonstrated higher success and significantly outperformed the conventional restorations.

Objective: The purpose of this systematic review was to compare the efficacy of single-visit pulpectomy (SVP) vs multiple-visit pulpectomy (MVP) in infected primary teeth. Materials and methods: An extensive literature search in the English language was conducted in PICO format using MeSH terms using databases (PubMed, EBSCO, Ovid, and Cochrane) and pre-specified inclusion and exclusion criteria were applied to identify relevant studies comparing pulpectomy in single and multiple visits. Results: Only 4 studies (3—in vivo clinical study; 1—in vivo microbial study) sustained the final analysis and were included for critical appraisal. Results of the systematic search revealed that there are only a few studies comparing the efficacy of single-visit pulpectomy vs multiple-visit pulpectomy in infected primary teeth. Conclusion: On the basis of the available studies, evidence favors the SVP protocol over the MVP protocol. Whenever possible the single-visit protocol can be preferred over the multiple-visit protocol. The quality of evidence available is low.

Pulpectomy is one of the most important procedures in maintaining the necrotic primary teeth until physiologic exfoliation. In clinical practice, time efficacy is invaluable, especially in pediatric endodontics, where unpredictability and difficulty of root canal morphology adds to a clinician's challenge. The success of a pulpectomy procedure mainly depends upon the biomechanical preparation of the root canal systems. With the advent of NiTi rotary files, adult endodontic procedures have been rendered easy, but its popularity in pedodontic practice is limited. Therefore, the purpose of this article is to review the use of NiTi rotary files for root canal instrumentation in primary teeth.

Dentinogenesis imperfect is a hereditary dentin defect leading to discoloration as well as early tooth wear. Timely diagnosis and treatment are required to prevent further tooth loss. Two patients reported to the department of pediatrics dentistry with dentinogenesis imperfecta (DI). In the first case, patient complained of discoloration of both primary and permanent teeth and delayed eruption of permanent teeth. In the second case report, patient reported with mobile anterior tooth and missing teeth due to extraction of mobile teeth. Extraction was followed by space maintainers in the first case, and extraction was followed by partial denture in the second case. Both the patients and their parents were happy with the treatment provided.

Background: The premature loss of the primary teeth after the eruption of first permanent molar can result in mesial shift of the first permanent molar. In such circumstances, we require space regainer. The “banded helical retractor” was designed to overcome some of the limitations of the conventional removable and fixed regainers. Aim and objectives: This paper presents a case report with premature loss of second deciduous molar after the eruption of first permanent molar, and regaining the space loss by using innovative design “banded helical retractor”. Case description: A 7-year-old patient with loss of space due to early exfoliation of 75 was given an innovative space regainer “banded helical retractor”. Results: After 6-weeks followup, space was regained with uprighting of molars. Conclusion: “Banded helical retractor” as a space regainer was effective in regaining the space in the short duration of time.

Aim: To make dentists and pedodontists aware of a possible outcome of a rapidly growing swelling. Background: Ewing's sarcoma is a rare aggressive variant of small round cell tumors and is an uncommon malignancy that occurs usually in childhood. It constitutes 10–15% of all primary malignant tumors and represents the second most common malignant bone tumor occurring in children and young adults. Case description: We report a case of Ewing's sarcoma in an 11-year-old male child who reported with a rapidly progressing swelling in the left mandibular posterior region. Panoramic view and computed tomography showed characteristic moth eaten and sun-ray appearance. Fine-needle aspiration cytology revealed a small round cell tumor. Since the exact diagnosis is hard to achieve before biopsy, the condition poses a difficult diagnostic dilemma for the clinician. Histopathology was performed for the accurate diagnosis. Conclusion: Dentists and pedodontists should develop a high index of suspicion in diagnosing cases with rapidly enlarging intraoral or extraoral swellings as early and correct diagnosis may improve clinical management and survival for patients with this disease. Clinical significance: Our case report is an attempt to help the dental community in developing familiarity with the clinical presentation of Ewing's sarcoma.

The caliber-persistent labial artery (CPLA) is a vascular anomaly in which a main branch of the artery penetrates the submucosal area of the lip without loss of caliber. It commonly presents as an elevated soft tissue mass and is often pulsatile on manual palpation. Clinical suspicion is important, given the risk of bleeding, either from slight trauma or accidentally if lack of awareness leads to excision of the lesion owing to an incorrect diagnosis. CPLA should be considered in the differential diagnosis of any lesion affecting the lip, especially to differentiate from mucocele or squamous cell carcinoma. This particular case of CPLA in the upper lip of a girl presents a both unusual and interesting clinical picture and could provide essential diagnostic and procedural information.