International Journal of Clinical Pediatric Dentistry

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2021 | July-August | Volume 14 | Issue 4

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Rahul R Chaudhari, Harshit R Srivastava, Renuka P Chinchalkar, Saloni Gattani, Pooja Sen

Effect of Saliva Contamination on Shear Bond Strength of Self-etch Adhesive System to Dentin: An In Vitro Study

[Year:2021] [Month:July-August] [Volume:14] [Number:4] [Pages:4] [Pages No:443 - 446]

Keywords: Contamination, Saliva, Self-etch adhesive systems, Shear bond strength

   DOI: 10.5005/jp-journals-10005-1981  |  Open Access |  How to cite  | 


Aim and objective: This study aimed to evaluate the outcome of saliva contamination on shear bond strength (SBS) of a self-etch adhesive system to dentin. Materials and methods: A total of 60 premolars were selected. Occlusal surfaces of the teeth were severed off. Three groups of 20 teeth in each were formed after the samples were randomly divided. Group I: Not subjected to any contamination (control group). Group II: Contamination with saliva occurred before coating the teeth with a self-etch adhesive system. Group III: Contamination with saliva occurred after coating the teeth with a self-etch adhesive system. After the contamination, the composite was placed with the help of a Teflon tube. Under the universal testing machine, the SBS of these samples was then tested. Results: The data obtained after testing were analyzed using SPSS software. Statistical difference was seen between all the three groups. Group II projected the least SBS. Conclusion: Contamination with saliva has a deleterious effect on the SBS. Contamination that occurs before the application of adhesive systems has shown considerably reduced SBS. Clinical significance: This study successfully established that saliva contamination acts as a major factor in reducing the SBS of the bonding agent. Hence, in clinical situations, it is necessary to ensure sufficient steps are taken to eliminate or reduce the chances of contamination with saliva to aid in the success of the restoration.



Sudha B Patil, Divya D Popali, Prashant A Bondarde, Nikhil S Khandare, Akshay R Kothari, Pooja S Chawla, Sayali Gawale, Gaurav A Shinde, Rachana S Agrawal, Aditi S Patkar, Saurabh R Mirgal

Comparative Evaluation of the Effectiveness of Different Pain-alleviating Methods before Local Anesthetic Administration in Children of 6 to 12 Years of Age: A Clinical Study

[Year:2021] [Month:July-August] [Volume:14] [Number:4] [Pages:7] [Pages No:447 - 453]

Keywords: 2% Lignocaine, Eutectic mixture of lignocaine and prilocaine, Pain scales, Transcutaneous electrical nerve stimulation, Vibrator

   DOI: 10.5005/jp-journals-10005-1998  |  Open Access |  How to cite  | 


Background and aim of the study: Pediatric patients are apprehensive regarding having dental treatment mainly because of painful local anesthetic (LA) injections. Various techniques like transcutaneous electrical nerve stimulation (TENS), topical anesthetic agents, and vibrator device are introduced to reduce discomfort before LA administration. Therefore, the present study aimed to compare and evaluate the effectiveness of TENS, 2% lignocaine gel, eutectic mixture of lignocaine and prilocaine (EMLA), and vibrating device before LA injections in alleviating pain in pediatric patients. Materials and methods: Sixty healthy children aged 6 to 12 years who required LA injections for dental procedures were selected and divided into four groups with 15 patients in each group. Wong–Baker's facial pain rating scale (WBFPRS) and face, legs, activity, cry, and consolability scale (FLACC) are used for pain perception which are tabulated, and statistically analyzed. Results: The test results demonstrated that the TENS group has shown the least mean WBFPRS and FLACC score, followed by vibrator devices, EMLA gel, and lignocaine gel. Conclusion: The newly introduced TENS apparatus showed encouraging results, hence can be used as a safe and reliable technique to be used in pediatric dentistry.



Navneet Grewal, Soumya Jha, Nirapjeet Kaur

Clinical and Radiographic Success of Resin-bonded Strip Crowns in Primary Incisors with Varying Extents of Sound Tooth Structure Available for Bonding

[Year:2021] [Month:July-August] [Volume:14] [Number:4] [Pages:8] [Pages No:454 - 461]

Keywords: Esthetic, Primary Incisors, Resin composite, Restorative dentistry, Strip crown, Tooth surface area

   DOI: 10.5005/jp-journals-10005-1984  |  Open Access |  How to cite  | 


Context: First-time dental treatment for children is often sought due to carious, malformed, fractured, and discolored teeth. The strip crown represents a highly esthetic and popular option for the restoration of primary anterior teeth. However, there are limited data on the clinical success of these crowns based on the extent of surface area used for adhesion. Aims, settings and design: This in vivo study aimed to assess the clinical, radiographic, and photographic performance of 66 composite strip crown restorations on primary anterior teeth for up to 15 months and compare the outcome based on the extent and surface area of tooth structure available. Materials and methods: The amount of surface area available in each group after removal of affected enamel was evaluated through 3D scanning of study casts and digital measurements. The teeth were thus grouped into three categories: group I with crown structure involvement up to the incisal one-third, group II with involvement up to the middle of the middle third, and group III with involvement up to the cervical one-third. Statistical analysis used: Kruskal–Wallis H test and Mann–Whitney U test were used for computation of mean scores for intra- and intergroup comparison, respectively. Scoring was done as per FDI clinical criteria on a scale of 1 to 5. Results: Group III showed the highest mean scores at different time intervals and also the highest failure rate (52.38%), followed by group II (12%) and group I (5%). The overall retention rate observed for the strip crowns was 77.28% at the end of 15 months. Conclusion: Strip crowns should be considered for teeth that offer a minimum of half to two-thirds of the healthy tooth structure remaining. Further, longitudinal studies are required to add to the results of the final outcome of these restorations. Key messages: A critical surface area value of <50 mm2 or less than half of the available sound tooth structure was found to be detrimental to the retention rate of these crowns in this study. It could therefore be suggested to consider strip crowns for teeth that offer a minimum of half to two-thirds of healthy tooth structure remaining.



B Sandhyarani, Ramoli R Pawar, Mital V Kevadia

Effect of Low-level Laser on LI4 Acupoint in Pain Reduction during Local Anesthesia in Children

[Year:2021] [Month:July-August] [Volume:14] [Number:4] [Pages:5] [Pages No:462 - 466]

Keywords: Acupuncture, Laser acupuncture, Local anesthesia, Low-level laser therapy

   DOI: 10.5005/jp-journals-10005-1995  |  Open Access |  How to cite  | 


Background: Pain is a multidimensional construct that involves sensory, emotional, and cognitive processes. It is an essential component of child behavior guidance. The injection of a local anesthetic agent during pediatric dental treatment is one of the most painful and distressing procedures performed, stimulation of acupoint LI4 provides an analgesic effect in the orofacial region, thus decreasing the pain during injection. Aims and objectives: To compare and evaluate the effect of low-level laser on LI4 acupoint and surface-acting 20% benzocaine gel during local anesthesia. Materials and methods: Children of age-group between 5 years and 9 years receiving bilateral local anesthesia were scheduled for dental treatment. Split-mouth cross-over study was planned and was divided into two groups, receiving low-level laser acupuncture on LI4 acupoint with placebo as a moist cotton swab in the first visit and 20% benzocaine gel with placebo as low-level laser acupuncture off mode in second visit and vice versa. Pain intensity was evaluated using the sound eye motor scale as subjective scale, Wong–Bakers pain rating scale. Pulse rate was measured before, during, and after the procedure using a pulse oximeter. Results: The average heart rate, Wong–Bakers pain rating scale, and Sound Eye Motor scale were significantly lower in the group having low-level laser when compared with the group having placebo low-level laser therapy. Conclusion: The low-level laser can be used to control pain during local anesthesia in children.



Tanvi Aggarwal

Prevalence of Traumatic Dental Injuries among 1- to 14-year-old Children: A Retrospective Study

[Year:2021] [Month:July-August] [Volume:14] [Number:4] [Pages:4] [Pages No:467 - 470]

Keywords: Ellis class IV, Retrospective, Trauma

   DOI: 10.5005/jp-journals-10005-1961  |  Open Access |  How to cite  | 


Aim and objective: To evaluate the prevalence of dental trauma in children in the age-group of 1 to 14 years in New Delhi. Materials and methods: This is a retrospective study conducted from March 2017 to December 2017. A total of 6,765 children between 1 years and 14 years of age, who reported in OPD were evaluated for age, gender, type of trauma, and involvement of soft tissue. Results: The mean age of participating children was 9.98 ± 1.704 and trauma was present in 1.25% of children. Ellis class IV type of trauma was seen in maximum (36.5%) cases with maxillary central incisors being most frequently injured during dental trauma. Conclusion: The present retrospective study surveys traumatic dental injuries which are frequently seen. The knowledge of the prevalence and etiology of trauma to anterior teeth is necessary to identify the risk groups, treatment requirements, and strengthening of preventive programs.



Neethu Ann Preethy, Erulappan M Subramanian

Evaluation of Quality of Obturation Using Two Different Rotary Files and Hand Files in Primary Teeth: A Randomized Controlled Trial

[Year:2021] [Month:July-August] [Volume:14] [Number:4] [Pages:4] [Pages No:471 - 474]

Keywords: Deciduous teeth, Hand K files, Obturation quality, Pediatric rotary files

   DOI: 10.5005/jp-journals-10005-1990  |  Open Access |  How to cite  | 


Aim and objective: To estimate the obturation quality and instrumentation time on comparing traditional hand files and two rotary file types during root canal instrumentation in deciduous molars. Materials and methods: Forty-five deciduous mandibular molars were taken and randomly allotted to three groups (n = 15). Group I: K-hand files, group II: ProTaper Gold rotary file, and group III: Kedo-SG Blue rotary files. Before and after root canal instrumentation, standardized digital radiography was taken and the instrumentation time was also noted. The recorded data were then subjected to statistical analysis utilizing SPSS Software version 22.0. To compare the instrumentation time and quality of obturation between the groups, a Chi-square test and ANOVA with the level of significance at 0.05 were employed. Results: There was no significant difference recorded with reference to the quality of obturation (p > 0.05). However, the difference was noticed to be statistically significant when the instrumentation time between the two rotary groups and the manual instrumentation groups was taken into account (p < 0.05). The rotary systems ProTaper Gold and Kedo-SG Blue exhibited a significantly less instrumentation time on comparing with that of the hand files. Conclusion: Concerning the quality of obturation, all three file groups demonstrated almost a similar performance. However, there was a significant difference noticed in the instrumentation time with the use of manual instrumentation in comparison to rotary instrumentation in deciduous teeth.



Poonam Shingare, Vishwas Chaugule

An In Vitro Microleakage Study for Comparative Analysis of Two Types of Resin-based Sealants Placed by Using Three Different Types of Techniques of Enamel Preparation

[Year:2021] [Month:July-August] [Volume:14] [Number:4] [Pages:7] [Pages No:475 - 481]

Keywords: Acid etching, Enamel preparation, Fissure sealants, Lasing, Microleakage, Pit

   DOI: 10.5005/jp-journals-10005-1991  |  Open Access |  How to cite  | 


Background: Clinicians always experience dilemmas while choosing the type of pit and fissure sealant and the method of enamel preparation before the application of sealant. This study was accomplished using the unfilled and filled types of resin sealant deploying three different techniques of enamel preparation. Aim and objective: To do a comparative analysis of unfilled and filled sealants by deploying three techniques of enamel preparation. Materials and methods: The total number of 60 extracted teeth were divided into 3 groups, each containing 20 samples. Conventional acid etching of enamel was labeled as (group I), laser application as (group II), and fissurotomy bur (group III). The samples of group I were prepared by conventional acid etching, the group II was subjected to Er:YAG lasing, while in group III fissurotomy followed by acid etching was done. The sealant placement was done using split tooth design in all the samples. Dye penetration using 5% methylene blue was used for microleakage assessment. Results: The highest microleakage was found with Gr. II whereas Gr. I exhibited the least microleakage. No statistical difference was observed between the unfilled and filled sealant (p = 0.652). Conclusion: Conventional acid etching alone or with fissurotomy weighed up appropriate option regardless of the type of sealant material used. Clinical significance: In regard to the selection of material and proper technique of enamel preparation, this study will be useful to clinicians.



Aarti Kumari, Charumohan Marya, Sukhvinder Singh Oberoi, Ruchi Nagpal, Sourav Chandra Bidyasagar, Pratibha Taneja

Oral Hygiene Status and Gingival Status of the 12- to 15-year-old Orphanage Children Residing in Delhi State: A Cross-sectional Study

[Year:2021] [Month:July-August] [Volume:14] [Number:4] [Pages:6] [Pages No:482 - 487]

Keywords: Brushing frequency, Gingival status, Oral hygiene status, Orphanage children, Plaque status

   DOI: 10.5005/jp-journals-10005-1989  |  Open Access |  How to cite  | 


Aim and objective: To assess oral hygiene status and practices among 12- to 15-year-old orphanage children in Delhi State, India. Study design: In this cross-sectional study, a one-stage cluster sampling design was carried out with orphanages as a cluster unit to assess oral hygiene status and practices among orphanage children in Delhi state, India. Results: The majority of the orphanage children had good oral hygiene status (53.8%) followed by fair (32.3%) and poor (13.9%) oral hygiene status. A large proportion (48.3%) of the orphanage children had mild gingival status followed by moderate (34.9%) and severe (16.8%) gingival status. No statistical difference was reported for the distribution of oral hygiene status and gingival score across all the age-groups. Most (53%) of the orphanage children among all age-groups had good plaque status. The correlation of gingival index (GI) scores with plaque index (PI) score and oral hygiene index-simplified (OHI-S) scores showed a significant correlation of GI scores with PI scores (r = 0.815) and OHI-S scores (r = 0.799). Conclusion: The oral hygiene practices and oral hygiene status along with gingival status were found to be satisfactory among orphanage children in the present study. Clinical significance: Gingival and periodontal diseases have a high prevalence among orphanages because of poor hygiene practices. Untreated oral diseases could lead to general health problems. Thus, the preventive strategies can be planned with the exact knowledge of the oral hygiene status of these special needs children in Delhi state.



Osama Felemban, Haifa Alagl, Waad Aloufi

Success Rate of Stainless-steel Crowns Placed on Permanent Molars among Adolescents

[Year:2021] [Month:July-August] [Volume:14] [Number:4] [Pages:4] [Pages No:488 - 491]

Keywords: Adolescents, Permanent molars, Stainless-steel crowns

   DOI: 10.5005/jp-journals-10005-1982  |  Open Access |  How to cite  | 


Aim and objective: To evaluate the success rate of stainless-steel crowns (SSCs) placed on permanent molars among adolescents in King Abdulaziz University Dental Hospital (KAUDH). Materials and methods: Electronic records of KAUDH patients aged 10 to 15 years who had an SSC placed on a permanent molar from 2013 to 2018 were reviewed. The patients were contacted by telephone and were invited to participate in the study. The patients were examined clinically and radiographically. Results: The response rate was 42.6%. The total number of SSCs included in the study was 36 crowns. The mean age was 11.75 ± 1.95. Males represented 75.76% of the subjects. The success rate of SSCs placed on permanent molars was 86.10%. Conclusion: Placement of SSCs on permanent molars is a highly successful long-term temporary restoration that preserves badly destructed molars in adolescents until definitive prosthetic treatment can be done. Clinical significance: To provide updated knowledge to healthcare providers and researchers about the success rate of SSCs when placed on permanent molars.



Tata Lakshmi Manasa Devi, Kocherlakota Subbaraya Dwijendra, Kesary P Reddy, Vallala Pranitha

Prevalence and Pattern of Non-syndromic Hypodontia among Adolescents in Southern Part of India

[Year:2021] [Month:July-August] [Volume:14] [Number:4] [Pages:5] [Pages No:492 - 496]

Keywords: Congenitally missing tooth, Non-syndromic hypodontia, Tooth agenesis

   DOI: 10.5005/jp-journals-10005-1983  |  Open Access |  How to cite  | 


Background: Non-syndromic hypodontia is the most common developmental dental anomaly, but there is a paucity of literature on its prevalence and severity in the Indian population. Aim and objectives: To estimate the prevalence of non-syndromic hypodontia among adolescent schoolchildren in the southern part of India. Settings and design: This cross-sectional study was conducted in 20 schools from two states of southern India, named—Andhra Pradesh and Telangana. A total of 5,458 children in the age-group 13 to 15 years were selected. Materials and methods: Clinical examination was carried out to check the absence of a permanent tooth and was confirmed by radiographic findings. The inclusion criterion was children with all the permanent teeth erupted (except third molars) and exclusion criteria were teeth missing due to reasons other than congenital agenesis. A Chi-square test was applied to check the significance. Results: The total prevalence of hypodontia in the study sample was 1.4%. Girls displayed a higher prevalence value (1.9%) than boys (1.1%). Maxillary lateral incisor was the most commonly congenitally missing tooth, followed by mandibular incisors and mandibular second premolar. Overall, hypodontia with a predominance of unilateral pattern and a predilection for the left side was observed. Conclusion: The most common missing permanent tooth (except third molars) was the maxillary lateral incisor. Hypodontia was more prevalent in females and had a predominance of unilateral patterns with a predilection toward the left side.



Balsam Noueiri, Nahla Nassif

Dental Treatment Effect on Blood Glucose Level Fluctuation in Type 1 Unbalanced Diabetic Children

[Year:2021] [Month:July-August] [Volume:14] [Number:4] [Pages:5] [Pages No:497 - 501]

Keywords: Blood glucose level, Dental treatment, Diabetic child

   DOI: 10.5005/jp-journals-10005-1985  |  Open Access |  How to cite  | 


Diabetic patients struggle to maintain their blood glucose near normal levels to avoid the occurrence of hypo- or hyperglycemia discomfort. Dental practitioners must foresee such complications as they can also take place during dental treatment. Aim and objective: This study aims to evaluate the impact of the type and duration of dental treatment on the blood glucose level (BGL) fluctuation in type 1 unbalanced diabetic children [hemoglobin A1c (HbA1c) >7]. Material and methods: A cross-sectional approach was conducted on 83 type 1 unbalanced diabetic children (HbA1c) > 7%, aged between 7 years and 12 years, divided into 40 females and 43 males in the Department of Pediatric Dentistry at the Lebanese University in Beirut. For dental treatments, diabetic children were scheduled for morning sessions 60–90 minutes after breakfast intake and a habitual insulin shot. Only patients with a BGL between 70 mg/dL and 300 mg/dL underwent dental treatments. The type, the duration of the dental session, and the BGL at the baseline (T0), and at the end of the session (T1) were recorded. The dental acts were classified into simple (without local anesthesia) and unpleasant with a solution of 2% lignocaine with 1:200,000 epinephrine. Statistical analyses were performed. Results: Fifty of 83 showed a decrease in their BGLs after dental treatments, 20 an increase, and 13 no change. For both genders, in simple acts, a statistical significance was noted (p = 0.0002) for the female and (p = 0.0014) for the males. Conclusion: Treatment unbalanced diabetic children can be safely done by taking some precautions and measures to avoid a hypo- or hyperglycemia episode.



Ratika Solanki

QLF-D: A Contemporary Plaque Control Tool in Children

[Year:2021] [Month:July-August] [Volume:14] [Number:4] [Pages:4] [Pages No:502 - 505]

Keywords: Audiovisual aids, Dental plaque, Mechanical plaque control, Oral health education, Q-scan device

   DOI: 10.5005/jp-journals-10005-2001  |  Open Access |  How to cite  | 


Background and objectives: The main causative factors for maximum periodontal diseases are dental plaque and oral biofilms. This study was done to check the impact of quantitative light-induced fluorescence-digital (QLF-D) as a motivational tool for plaque control among children from various schools situated in Dehradun district along with education using audiovisual aids. Materials and methods: A total sample of 800 school-going children including both males and females aged 6 to 12 years from various schools situated in Dehradun district of Uttarakhand were surveyed. A pro forma was prepared and the demographics of the students were noted. All the students were first examined for the Oral Hygiene Index-Simplified (OHI-S) and then the random division was done into two groups, group A (Q-scan) and group B (basic diagnostic aids) for examination of plaque index. Results: The results of the study revealed that good OHI-S scores increased significantly from 1st visit to 3rd visit. The plaque scores for the control group, when examined with basic diagnostic aids of all three visits, were significantly good which increased subsequently from 1st visit to 3rd visit. Good plaque index score increased significantly for the test group from 1st to 3rd visit when examined with QLF-D. Conclusion: We found in our study that QLF technology is of paramount importance in epidemiological surveys and plays a pivotal role in evaluating masses in maintaining oral health care.



Deepika Patidar, Dinesh C Patidar, Aayush Malhotra

Traumatic Dental Injuries in Pediatric Patients: A Retrospective Analysis

[Year:2021] [Month:July-August] [Volume:14] [Number:4] [Pages:6] [Pages No:506 - 511]

Keywords: Dental trauma, Fracture, Management

   DOI: 10.5005/jp-journals-10005-2004  |  Open Access |  How to cite  | 


Aim: This retrospective study aimed to analyze dental traumatic injuries and their management in children up to 16 years of age. Materials and methods: Records of the patients who sustained dental trauma from 2013 to 2018 were evaluated for age, gender, etiology, type of injuries, and their management. Children were divided into three groups—primary (0–5 years), mixed (6–11 years), and permanent dentition group (12–16 years). Dental trauma was assessed by Ellis and Davey's classification of tooth fracture along with other associated injuries. Results: Total records of 466 children with 750 injured teeth (665 permanent and 85 primary) were evaluated. Males were reported twice as females. Fall was noted as the major etiological factor (93.1%). The highest frequency of dental trauma was observed in the permanent dentition group (54.7%). Ellis class IV fracture was the most common dental injury and maxillary central incisor was the most frequently injured tooth. Soft tissue injury was noted as the most commonly associated injury. Most of the dental traumatic injuries in permanent teeth were treated by root canal treatment while the majority of primary dentitions were managed by observation and wound care. Conclusion: Ellis class IV fracture was noted as the most frequent type of dental injury and fall was a major etiological factor. The permanent dentition group of children was more affected and a male predominance was observed. Clinical significance: The information gained from the present study would help in providing various preventive modalities to parents, caregivers, and teachers regarding these injuries in the future and also facilitate several new researches in this field.



Mridula Trehan, Chirag Patil

Evaluation of Alkaline Phosphatase as Skeletal Maturity Indicator in Gingival Crevicular Fluid

[Year:2021] [Month:July-August] [Volume:14] [Number:4] [Pages:6] [Pages No:512 - 517]

Keywords: Alkaline phosphatase, Biomarker, Gingival crevicular fluid, Hand-wrist radiograph, Skeletal maturity

   DOI: 10.5005/jp-journals-10005-1996  |  Open Access |  How to cite  | 


Introduction: The aim of this study was a comparison of the mean alkaline phosphatase (ALP) levels in gingival crevicular fluid (GCF) at distinct phases of skeletal maturity with the use of a hand-wrist radiograph and to analyze if GCF ALP levels can be used as a non-invasive biomarker for evaluation of skeletal maturity in patients undergoing orthodontic treatment. Materials and methods: In this study, a standardized volume of 5 μL was collected from the subjects in the preadolescent, adolescent, and postadolescent phases from the mesial and distal embrasures of maxillary and mandibular central incisors after which a hand-wrist radiograph was obtained. Eppendorf tubes with buffer solution were used to transfer GCF to the laboratory for estimation of ALP level. Results: The data collected were analyzed using Kruskal–Wallis and Mann–Whitney U test to obtain the ALP levels. Gingival crevicular fluid ALP levels were significantly higher in the adolescent stage. The site-wise comparison in the three groups show that there is a statistically insignificant difference between maxilla and mandible or between males and females. Conclusion: It was concluded that the mean ALP levels were significantly increased in the adolescent phase in contrast with the pre- and post-adolescent stages. Gingival crevicular fluid ALP can be considered a promising diagnostic tool as a non-invasive biomarker of an adolescence growth spurt.



Yashika Singhal, Vandana Reddy

Efficacy of Root Canal Instrumentation and Fracture Strength Assessment in Primary Molars after Preparing Two Different Shapes of Access Cavity: An Ex Vivo Histological Study

[Year:2021] [Month:July-August] [Volume:14] [Number:4] [Pages:7] [Pages No:518 - 524]

Keywords: Access cavity, Fracture strength, Pediatric endodontics, Primary tooth, Root canal debridement, Root canal instrumentation

   DOI: 10.5005/jp-journals-10005-1997  |  Open Access |  How to cite  | 


Aim and objective: To evaluate the efficacy of root canal instrumentation and fracture strength assessment in primary molars after preparing different shapes of access cavity design. Materials and methods: Sixty extracted primary mandibular molars with at least 2/3rd roots were randomly, equally divided into two groups based on shapes of the access cavities; Group I: Traditional access cavity (TAC), Group II: Conservative access cavity (CAC). Each group was further subdivided into two subgroups with 15 samples each. After, root canal debridement, samples in subgroup 1 were sectioned for histological evaluation of root canal instrumentation efficacy, while subgroup 2 were assessed for fracture strength using a Universal Testing Machine. The data were analyzed statistically using Mann–Whitney and post hoc Tukey tests, with a p value <0.05. Results: Traditional access cavity showed statistically significant root canal debridement efficacy (p < 0.05) compared with CAC. Statistically significant differences were obtained between fracture strength values among the two groups (p < 0.05), with considerably higher fracture strength in the CAC group than TAC. Conclusion: Traditional access cavity design resulted in complete root canal debridement but caused weakening of tooth structure due to low fracture strength, necessitating the use of full coverage restoration postendodontic therapy.



Clara Lerond, Julie Hudry, Sélima Zahar, Aidan Makwana, Nora Schneider

Soothing Effect of an Edible Teether: A Pilot Study in Children during Primary Dentition Age

[Year:2021] [Month:July-August] [Volume:14] [Number:4] [Pages:6] [Pages No:525 - 530]

Keywords: Children, Edible teether, Soothing, Teething

   DOI: 10.5005/jp-journals-10005-2002  |  Open Access |  How to cite  | 


Background: Irritability and discomfort are common symptoms during teething periods in infants and toddlers. Non-pharmacological remedies to relieve teething symptoms include teethers and food for chewing. However, the efficacy of such remedies for their soothing effect has been poorly investigated. Materials and methods: In this home-based pilot study, the soothing effect of a novel edible teether with a slowly dissolvable texture was investigated in 12 children aged 5 to 19 months old during primary dentition age. After parents observed their child getting irritable, the child received the edible teether for an exposure duration of 15 to 20 minutes. Parental ratings of children's mood states (crankiness, stress, happiness, and calmness) were collected using visual analog scales, and child cardiac measurements (heart rate and heart rate variability) were assessed using a wearable device. The soothing effect was quantified via mood ratings and physiological calming responses as a before-after comparison using Wilcoxon signed-rank tests. Results: Parents perceived their child as significantly calmer and happier, less stressed, and marginally less cranky after edible teether exposure than before. The child cardiac variables showed no significant changes; however, exposure to the teether induced a marginal increase in HR within normal ranges, potentially indicating a stimulation effect. Conclusion: The pilot study provides the first insight on the soothing effect of a novel edible teether on parent-reported mood states in young children during primary dentition age. Further research is needed to understand the relative contribution of the different components of an edible teether to the observed effects, such as texture and exposure duration, and to demonstrate its efficacy against a control product. Trial registration: Swiss registry of clinical trial: CER-VD 2019-02155.



Arvind Jain, Sandhya Jain, Ajay Pratap Singh Parihar, Amit Rawat

Prevalence of Developmental Dental Anomalies of Number and Size in Indian Population According to Age and Gender

[Year:2021] [Month:July-August] [Volume:14] [Number:4] [Pages:6] [Pages No:531 - 536]

Keywords: Anomaly, Developmental dental anomalies, Hypodontia, Numeral anomaly, Size anomaly

   DOI: 10.5005/jp-journals-10005-1980  |  Open Access |  How to cite  | 


Introduction: Dental anomalies arise due to genetic and environmental factors in the morphodifferentiation stage of odontogenesis lead to alteration in the number and size of the tooth as well as the root.1–3 The knowledge of their prevalence and the extent of involvement can provide valuable information for phylogenic and genetic studies and also help in the understanding of differences among the population and between various population groups.4 We aim to identify the prevalence and distribution of such anomalies according to age and gender. The acquired details of cases will further help the dental clinicians to understand their etiology which can further facilitate their diagnosis and effective management. Also, timely intervention can be achieved. Materials and methods: Retrospective study of 4,000 subjects (equal proportion of males and female) of age range from 10 to 40 years were studied. Their radiographs, dental casts, and clinical findings were evaluated for number and size developmental dental anomaly. Results: Incidence of overall 331 cases (8.27%) of number and size developmental dental anomalies were recorded with 173 (8.6%) males and 158 (7.9%) females. Hypodontia was the most frequently found dental anomaly in both males (4.9%) and females (4.4%) followed by hyperdontia and supernumerary roots. Microdontia was the most frequently found size anomaly in both males (1.6%) and females (1.9%). Conclusion: Hypodontia (4.7%) is the most frequently found numeral anomaly in both males and females. Intergroup study shows a significant statistical difference in cases of hypodontia in the 10–25 years of age-group (6.2%) with a p value ≤ 0.00001.



Zohra Jabin, Iffat Nasim, V Vishnu Priya

Quantitative Analysis and Effect of SDF, APF, NaF on Demineralized Human Primary Enamel Using SEM, XRD, and FTIR

[Year:2021] [Month:July-August] [Volume:14] [Number:4] [Pages:5] [Pages No:537 - 541]

Keywords: Primary teeth, Silver diamine fluoride, Sodium fluoride, Tooth remineralization

   DOI: 10.5005/jp-journals-10005-1988  |  Open Access |  How to cite  | 


Introduction: Topical fluoride therapy has proven benefits in the prevention of demineralization. Tooth enamel has shown a great potential for remineralization with an application of topical fluorides if administered at an appropriate time. In an effort to find an effective remineralizing agent, a novel fluoride agent silver diamine fluoride (SDF) has emerged as a potent caries arresting as well as caries preventing agent. Aim and objective: The present study was aimed at determining the primary tooth enamel resistance to demineralization after topical application of three fluoride agents SDF, APF, and NaF. Materials and methods: Enamel specimens were prepared from 40 caries-free primary molars. These specimens were randomly allocated into three groups of 10 specimens each and they were treated by different topical fluorides namely: Group I–SDF, group II–Acidulated phosphate fluoride (APF), group III–Sodium fluoride. Three enamel specimens from each group were placed on custom-made acrylic blocks with 5 × 5 mm of an exposed window for scanning electron microscope (SEM) evaluation and rest of the specimens were ground into a fine powder for X-ray diffraction (XRD) and Fourier transform infrared spectroscopy (FTIR) analysis. The tooth blocks and treated samples were subjected to the demineralization process for 168 hours. They were then qualitatively assessed to evaluate their resistance to demineralization using SEM, XRD, and FTIR. Results and conclusion: Morphologically, the enamel of all groups specimens was mostly smooth with some groves and microporosities. Chemically, the Ca/P molar ratios of all groups were similar with slight variations. Structurally, the crystalline phases found in enamel by powder XRD were hydroxyapatite and carbonate apatite; and there was a higher amount of incorporated type B carbonate than type A carbonate as evidenced by FTIR. The study concludes that topical application of a 38% SDF solution can inhibit demineralization of enamel.



D Vaishali Naidu, J Sharada Reddy, Tarasingh Patloth, K Suhasini, I Hema Chandrika, Hasanuddin Shaik

Cone-beam Computed Tomographic Evaluation of the Quality of Obturation Using Different Pediatric Rotary File Systems in Primary Teeth

[Year:2021] [Month:July-August] [Volume:14] [Number:4] [Pages:6] [Pages No:542 - 547]

Keywords: Cone-beam computed tomography, Kedo SG blue rotary files, Pediatric rotary files, Pedo flex rotary files, Primary molars, Prime Pedo rotary files, Quality of obturation

   DOI: 10.5005/jp-journals-10005-2000  |  Open Access |  How to cite  | 


Aim and objective: To compare and evaluate the efficacy of three different pediatric rotary file systems in primary molars using cone-beam computed tomography (CBCT). Materials and methods: Thirty extracted mandibular primary molars were selected and divided into three groups with ten teeth each, instrumented with Kedo SG Blue rotary files, Pro AF Baby gold rotary files, and Pedo Flex rotary files, respectively. Root canal obturation was done with zinc-oxide eugenol cement and the quality of obturation was assessed using CBCT based on the extent of filling as underfilled or optimally filled and the presence or absence of voids within the filling. The data were statistically analyzed using the Chi-square test. Results: Among the three groups, the Kedo SG Blue group showed more number of optimally filled teeth with minimal voids (p < 0.05) followed by the Pro AF Baby gold group and Pedo Flex group. Conclusion: Within the study limitations, the Kedo SG Blue group showed ideal endodontic obturation when compared with Pro AF baby gold and Pedo Flex rotary file systems. Clinical significance: The present study will guide the pedodontists regarding the efficacy of pediatric rotary file systems and their usage protocols.



Adesh Kakade, Bhagyashree Deshmukh, Akanksha Juneja

Oral Health Assessment of Children with Autism Spectrum Disorder in Special Schools

[Year:2021] [Month:July-August] [Volume:14] [Number:4] [Pages:6] [Pages No:548 - 553]

Keywords: Autism, Cross sectional study, Oral health status

   DOI: 10.5005/jp-journals-10005-1972  |  Open Access |  How to cite  | 


Background: Sensory over-responsivity is an important factor influencing the ability of children with an autism spectrum disorder to receive proper oral care. Dental care remains the most prevalent, unmet health care need for children with special health care needs. Aim and objective: To assess the oral health of children with autism in special schools. Materials and methods: A cross-sectional study was conducted to record the oral health problems of 142 autistic children attending special schools across the suburbs of Mumbai city in India. Clinical examination was carried out for the presence of dental plaque, gingivitis, caries, restorations, traumatic injuries, and self-injurious habits. The participants were divided into three groups based on their age. Results: Children with primary and mixed dentition had a higher incidence of dental caries when compared with the permanent dentition group. Good oral hygiene was observed in the study population with a mean OHI-S score of 0.88 ± 0.79. Traumatic dental injuries, bruxism, drooling of saliva from the corner of the mouth, and self-injurious habits were also recorded. Conclusion: Due to the nature of their neurological deficit and difficulty in providing dental treatment, it is recommended that preventive dental care be enforced on these children.



Priyanka Sharma

Evaluation of Various Factors Which Motivate Children in Ashram Schools of Central India Region to Consume Tobacco Products

[Year:2021] [Month:July-August] [Volume:14] [Number:4] [Pages:4] [Pages No:554 - 557]

Keywords: Access, Cancer, Motivation, Tobacco

   DOI: 10.5005/jp-journals-10005-1977  |  Open Access |  How to cite  | 


Background: Tobacco is consumed in myriad forms in India. The rural population has to bear the brunt of smokeless tobacco products. This leads to several complications. More so, among the rural population, this habit comes into practice at a very young age. Aims and objectives: To determine the prevalence of consumption of tobacco products among young adolescents, at the same time to evaluate the psychological motivation factors for the same. Materials and methods: A sample of 2,000 students of the ashram schools was given a detailed questionnaire which included the questions regarding accessibility, liking, source of motivation, and fear of health hazards. Statistical analysis: The statistical analysis was done using the Statistical Package for the Social Science (SPSS version 22, Armonk, NY: IBM Corp). Depending on the nature of the data, descriptive statistics were performed to assess the prevalence of tobacco consumption and motivational factors associated with it. Results: The prevalence of tobacco consumption among children was 37.2%. Fifty-one percent of the tobacco users consumed kharra (a mixture of tobacco, lime, areca nut). Forty percent of the tobacco users began using tobacco after the age of 10 years. For 65% of the individuals’ tobacco products were easily accessible. Conclusion: With the findings of the study, it can be concluded that the easy accessibility to the products in the rural areas is responsible for the children to indulge in such a harmful habit. Clinical significance: This study focused on the factors that motivate the school-going children in the ashram schools to consumption of various tobacco products. This can give a clear insight as to what measures need to be taken to curb such a problem.



Saurabh Jain, Khalil Ibrahim A Idris, Neda Essa M Al Omar, Aeshah YM Atiah, Afnan YM Atiah, Aparna Aggarwal

Replacement Time of Custom Ocular Prosthesis in Children: A Review Article

[Year:2021] [Month:July-August] [Volume:14] [Number:4] [Pages:4] [Pages No:558 - 561]

Keywords: Custom ocular prosthesis, Eye prosthesis for children, Maxillofacial prosthodontics, Ocular prosthesis, Stock ocular prosthesis

   DOI: 10.5005/jp-journals-10005-1978  |  Open Access |  How to cite  | 


The aim and objective of this article is to analyze the published literature on the replacement time of ocular prostheses in children. A systematic search of Indexed English literature up to November 31, 2020, was conducted. Data from PubMed, Scopus, and Cochrane library were searched for relevant manuscripts. Predefined inclusion and exclusion criteria were used by assessors, who inspected 910 manuscripts and selected 7 manuscripts, after analyzing their full texts. Because of the constant growth of the orbital socket in children, the ocular prosthesis has to be replaced till the growth of the orbit is complete. Custom ocular prosthesis requires recurrent relining or replacement, in growing children. The rate of relining or replacement of the prosthesis varies according to the growth of the orbit. Children with ocular prostheses should be appointed biannually or quarterly for routine examination. Yearly replacement or relining of the prosthesis should be conducted. Various factors, like patient comfort, age, signs, and clinical assessment, should be evaluated before relining or replacing the old prosthesis.



Basavaraj S Nimbeni, Darshan Devang Divakar

Role of Chitosan in Remineralization of Enamel and Dentin: A Systematic Review

[Year:2021] [Month:July-August] [Volume:14] [Number:4] [Pages:7] [Pages No:562 - 568]

Keywords: Casein phosphopeptide-amorphous calcium phosphate, Chitosan, Demineralization, Dental caries, Fluorides, Remineralization

   DOI: 10.5005/jp-journals-10005-1971  |  Open Access |  How to cite  | 


Aim and objective: The purpose of this research was to analyze the role of chitosan in the remineralization of enamel and dentin. Materials and methods: An electronic search was done for articles published from January 2009 to January 2020. A manual search was done from bibliographies of selected articles for relevant articles that were unexplored. Only in vitro studies conducted on the application of chitosan for remineralization of enamel and dentin were included in the study. Results: Of the 162 articles that were searched, only 15 in vitro studies were selected for the study. These studies met the inclusion criteria and were published from January 2009 to January 2020. Conclusion: The review provides insight into the mechanism of remineralization of enamel and dentin. The properties of chitosan make it an ideal biomaterial that can be employed in the formulation of a novel remineralizing gel. However, more in vivo studies, clinical trials, and research are essential to transform chitosan-based remineralizing gels from research to clinical use. Clinical significance: This review article opens a new window of opportunities for remineralizing enamel and dentin which have been long considered a challenging job.



Vijay Yadav

Diagnostic and Treatment Approach in the Management of Dental Anomalies Associated with Stevens–Johnson Syndrome: A Case Report

[Year:2021] [Month:July-August] [Volume:14] [Number:4] [Pages:6] [Pages No:569 - 574]

Keywords: Cone-beam computed tomography, Differential diagnosis, Impaction, Short root anomaly, Stevens–Johnson syndrome, TAD

   DOI: 10.5005/jp-journals-10005-1986  |  Open Access |  How to cite  | 


Background: Stevens–Johnson syndrome is a rare medical condition with severe mucocutaneous lesions due to adverse drug reactions characterized by exudative multiform erythema, stomatitis, and conjunctivitis. Long-term oral consequences of such cases include xerostomia, caries, impactions, and multiple dental developmental aberrations as short root anomalies. Aim and objective: To highlight the role of pedodontist in early diagnosis and treatment planning of dental abnormalities due to Stevens–Johnson syndrome (SJS) using a cone-beam computed tomography (CBCT). Case description: A 16-year-old male reported a chief complaint of decayed posterior teeth. Past medical history revealed adverse reactions to an unknown drug at the age of 4 to 5 years. In addition to carious teeth, clinical examination revealed that all canines were missing along with mandibular incisors. On CBCT examination, abnormal short, plump roots with normal crown were seen in all permanent first molars and incisors along with impacted canines and mandibular incisors. This condition was diagnosed as a “Short root anomaly” (SRA) due to SJS. He was found positive to allergy tests for NSAIDs such as ibuprofen and paracetamol. Conclusion: NSAIDs can cause a severe adverse reaction resulting in SJS. If this hypersensitivity reaction occurs early during the development of a permanent tooth it may cause dental anomalies such as short roots, root dysmorphia, agenesis, and multiple impacted teeth. Clinical significance: This report highlights a unique case of multiple dental aberrations due to SJS and the role of a pedodontist in the early diagnosis and treatment planning of such cases with the help of CBCT. Short root anomalies can be misdiagnosed as root resorption or immature apex. Medical history, clinical and CBCT findings are essential for diagnosis and treatment in SJS patients. Careful orthodontic treatment planning is required in cases of short root anomalies.



Sunita Gupta, Chetna Chaudhary, Prerna Singh, Ridam Sharma

Novel Treatment Approach of Oral Submucous Fibrosis in a 6-year-old Girl: A Case Report

[Year:2021] [Month:July-August] [Volume:14] [Number:4] [Pages:5] [Pages No:575 - 579]

Keywords: Areca nut, Oral Fibrosis, Oral submucous fibrosis, Pediatric

   DOI: 10.5005/jp-journals-10005-1999  |  Open Access |  How to cite  | 


Background: Oral submucous fibrosis is characterized by stiffness of oral mucosa, blanching and functional limitation, and areca nut predisposition is considered to be one of the main etiological factors. In recent years, there is an increasing prevalence of OSMF in the Indian subcontinent owing to increased consumption of smokeless tobacco products. Very few cases of pediatric OSMF are reported in PubMed literature. Oral submucous fibrosis has a malignant transformation rate of 7–13% and hence, it is important to intervene at an appropriate stage and manage it well in time. Aim and objective: To report a case of oral submucous fibrosis (OSMF) in a 6-year-old Indian girl along with its management and follow-up. Case description: A 6-year-old girl of Indian origin was diagnosed with OSMF and we have used sesame oil pulling as a novel treatment approach and observed good results with long-term follow-up. We have also reviewed PubMed literature for cases of pediatric OSMF reported till date. Conclusion: A timely diagnosis and intervention becomes necessary in pediatric OSMF to improve oral function and prevent malignant transformation. Clinical significance: It is important to report oral potentially malignant disorder (OPMD) cases in pediatric patients and create awareness through health education programs so that parents and children know about the ill effects of consuming tobacco products.



R Bhavyaa

Glanzmann Thrombasthenia: Use of the Soft Splint with Tranexamic Acid Paste to Reduce Spontaneous Oral Bleeding

[Year:2021] [Month:July-August] [Volume:14] [Number:4] [Pages:6] [Pages No:580 - 585]

Keywords: Glanzmann thrombasthenia, Oral bleeding, Soft splint, Tranexamic acid

   DOI: 10.5005/jp-journals-10005-1973  |  Open Access |  How to cite  | 


Background: Glanzmann thrombasthenia is a rare bleeding disorder due to defects in the glycoprotein Ilb/IIIa complex present on the platelet membrane. The most common mode of treatment for this disorder is platelet transfusion. However, scientific evidence does state that repeated transfusions could lead to auto immunization making transfusions ineffective. Aim and objective: To describe the use of a novel technique of soft splint with tranexamic acid paste to stop oral bleeding in a patient with Glanzmann thrombasthenia (GT). Case description: A 7-year-old female patient with a known history of GT was referred to the pediatric department. The chief complaint of the patient revealed a history of spontaneous bleeding from the oral cavity. The patient required multiple teeth extractions due to severely carious teeth. History revealed that the patient was admitted to the hospital (casualty) three times within 1 month due to a similar complaint leading to hypovolemic shock. Several transfusion procedures were done to stop the spontaneous bleeding. To stop the intraoral bleeding without transfusions, a novel method of using a soft splint with tranexamic acid paste (500 mg tablet crushed and mixed with saline) in the area of spontaneous bleeding was employed with a successful follow-up of 7 months. Conclusion: Soft splint with the tranexamic acid paste can serve as an effective method of treatment for patients with spontaneous oral bleeding due to medical conditions like GT. Clinical relevance: This case report highlights the need for awareness among all the healthcare providers about the importance of regular dental visits. The healthcare providers also need to emphasize the same to all patients with medical conditions to avoid such life-threatening situations.



Varsha Bhat, Vidya S Bhat, Jamsheera Vadakkan, Sanath Shetty, Sundeep K Hegde

Prosthodontic Management of Congenital Hypothyroidism with Anodontia: A Case Report

[Year:2021] [Month:July-August] [Volume:14] [Number:4] [Pages:4] [Pages No:586 - 589]

Keywords: Anodontia, Congenital hypothyroidism, Pediatric prosthodontics

   DOI: 10.5005/jp-journals-10005-1994  |  Open Access |  How to cite  | 


Thyroid dysfunction has various manifestations which include orofacial abnormalities like delayed eruption, retained deciduous teeth, etc. Early detection of this deregulation of thyroid homeostasis can prevent associated complications. This report is a case of congenital hypothyroidism (CH) in a 4-year-old boy who presented with a completely edentulous maxilla and hypodontic mandible. Based on various biochemical and radiographic investigations, a diagnosis of CH was established. He was prosthodontically rehabilitated with removable dentures.



Divya Jyoti, Jeevendra N Shukla, Aparna Singh, Sulekha

Modified RURS Elbow Guard: An Alternative Approach for Thumb Sucking

[Year:2021] [Month:July-August] [Volume:14] [Number:4] [Pages:3] [Pages No:590 - 592]

Keywords: Digit sucking, Habit breaking appliance, Modified RURS elbow guard, RURS elbow guard

   DOI: 10.5005/jp-journals-10005-1993  |  Open Access |  How to cite  | 


Digit sucking or thumb sucking is one of the most common habits usually seen in children. These habits habitually lapse in mid-childhood. The continued persistence of these habits will bring about harmful unbalanced pressures to alveolar ridges, changes in the position of teeth, and occlusion which may result in abnormality if they are continued for a long time. This case report presents a case of a 5-year-old male child patient with a habit of thumb sucking that was successfully ceased by a modified RURS elbow guard appliance.



Dipti Chawla

Management of Root Perforation due to Internal Resorption: A 1-year Follow-up Study

[Year:2021] [Month:July-August] [Volume:14] [Number:4] [Pages:3] [Pages No:593 - 595]

Keywords: Inflammatory root resorption, Mineral trioxide agglomerate, Replacement resorption, Resin-modified glass ionomer cement, Surgical management

   DOI: 10.5005/jp-journals-10005-1992  |  Open Access |  How to cite  | 


Diagnosing tooth resorption is critical for effective management. Internal resorption is a rare phenomenon, presenting with a pathognomonic clinical sign of a “pink spot” in the crown. In case of infection-induced tooth resorption, endodontic therapy needs to be carried out to decrease bacterial load within the pulp space and facilitate repair of resorbed tooth structure. Following inflammation of the pulpal tissue, clastic cells infiltrate the pulp chamber along with physiological blood supply and thereby initiate the process of internal tooth resorption. Tooth resorption involves two phases: an initial injury phase and the subsequent stimulation phase. The injury phase pertains to the pulpal tissue getting injured by a noxious stimulus, whereas stimulation is caused by the infection present in the vicinity of the tooth. Additionally, in a case where the resorption is caused due to trauma, a multidisciplinary approach becomes imperative so that the long-term solution is achieved. This paper presents a case with internal resorption with a poor prognosis. However, surgical intervention was made to preserve the tooth until a definitive procedure can be instituted.



Amol Kamble, Manasi R Shimpi, Jayant K Dash, Shweta Chaudhary, Minu Doiphode

Adenomatoid Odontogenic Tumor of the Maxilla in a 13-year-old Patient: A Rare Case Report with a Review of Literature

[Year:2021] [Month:July-August] [Volume:14] [Number:4] [Pages:5] [Pages No:596 - 600]

Keywords: Adenomatoid odontogenic tumor, Jaw, Maxilla, Neoplasm, Odontogenic, Tumor

   DOI: 10.5005/jp-journals-10005-1771  |  Open Access |  How to cite  | 


Background: The AOT is an atypical tumor of odontogenic origin that comprises about 0.1% of jaw tumors and cysts as well as up to 3% of odontogenic tumors (OTs). Aim and objective: This review describes the clinical, radiographical, histopathological, and immunohistochemical properties of adenomatoid odontogenic tumor (AOT) and reports an occurrence of an AOT in a boy, 13 years of age. Case description: A male, 13 years of age, presented with a swelling with respect to the left maxilla, painless, and with obvious facial asymmetry. The orthopantomogram and computed tomography scan revealed a large unilocular radiolucency in the left maxilla with permanent lateral incisor embedded within the lesion and permanent canine pushed away from its normal position. After complete enucleation of the cyst under local anesthesia and extraction of associated impacted permanent teeth and retained deciduous teeth related to the lesion, the defect was filled with a bone graft and closed. Postoperative follow-up was uneventful. Conclusion: An accurate diagnosis should be established through clinical, radiographical, and pathological correlations in order to be able to differentiate AOT from other conditions for early diagnosis. Clinical significance: This report highlights the salient features of the AOT to be able to correctly diagnose and manage the lesion.


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