International Journal of Clinical Pediatric Dentistry

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2022 | November-December | Volume 15 | Issue 6

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Sagar D Misal, Prasanna T Dahake, Mukul Jain

Comparison of Cariostatic and Remineralizing Potential of Two Commercial Silver Diamine Fluoride Preparations Using Confocal Laser Microscopy and EDX-SEM Spectroscopy: An In Vitro study

[Year:2022] [Month:November-December] [Volume:15] [Number:6] [Pages:9] [Pages No:643 - 651]

Keywords: Confocal laser scanning microscopy, Dental caries, Fluoride, Silver diamine fluoride, X-ray emission spectroscopy

   DOI: 10.5005/jp-journals-10005-2454  |  Open Access |  How to cite  | 


Aim: To investigate the cariostatic and remineralizing effect of two commercial silver diamine fluoride (SDF) preparations on enamel and dentinal caries using a bacterial plaque model. Materials and methods: A total of 32 extracted primary molars were divided into two groups (n = 16), group I (FAgamin), and group II (SDF). Plaque bacterial model was used to induce caries on enamel and dentin. Preoperative evaluation of samples was done using confocal laser microscopy (CLSM) and energy-dispersive X-ray spectroscopy-scanning electron microscope (EDX-SEM). All samples were treated with test materials and evaluated for postoperative remineralization quantification. Results: Energy-dispersive X-ray spectroscopy (EDX) revealed that mean preoperative levels (in weight %) of silver (Ag) and fluoride (F2) in carious enamel lesions were 0.0 and 0.0, which increased postoperatively to 11.40 and 31.05 for FAgamin and 13.61 and 31.87 for SDF, respectively. For dentinal caries, EDX revealed mean preoperative levels (in weight %) of Ag and F2 were 0.0 and 0.0, which increased to 11.47 and 48.71 for FAgamin and 10.16 and 47.82 for SDF, respectively postoperatively. Both the groups showed evident demineralization with exposed collagen under SEM. The mean value of enamel lesion depth for the group I and II were 38.64 and 39.30 µm, that reduced to 28.02 and 28.70 µm while for dentinal caries, the mean depth from 38.05 and 38.29 µm that reduced significantly to 28.96 and 30.10 µm, respectively (p < 0.001). Caries depth declined significantly after the application of both FAgamin and SDF (p < 0.001). Conclusion: FAgamin and SDF show similar cariostatic and remineralization potential for dental caries. The bacterial plaque model used in this study is an efficient method to induce artificial carious lesions in teeth. Clinical significance: A comparative evaluation of these two cariostatic and remineralizing agents will aid in identifying the efficacy of both commercial products in treating initial caries lesions in an effective noninvasive and child-friendly manner.



Siji Elizabeth, Saumya Paul, Megha Chawla

Impact on Quality of Life and Risk Factors Associated with Visible Maxillary Incisors Trauma among Young Children in Faridabad, Haryana

[Year:2022] [Month:November-December] [Volume:15] [Number:6] [Pages:8] [Pages No:652 - 659]

Keywords: Aesthetics, Child-oral impacts on daily performances, Dental trauma, Traumatic dental injury

   DOI: 10.5005/jp-journals-10005-2433  |  Open Access |  How to cite  | 


Aim: To assess the impact of upper incisor trauma on the quality of life (QoL) in young children studying between the age group 8 and 13 years in Faridabad, Haryana. Materials and methods: A cross-sectional, prospective study was conducted to assess the visible permanent maxillary incisor traumas according to the classification of traumatic dental injuries (TDI) and to determine the predisposing risk factors that affect TDI and their impact on QoL in children aged 8–13 years. Questionnaires were made to gather information on demographic and socioeconomic characteristics like age, gender, and the father's and mother's education. Data on dental caries in anterior teeth were also collected using current World Health Organization criteria. Result: There were a total of 66 males and 24 females. The total decayed, missing, and filled permanent teeth (DMFT) prevalence observed was 8.9%. The main reason for trauma was found to be an accident or accidental fall (36.7%). The most common place for trauma followed by road (21.1%). Time lapsed from the injury reported was >1 year in males (34.8%), while it was within 1 year (41.7%) in females (p = 0.014). The most prevalent and impacted performance was smiling (80.0%; m = 8.7778 ± 8.658), and the least affected was speaking (4.4%; m = 0.5111 ± 3.002). Conclusion: A number of risk factors need to be considered when assessing TDIs, as TDIs can have a negative impact on the functional, social, and psychological well-being of young children. As they are frequent in children, affecting teeth, their supporting structures, and adjacent soft tissues, they may cause both functional and esthetic problems. Clinical significance: When injuries to incisor(s) produce pain, disfigurement, poor aesthetics, or other psychological effects, children may avoid laughing or smiling, and this can affect their social relationships. So, it is important to address the risk factors that predispose upper front teeth to TDIs.



Hitaf Nasrallah, Balsam Noueiri

Biodentine™ Pulpotomy in Stage I Primary Molars: A 12-month Follow-up

[Year:2022] [Month:November-December] [Volume:15] [Number:6] [Pages:7] [Pages No:660 - 666]

Keywords: Apical closure, Biodentine™, Primary teeth, Pulpotomy, Root edification

   DOI: 10.5005/jp-journals-10005-2400  |  Open Access |  How to cite  | 


Aim: This study aims to evaluate, over 12 months of clinical and radiographic follow-ups, the performance and outcomes of Biodentine™ pulpotomy in stage I primary molars. Materials and methods: A total number of 20 stage I primary molars requiring pulpotomy were selected from eight healthy patients aged between 34 and 45 months. Patients presenting a negative attitude toward dental treatment on the dental chair were scheduled for dental treatments under general anesthesia. Pulpotomy with Biodentine™ as a pulp-dressing material was performed on all selected molars. The patients were called back at 1 and 3 months for clinical follow-ups, then at 6 and 12 months for clinical and radiographic follow-ups. Data were tabulated according to follow-up intervals and occurrence of any changes in root maturation, pulp canal obliteration (PCO), periodontal ligament space (PLS), and bone or root lesion. Results: No statistically significant differences were recorded at 1, 3, 6, and 12 months. There was a statistically significant increase in number of roots with closed apices from six roots at 6 months to 50 roots at 12 months (p < 0.0005) and the PCO was present in all 50 roots at 12 months, after it was present in 36 roots only at 6 months (p = 0.0001). Conclusion: This is the first randomized clinical trial that evaluates the performance of Biodentine™ as a pulp-dressing agent in stage I primary molar pulpotomy over 12 months of follow-up. Contrary to previous studies, the present work highlights the continued root formation and apical closure (AC) in pulpotomized immature primary molars.



Susan Kattimani, Navin Hadadi Krishnamurthy

Knowledge about the Harmful Effects of Environmental Tobacco Smoke, Perceptions toward Initiation of Smoking and Factors Influencing Smoking in Adolescents: A Cross-sectional Study

[Year:2022] [Month:November-December] [Volume:15] [Number:6] [Pages:5] [Pages No:667 - 671]

Keywords: Adolescents, Environmental tobacco smoke, Factors affecting smoking, Knowledge, Parents

   DOI: 10.5005/jp-journals-10005-2467  |  Open Access |  How to cite  | 


Background: The main hope of a nation lies in the proper education of its adolescents because the youths of today are the leaders of tomorrow. About 15% of children of ages 13–15 years are ingesting tobacco in certain forms and are getting addicted to tobacco. Hence, tobacco has become a burden in our society. Similarly, environmental tobacco smoking (ETS) is more dangerous than smoking and is common among young adolescents. Aim: This study is aimed to explore the knowledge about the hazards of ETS and the factors which are responsible for adolescents to initiate tobacco smoking among parents visiting the pediatric dental clinic. Materials and methods: A cross-sectional survey on the knowledge about the harmful effects of ETS and factors influencing the initiation of tobacco use among adolescents was assessed using a self-administered questionnaire. A sample size of 400 parents of adolescents aged between 10 and 16 years visiting the pediatric clinics was included in the study; data thus obtained was subjected to statistical analysis. Results: The effect of ETS in increasing the risk of cancer was known to be 64.4%. But the effect on premature babies was least known by 37% of the parent population, which is statistically significant. About 14% of parents perceive that children initiate smoking to experiment or relax, which is statistically significant. Conclusion: Parents have very little knowledge regarding the effects of ETS on children. They can be counseled regarding types of smoking and smokeless tobacco products, health hazards, the deleterious health effects of ETS, and passive smoking, particularly in children with respiratory diseases.



Aruna P Vishwakarma, Prashant Bondarde, Prashanthkumar Vishwakarma, Arun S Dodamani, Shoeb Mujawar, Sandesh Bansal

Evaluation of Fluoride Uptake of Two Fluoride Varnishes into and onto the Enamel Surface at Different Temperatures: An In Vitro Study

[Year:2022] [Month:November-December] [Volume:15] [Number:6] [Pages:8] [Pages No:672 - 679]

Keywords: Enamel surface remineralization, Fluoride uptake, Fluoride varnish, Potassium hydroxide insoluble fluoride, Potassium hydroxide soluble fluoride, Temperature

   DOI: 10.5005/jp-journals-10005-2449  |  Open Access |  How to cite  | 


Background: Fluoride (F) is an effective anticaries agent and can be delivered through various mediums at different concentrations. The ability to increase the enamel resistance to acid by decreasing solubility through the incorporation of F into the enamel apatite structure is the primary function of these agents. The efficacy of topical F can be determined by measuring the amount of F incorporated in and on human enamel. Aim: To compare the F uptake into and onto the enamel surface of two different F varnishes at different temperatures. Materials and methods: In this study, 96 teeth were divided equally and randomly (n = 48) into two experimental groups (group I and group II). Each group was further divided into four equal subgroups (n = 12); depending on the temperature (25°, 37°, 50°, and 60°C) they were subjected to Fluor-Protector® 0.7% and Embrace® 5% F varnishes were allocated to experimental groups I and II, respectively, and every sample was individually treated with the assigned F varnish. After the varnish application, two specimens from each subgroup, the group I and group II (n = 16), were mounted for hard tissue microtome sectioning for scanning electron microscope (SEM) analysis. The remaining 80 teeth underwent potassium hydroxide (KOH) soluble and KOH-insoluble F estimation. Results: Group I and group II, both, showed maximum F uptake of 2817.07 ppm and 1626.8 ppm at 37°C temperature and the lowest of 1168.9 ppm and 1068.93 ppm at 50°C, respectively. The intergroup comparison was carried out using an unpaired t-test and the intragroup comparison was done using one-way analysis of variance (ANOVA) univariate analysis. Post hoc Tukey test was performed for pairwise comparison between different temperature groups. In group I (Fluor-Protector®), the difference in F uptake was statistically significant when the temperature was increased from 25° to 37° C (mean difference = −9.90, p = 0.016). In group II (Embrace®), a statistically significant difference in F uptake was observed when the temperature was increased from 25° to 50°C (mean difference = 10.00, p = 0.003) and 25° to 60°C (mean difference = 13.38, p = 0.001), respectively. Conclusion: Fluor-Protector® varnish proved to have better F uptake in comparison to Embrace® varnish on human enamel. Topical F varnishes were most effective at 37°C, which is close to the standard human body temperature. Thus, the application of warm F varnish ensures more uptake of F in and onto the enamel surface for greater protection against dental caries.



Gauri Vijaykumar Rathi, Dimple Padawe, Vilas Takate, Kishor Dighe, Kshitija K Bansode, Ajinkya U Narwade

Comparative Evaluation of Ease of Dental Treatment and Clinical Efficiency of Midazolam vs Midazolam and Ketamine Combination for Sedation in Young Uncooperative Pediatric Patients: A Systematic Review

[Year:2022] [Month:November-December] [Volume:15] [Number:6] [Pages:7] [Pages No:680 - 686]

Keywords: Clinical efficiency, Ease of dental treatment in uncooperative children, Midazolam, Midazolam and ketamine combination

   DOI: 10.5005/jp-journals-10005-2456  |  Open Access |  How to cite  | 


Aim: To assess and compare the effectiveness of midazolam vs midazolam and ketamine combination in the management of young uncooperative pediatric patients. Materials and methods: The research question was developed by using population, intervention, comparison, outcome, and study design framework. The literature search was performed using three electronic databases: PubMed, Scopus, and EBSCOhost. The risk of bias of the studies was independently appraised using the Cochrane Handbook for Systematic Reviews of Interventions. Results: Out of 98 preliminary records, five studies were selected for analysis. Three hundred forty-six uncooperative children were randomized through the five randomized controlled trials (RCTs), with a mean age of 5.8 years. Midazolam with ketamine was the most successful combination for delivering rapid and sufficient analgosedation in uncooperative children. The clinical efficiency of midazolam and ketamine combination had an overall success rate of 84% when compared to ketamine and midazolam alone. 50% of children in the midazolam and ketamine group demonstrated calm behavior, compared to 37% in the midazolam group. 44% of the children experienced modest intra and/or postoperative adverse effects that did not necessitate any special treatment. Conclusion: Midazolam and ketamine combination is more efficient than midazolam alone with respect to ease of treatment and clinical efficiency.



Lakshimi Lakshmanan

Microbial Evaluation of Root Canals after Biomechanical Preparation with Manual K-files, Manual H-files, and Kedo-SG Blue Rotary Files: An In Vivo Study

[Year:2022] [Month:November-December] [Volume:15] [Number:6] [Pages:4] [Pages No:687 - 690]

Keywords: Biomechanical preparation, Kedo files, Manual files, Microbial, Rotary files

   DOI: 10.5005/jp-journals-10005-2457  |  Open Access |  How to cite  | 


Aim: The purpose of the present study was to comparatively evaluate the efficacy of Kedo-SG blue rotary files, manual K-files, and manual H-files in eliminating the root canal microflora of primary molars. Materials and methods: Forty-five primary molars requiring pulpectomy were included in the study. Based on type of instrumentation, the teeth were randomly assigned to one of the three groups: group A: Kedo-SG blue rotary files, group B: manual H-files, and group C: manual K-files. Sterile absorbent paper points were used for sample collection and stored in sterile Eppendorf tubes containing saline as transport medium. Culturing was done on thioglycolate agar and blood agar media for the cultivation of anaerobic and aerobic microbes, respectively, and recorded as colony-forming units (CFU) using digital colony counter. Wilcoxon signed-rank test and one-way analysis of variance (ANOVA) test were performed for statistical analysis. Results: Postinstrumentation, 93–96% reduction of aerobic and anaerobic microbial count was recorded in group A. Whereas, it was 87–91% reduction in group B and 90–91% reduction in group C. No statistically significant difference was noted between the three groups. Conclusion: Kedo-SG blue rotary files showed a better reduction of microbes in root canals when compared to manual instrumentation. However, there was no significant difference between manual and rotary instrumentation in microbial reduction of primary root canals.



Manuela GSES Silveira, Bruna C Schneider, Thais FF Tillmann, Alexandre ER Silva

Excess Weight and Dental Caries throughout Childhood and Adolescence: Systematic Review of Longitudinal Studies

[Year:2022] [Month:November-December] [Volume:15] [Number:6] [Pages:8] [Pages No:691 - 698]

Keywords: Adolescent, Child, Dental caries, Longitudinal studies, Obesity

   DOI: 10.5005/jp-journals-10005-2458  |  Open Access |  How to cite  | 


Objective: The aim of the present study was to analyze existing scientific evidence on the longitudinal association between overweight/obesity and dental caries in children and adolescents and indicate possible gaps in the literature to guide future studies. Study design: A systematic search of the literature was performed for the identification of longitudinal studies on this issue. The search strategy included words related to the outcome (dental caries), exposure (overweight/obesity), population (children and adolescents), and study design (longitudinal) of interest. Searches were performed in the PubMed, Web of Science, and Latin American and Caribbean Health Sciences Literature (LILACS) databases. The risk of bias in the studies was appraised using the tool for the critical analysis of cohort studies proposed by the Joanna Briggs Institute. Results: Among the 400 studies retrieved from the databases, only seven met the inclusion criteria and were selected to compose the present review. Five of the studies had a low risk of bias, but all had methodological flaws. As the studies reported different findings, the association between obesity and dental caries continues to be undefined. Moreover, there is a lack of well-designed studies on this issue with standardized methods to enable comparisons. Conclusion: Future studies should consider longitudinal designs, more precise diagnostic methods for obesity and dental caries, as well as the rigorous control of confounding factors and effect modifiers.



Samhita Bijlani, Raghavendra Shanbhag

An In Vitro Evaluation of Ice Apple as a Novel Storage Medium to Preserve the Viability of Human Periodontal Ligament Fibroblasts

[Year:2022] [Month:November-December] [Volume:15] [Number:6] [Pages:5] [Pages No:699 - 703]

Keywords: Cell survival, Ice apple, Periodontal ligament fibroblasts, Storage media, Tooth avulsion

   DOI: 10.5005/jp-journals-10005-2468  |  Open Access |  How to cite  | 


Aim: For a better prognosis of an avulsed tooth, it is important to store it in an appropriate storage medium prior to replantation. The purpose of this study was to evaluate the ability of ice apples to preserve the viability of periodontal ligament (PDL) fibroblasts. Materials and methods: Periodontal ligament (PDL) fibroblasts were procured from the roots of healthy premolars and cultured in Dulbecco's Modified Eagle's Medium (DMEM). They were preserved with—ice apple water (IAW), 30 and 10% ice apple fruit pulp extract (IAFPE), DMEM, negative control without any agent, and positive control DMEM supplemented with fetal bovine serum (FBS). Culture plates were incubated with investigational media at 37°C for 1, 3, and 24 hours. Each experiment was repeated thrice. Assessment of cell viability was done using 3-(4,5-dimethylthiazol-2-yl)—2,5-diphenyltetrazolium bromide tetrazolium reduction (MTT) assay. After every test period, storage media was removed; 60 µL of MTT solution was added to each well and incubated for 3 hours at 37°C. The supernatant was aspirated and the formazan blue crystals formed were solubilized using dimethyl sulphoxide (DMSO) (100 µL). Optical density was measured at a wavelength of 490 nm. The effects of the test storage media at each time period were evaluated by a one-way analysis of variance (ANOVA) test, and this was followed by post hoc Tukey's multiple comparison tests (p < 0.05). Results: A total of 10% IAFPE demonstrated the maximum capacity to maintain PDL cell viability in all three test periods (p = 0.001). Among the different forms of ice apple used in this study, IAFPE showed better results as compared to IAW (p = 0.001). Conclusion: Ice apple fruit pulp extract (IAFPE) at 10% concentration showed the maximum capacity to maintain PDL cell viability across all three test periods. Therefore, it can be considered a suitable alternative natural storage medium for avulsed teeth. However, further, more detailed studies are required in this field.



Jaikiran Kaur, Sanguida Adimoulame

Anxiety Rating Scale for Speech and Hearing-impaired Children

[Year:2022] [Month:November-December] [Volume:15] [Number:6] [Pages:3] [Pages No:704 - 706]

Keywords: Anxiety assessment scale, Dental anxiety, Hearing-impairment, Pediatric dentistry, Speech impairment

   DOI: 10.5005/jp-journals-10005-2459  |  Open Access |  How to cite  | 


Background: It has been observed that children with special healthcare needs exhibit higher dental anxiety levels because of various barriers. In the literature, there is no anxiety assessment scale for speech and hearing-impaired children. A new concept of pictorial representation of common emotions observed during dental treatment was used to design an innovative scale, thereby helping to improve communication and in bringing out positive behavior among the children. This study aimed to assess and validate the efficacy of an anxiety rating scale for speech and hearing-impaired children. Materials and methods: A total of 36–12-year-old children with speech and hearing impairments from a special school were selected for this study. The pretreatment anxiety score among the children was assessed using the pictorial anxiety rating scale. Results: The anxiety rating scale was well accepted by speech and hearing-impaired children. It was well-supported by expert opinions and equal distribution of anxiety scores. Conclusion: The pictorial scale is a valid anxiety assessment scale for measuring dental anxiety among speech and hearing-impaired children. It can be used independently to assess dental anxiety in clinical settings and epidemiological studies as well.



Anju Vinod, Sunil N Raj, Anitha Anand, Arjun Dilip Shirly

Dental Considerations for the Treatment of Patients with Morquio Syndrome

[Year:2022] [Month:November-December] [Volume:15] [Number:6] [Pages:4] [Pages No:707 - 710]

Keywords: Morquio syndrome, Mucopolysaccharidosis, Oral health needs, Treatment implications

   DOI: 10.5005/jp-journals-10005-2451  |  Open Access |  How to cite  | 


Aim: Morquio syndrome, also called Mucopolysaccharidosis IV (MPS IV), is a rare autosomal recessive metabolic lysosomal disorder that results in the deposition of glycosaminoglycans (GAGs) in various tissues and organs, resulting in an array of signs and symptoms. The aim of the study was to systematically record the clinical features with a special emphasis on oral manifestations of patients diagnosed with MPS IV and asses the dental treatment implications of the disease manifestations. Materials and methods: A cross-sectional study was conducted on patients diagnosed with MPS IV (n = 26). A complete clinical and oral examination was done and the findings were systemically recorded. Results: The study showed that the patients diagnosed with MPS IV have multiple treatment challenges owing to the range of disease manifestations. Furthermore, they have higher oral health care needs because of the anatomical and pathological changes. Conclusion and clinical significance: Dental professionals must be aware of the implications of the disease manifestation and their accompanying challenges while treating patients with MPS IV. The oral health needs are higher for these patients and regular dental evaluation and treatment must be incorporated into their health care regimen.



Rafif A Mandura, Moaz H Attar, Rana A Alamoudi, Amal O Dafar, Mona T Rajeh, Rayyan A Kayal, Najat M Farsi

Assessment of Oral Hygiene, Gingival, and Periodontal Health, and Teeth Eruption among Type 1 Diabetic Saudi Children

[Year:2022] [Month:November-December] [Volume:15] [Number:6] [Pages:6] [Pages No:711 - 716]

Keywords: Case-control study, Children, Dental health, Diabetes mellitus, Periodontal health, Tooth eruption

   DOI: 10.5005/jp-journals-10005-2462  |  Open Access |  How to cite  | 


Aims and objectives: To determine the differences between type 1 diabetic children and healthy children regarding oral hygiene, gingival and periodontal health, and permanent teeth eruption. Materials and methods: A case-control study was conducted on 80 children (40 type 1 diabetic children and 40 healthy children) aged 6–12-year-old. The groups were further divided into subgroups (early and late mixed dentition). All study aspects were examined clinically using the simplified oral hygiene index, Löe and Silness gingival index, clinical attachment loss (CAL), and Logan and Kronfeld stages for tooth eruption. The data were analyzed using Fisher's exact test, chi-squared test, and logistic regression models. A p-value of ≤0.05 was the threshold for statistical significance. Results: No significant difference was found between diabetic and healthy children regarding oral hygiene and gingival health. Most children had poor oral hygiene (52.5% in the case group and 60% in the control group), with fair gingival health (70% in the case group and 55% in the control group). Diabetic children had significantly (p = 0.05) more periodontitis than healthy children. Teeth in the advanced stage of the eruption were significantly higher in diabetic than control subjects (p = 0.048 in stage V and p = 0.003 in stage VI). Older diabetic children in late mixed dentition exhibited accelerated eruption. Conclusion: Periodontitis was significantly more common in diabetic than in healthy children. The advanced stage of the eruption was significantly higher in diabetic than in control subjects. Clinical significance: Type 1 diabetic children had more periodontal disease and advanced stage of permanent teeth eruption compared to healthy children. Therefore, periodic dental evaluation and a strong preventive plan for diabetic children is crucial.



Roberto Ferro, Alberto Besostri, Armando Olivieri, Luca Benacchio

Early Childhood Caries in a Preschool-based Sample in Northeast Italy: Socioeconomic Status and Behavioral Risk Factors

[Year:2022] [Month:November-December] [Volume:15] [Number:6] [Pages:7] [Pages No:717 - 723]

Keywords: Early childhood caries, Preschool children, Prevalence, Risk factors, Toothbrushing

   DOI: 10.5005/jp-journals-10005-2469  |  Open Access |  How to cite  | 


Aim: To assess the relationship among caries and age, gender, immigrant condition, socioeconomic status (SES), and a behavioral risk factor (toothbrushing) in a sample of 3–5-year-old children. Materials and methods: We performed a random cross-sectional survey from January to December 2017, carrying out clinical examinations to estimate the decayed, missing, and filled teeth (dmft) score. Parents filled in a questionnaire reporting their education level (SES) and the daily frequency of children's toothbrushing. The multivariate analysis assessed the association between caries occurrence and the independent variables. The dmft score was assessed by zero-inflated negative binomial regression (ZINBR). Results: Out of 1,441 children in the sample, 357 (26.0%) presented at least one caries-affected tooth. Caries risk significantly increased with age and irregular toothbrushing, and it was significantly higher in children with lower SES levels. We modeled caries risk by means of ZINBR. The degree of caries experience increased in children from lower SES positions, immigrant status, and of older age; regular toothbrushing (twice a day) is a predicting factor to belong to the “zero caries” group. Conclusion: Dental caries represent a significant burden in preschool children and can be regarded as an early marker of social disadvantage. Clinical significance: The confirmation of the earliest preventive approach as the only chance to grant a “caries free” dentition in all ages and the first target for a pediatric dentist.



K Kiran, Bhargavi Vojjala, Priya Subramaniam

Comparison of Clinical Efficacy of Glass Ionomer-based Sealant Using ART Protocol and Resin-based Sealant on Primary Molars in Children

[Year:2022] [Month:November-December] [Volume:15] [Number:6] [Pages:5] [Pages No:724 - 728]

Keywords: Atraumatic restorative treatment sealant, Glass ionomer sealant, Pit and fissure sealants, Primary molars, Resin-based sealant

   DOI: 10.5005/jp-journals-10005-2450  |  Open Access |  How to cite  | 


Aim: The present in vivo study aims to evaluate and compare the clinical efficacy and survival rate of resin-based composite sealant (Clinpro Sealant, 3M ESPE, Irvine, California, United States of America) with high viscosity glass ionomer (GI) (Equia Forte, GC India, Patancheru, Telangana, India) using atraumatic restorative treatment (ART) sealant protocol in primary molars. Materials and methods: The design of the study was a clinical, prospective split-mouth study. A total of 100 contralateral primary molars were selected and divided into two groups. In group I, children received Equia Forte, and in group II, children received Clinpro Sealant. The follow-up examinations were performed in the 1st and 6th months. Simonsen's Criteria were used to check for retention. International Caries Assessment and Detection System II (ICDAS II) criteria were used to check for dental caries. The data obtained were subjected to statistical analysis. Results: At 6 months, there was no statistically significant difference between the groups with regard to retention and caries preventive effect. Conclusions: High-viscosity GI sealants can be applied using the ART protocol and provide an alternative to resin-based sealants. Clinical significance: There is a limited number of studies on the performance of ART sealants in primary molars. Thus, the clinical efficacy and survival rate of resin-based composite sealant (Clinpro Sealant, 3M ESPE, Irvine, California, United States of America) with high viscosity GI (Equia Forte, GC India, Patancheru, Telangana, India) using ART sealant protocol in primary molars were evaluated. The research concluded that high-viscosity GI sealants using ART protocol are effective sealants in primary molars.



Merlyn R Mathias, Vikas D Bendgude, Rashmi S Chauhan, Apurva Borde, Tripti Lath, Sejal S Shah

Comparative Fluoride Ion Release Pre and Postrecharge Situations among Three Different Pediatric Dental Restorative Materials: An In Vitro Study

[Year:2022] [Month:November-December] [Volume:15] [Number:6] [Pages:7] [Pages No:729 - 735]

Keywords: Acidulated phosphate fluoride gel, Fluoride release, Fluoride rerelease, Ion selective electrode

   DOI: 10.5005/jp-journals-10005-2461  |  Open Access |  How to cite  | 


Objectives: To determine the initial fluoride (F) release and rerelease after recharge of three pediatric dental restorative materials when aged in artificial saliva (M1) and deionized water (M2). Materials and methods: A total of 30 disks, 10 disks of each restorative material R1: Jen Rainbow, Jen Dent Ukraine; R2: Tetric® N-Flow, Ivoclar Vivadent, and R3: resin-modified glass ionomer cement (RMGIC) (Fuji II LC- GC Corporation) were fabricated and were tested for F dynamics in two different media, M1: artificial saliva, M2: deionized water group. The F initial release was measured on the 1st, 7th, 14th, 21st, and 30th day, and on the 31st day, acidulated phosphate F (APF) gel was applied and F rerelease was measured on the 31st, 37th, 44th, 51st, and 60th day using F ion-specific electrode (Orion). The result was statistically analyzed using two-way analysis of variance (ANOVA) and post hoc Bonferroni test. Results: Fluoride (F) ion release was significantly higher in deionized water than in artificial saliva (M1), and F ion rerelease (after recharge) was significantly higher in artificial saliva (M1). Fuji-II LC demonstrated a significantly (p < 0.05) higher F release and rerelease among all the tested materials. Among the tested composites, R2: Tetric® N-Flow exhibited significantly higher F dynamics than R1: Jen Rainbow composite. Conclusion: All the tested restorative materials exhibited optimum F release (0.024 ppm, that is, the range to prevent newer carious lesions) in both the pre and postrecharge conditions. Even though Fuji-II LC demonstrated significantly better F dynamics in the tested scenarios, Tetric® N-Flow has the additional advantage of improved mechanical retentive and esthetic properties along with the optimum F release in pre and postrecharge scenarios.



Aishwarya Senthilkumar, Chaya Chhabra, Mridula Trehan, Srinandan Pradhan, Sonal Yadav, Nabil Humayoon Shamsudeen

Comparative Evaluation of Fluoride Release from Glass Ionomer, Compomer, and Giomer Sealants Following Exposure to Fluoride Toothpaste and Fluoride Varnish: An In Vitro Study

[Year:2022] [Month:November-December] [Volume:15] [Number:6] [Pages:3] [Pages No:736 - 738]

Keywords: Dental sealants, Pit and fissure caries, Topical fluorides

   DOI: 10.5005/jp-journals-10005-2477  |  Open Access |  How to cite  | 


Introduction: Applying sealants to the deep pit and fissure area will be an excellent way to stop and slow down tooth caries from developing. Dental sealants that include fluoride are more successful at lowering dental cavities. It is anticipated that exposure to fluoride from dental sealants of various origins may enhance the fluoride release from dental sealants. Therefore, this study's objective was to investigate the amount of fluoride released after using fluoride toothpaste and fluoride varnish from different sealants. Materials and methods: Using only a fluoride ion selective electrode, the initial release of fluoride was detected every 24 hours for 15 days. After every measurement, the saliva was refreshed. The samples were split into three identical subgroups and given the respective regimes on the 15th day—subgroup A was given fluoride toothpaste every morning and evening, subgroup B was provided fluoride varnish once, and subgroup C was not given any fluoride regime at all. After another 15 days of fluoride exposure, the fluoride release was monitored. Results: With notable variations across groups over the initial 15 days, glass ionomer sealants (GIS) released more amount of fluoride, second by giomer sealant, and third by resin sealant (p = 0.00). All dental sealants that have been tested released more fluoride when using fluoride toothpaste, with giomer sealants surpassing GIS, followed by resin sealants (p = 0.00). Giomer and resin sealants, fluoride varnish treatment dramatically improves fluoride release in GIS (p = 0.00). Conclusion: The release of fluoride among all dental sealants is improved by using fluoride toothpaste daily and fluoride varnish just once.



Harvinder Singh, Mannu Khanna, Chanjyot Walia, Harjoy Khatria, Asiya Fatima, Navjot Kaur

Displacement Pattern, Stress Distribution, and Archwire Play Dimensions during En-masse Retraction of Anterior Teeth using Sliding Mechanics: A FEM Study

[Year:2022] [Month:November-December] [Volume:15] [Number:6] [Pages:6] [Pages No:739 - 744]

Keywords: En-masse retraction, Finite element model, Height of power arm, Play, Temporary anchorage devices

   DOI: 10.5005/jp-journals-10005-2463  |  Open Access |  How to cite  | 


Aims: This finite element study was undertaken to evaluate the pattern of stress distribution around the implant and anterior teeth during en-masse retraction in the premolar extraction case. Displacement of the teeth and play of wire in the bracket slot were also evaluated to determine the most favorable height of the power arm attached to the arch-wire. Materials and methods: A three-dimensional (3D) finite element model of the maxilla was constructed using computed tomography (CT) scan. A total of 12 models were fabricated with different heights of power arms placed distal to the canine. A retraction force of 1.5 N was applied from the implant placed between the roots of the second premolar and first molar, and the response was predicted using Analysis of Systems (ANSYS) software. Results: When power-arm height was near the center of resistance of the anterior segment, stability in the stress distribution around the implant site and anterior teeth was observed. Displacement of the teeth varied along the three planes of space with the change in power-arm height. Conclusion: For en-masse retraction, power-arm height should be kept at a level of the center of resistance. Play in the bracket slot and the archwire show a negative role in the bodily movement of anterior teeth. Clinical significance: For efficient en-masse retraction of anterior teeth, it is imperative to study the most effective site of application of force. Therefore, our study recommends certain key points to keep in mind during the attachment of the power arm and engaging wire in the bracket slot, which could benefit the orthodontist immensely.



Sharath Asokan, PR Geetha Priya, Thendral Mathiazhagan, Sudhandra Viswanath

Association between Intelligence Quotient Dental Anxiety and Oral Health-related Quality of Life in Children: A Cross-sectional Study

[Year:2022] [Month:November-December] [Volume:15] [Number:6] [Pages:5] [Pages No:745 - 749]

Keywords: Behavior, Cognitive ability, Dental anxiety, Intelligence quotient, Oral health-related quality of life

   DOI: 10.5005/jp-journals-10005-2452  |  Open Access |  How to cite  | 


Background: Determining the intelligence quotient (IQ) grades of children help in managing dental anxiety (DA) and maintaining the good oral health-related quality of life (OHRQoL). Aim: To assess the association between IQ, DA, and OHRQoL in children aged 10–11 years. Design: This cross-sectional study was carried out among 202 children aged 10–11 years in the Southern part of Tamil Nadu, India. The IQ level, DA, and OHRQoL were measured using Raven's Coloured Progressive Matrices (RCPM), Children's Fear Survey Schedule-Dental Subscale (CFSS-DS), and Child Oral Health Impact Profile Short Form (COHIP-SF) 19, respectively. Chi-squared test and Spearman rank order correlation test were used for analysis. Results: The results revealed a significant negative correlation (p < 0.05; r = −0.239) between IQ and OHRQoL. DA was negatively correlated with IQ (r = −0.093) and OHRQoL (r = −0.065), but it was not statistically significant. The gender-based comparison revealed no significant difference in the distribution of girls and boys within different grades of IQ levels (p = 0.74), DA (p = 0.29), and OHRQoL (p = 0.85). Conclusion: Children with higher IQ showed low OHRQoL scores. DA was negatively correlated with IQ and OHRQoL.



Savitha Sathyaprasad, Monika Godilli Krishnareddy, Vinisha Vinod, Nikhil Das, R Ramesh, Irfana Ilyas

Comparative Evaluation of Fixed Functional Cantilever Space Maintainer and Fixed Nonfunctional Space Maintainer: A Randomized Controlled Trial

[Year:2022] [Month:November-December] [Volume:15] [Number:6] [Pages:11] [Pages No:750 - 760]

Keywords: Esthetics, Pediatric prosthesis, Space maintainer

   DOI: 10.5005/jp-journals-10005-2478  |  Open Access |  How to cite  | 


Background and objectives: Effective way to prevent mesial drift after the early loss of primary first molars is by inserting a durable space maintainer. Several space maintainers are available; fixed nonfunctional (FNF) space maintainer (crown and loop) is commonly used when abutment teeth need full-coronal restoration. Disadvantages of crown and loop space maintainer are nonfunctional, nonesthetic, and fracture of solder loop. To overcome this drawback, new design of fixed functional cantilever (FFC) space maintainer (crown and pontic) using bis-acrly composite resin. The study evaluated the longevity and acceptance of an FFC and compared it with a FNF space maintainer. Materials and methods: A total of 20 healthy children, aged 6–9 years, were selected having bilateral premature loss of lower deciduous first molars. FFC space maintainer in one quadrant and FNF space maintainer in the other was cemented. The subject's acceptance of treatment was checked using a visual analog scale after the treatment completion. Criteria for complication leading to the failure was assessed in both the designs in the 3rd, 6th, and 9th month. Cumulative success longevity was obtained at a 9 month evaluation. Results: Patient acceptability was greater in group I (FFC) in comparison to group II (FNF). In group I, fracture of the crown and pontic was the common complication leading to failure, followed by attrition of the crown and loss of material due to abrasion. In group II, fracture of the solder joint was the common complication leading to failure, followed by slippage of the loop gingivally and cement loss. The longevity of groups I and II were 70 and 85%, respectively. Conclusion: FFC can be considered a viable alternative to conventional FNF space maintainers.



Sanjana Kodical, Prabhakar Attiguppe, Raju Orekondi Siddalingappa, Deepak Bekshavathi Mata

Laser Activation of Aquatine Endodontic Cleanser: A Novel Approach to Root Canal Disinfection

[Year:2022] [Month:November-December] [Volume:15] [Number:6] [Pages:3] [Pages No:761 - 763]

Keywords: Aquatine endodontic cleanser, Diode laser, Enterococcus faecalis

   DOI: 10.5005/jp-journals-10005-2471  |  Open Access |  How to cite  | 


Aim: To evaluate and compare the antimicrobial efficacy of 2.5% sodium hypochlorite (NaOCl) and Aquatine Endodontic Cleanser (EC) with and without laser-activated disinfection against Enterococcus faecalis in the root canals of primary teeth. Materials and methods: A total of 45 human primary teeth were selected and inoculated with E. faecalis and divided into three groups as per intervention. In group I, irrigation was done using 2.5% NaOCl, in group II using Aquatine EC solution, and in group III with Aquatine EC activated by 810 nm diode laser. Results: Intragroup comparisons showed a decrease in colony-forming units in all three groups. Intergroup comparisons showed a statistically significant difference between group I and group II (p = 0.024) and between group I and group III (p = 0.03). Conclusion: Aquatine EC showed maximum antimicrobial efficacy under laser activation. Clinical significance: Aquatine EC can be considered a suitable alternative to NaOCl in light of its known toxic effects.



Shilpi Tiwari, Sanjana Bhargava, Parimala Tyagi, Saurabh Kale, Shikha Mali, Umang Akhani

Knowledge, Attitude, and Practice of Pediatric Dentists Regarding Oral Health Management of Visually Impaired Children

[Year:2022] [Month:November-December] [Volume:15] [Number:6] [Pages:6] [Pages No:764 - 769]

Keywords: Pediatric dentists, Oral health, Visually impaired children

   DOI: 10.5005/jp-journals-10005-2466  |  Open Access |  How to cite  | 


Aim: The aim of this study is to investigate the knowledge, attitude, and practices of pediatric dentists regarding oral health management of visually impaired children. Material and methods: A combination of convenience sampling and snowball sampling was used to send an online Google form survey questionnaire to pediatric dentists all around the world. Four sections made up the questionnaire—the first asked for personal information, while the second, third, and fourth examined the knowledge, attitudes, and practices of pediatric dentists, respectively. The IBM Statistical Package for the Social Sciences (SPSS) for Windows, version 21.0, was used to analyze the data. Result: The total responses (511) were broken up according to the different continents. The Asian continent produced the most pediatric dentists (206, 40.3%). Most of the participants in the study were females (365, 71.4%), and the maximum was postgraduate students (203, 39.7%). Moreover, the participants were practicing in the private sector (445, 87.1%) and had an experience of 2–5 years (118, 23.1%). Good knowledge scores were significantly associated with work profile (p = 0.014*) years of practice, and associated countries had shown significant differences (p ≤ 0.001). Conclusion: According to this study, the majority of the pediatric dentists included have just rudimentary knowledge of children who are visually impaired. Pediatric dentists are prevented from treating and properly managing visually impaired children as a result of deficient practices in the field of visually impaired children.



Sudhir R Pawar, Rajesh A Kshirsagar, Rakhi S Purkayastha, Samir Joshi

Adenomatoid Odontogenic Tumor Mimicking a Dentigerous Cyst in Maxilla

[Year:2022] [Month:November-December] [Volume:15] [Number:6] [Pages:4] [Pages No:770 - 773]

Keywords: Adenoameloblastoma, Adenomatoid odontogenic tumor, Dentigerous cyst, Teratomatous odontoma, Odontogenic tumor

   DOI: 10.5005/jp-journals-10005-2484  |  Open Access |  How to cite  | 


Aim: To present a case of adenomatoid odontogenic tumor (AOT) associated with impacted maxillary lateral incisor in a 12-year-old female that mimicked dentigerous cyst. Background: Adenomatoid odontogenic tumor (AOT) was first mentioned by Steensland in 1905, which is a rare tumor of odontogenic origin. Dreibladt in 1907 coined the term pseudo ameloblastoma. In 1948, Stafne considered it a distinct pathological entity. Case description: A 12-year-old female reported to the Department of Oral and Maxillofacial Surgery with the chief complaint of progressive swelling on the left maxillary anterior region for 6 months. The clinical and radiographical findings of the case represented a dentigerous cyst or unicystic ameloblastoma, but the histopathological interpretation was interpreted as AOT. Conclusion: The AOT is an unusual entity that is commonly misdiagnosed as a dentigerous or odontogenic cyst. Histopathology plays a vital role in diagnosis and further management. Clinical significance: The interest and relevance of the present case are the difficulties in diagnosing accurately based on the radiograph and histopathology. Both dentigerous cysts and AOT are entirely benign and encapsulated lesions, and enucleation poses no major difficulties. The case report highlights the importance of early diagnosis of neoplasm arising in odontogenic tissues. The fact that in cases of unilocular lesions surrounding the impacted tooth in the anterior maxillary region, AOT should also be considered as a differential diagnosis.



Shefali Yadav, Nikita Gulati, Devi Charan Shetty, Saurabh Juneja

Embryological Basis of Cystic Hygroma: A Case Report

[Year:2022] [Month:November-December] [Volume:15] [Number:6] [Pages:5] [Pages No:774 - 778]

Keywords: Amorphous, Cystic hygroma, Lymphoid aggregates, Malformation

   DOI: 10.5005/jp-journals-10005-2472  |  Open Access |  How to cite  | 


Aim: We intend to present a cystic hygroma (CH) case in a 2-year-old baby in the anterior cervical triangle, which is a rare site, as the most common site for the occurrence of CH is the supraclavicular fossa of the posterior cervical triangle. Background: Among developmental abnormalities in the lymphoid system, CH are usually seen in the posterior neck. Lymphatic malformations are generally exhibited either at birth or before the age of 2 years. Lymphatic channels are attenuated endothelium-lined spaces devoid of any cells and smooth muscle layer. Also, morphologically distinguishing normal lymphatic channels from venules or capillaries is a challenge. Case description: A 2-year-old female patient reported having a chief complaint of swelling in the left submandibular region for 4 days. The patient underwent surgery for CH 18 days after birth. Swelling was rubbery in texture and firm in consistency. Conclusion: A D2-40 immunoexpression was an identifying clue for normal lymphatics in comparison to morphology. Henceforth, this can be concluded that such tumors depict at least partial differentiation of endothelial cells lining lymphatic spaces. Clinical significance: The present article helps in illuminating the role of D2-40 in the diagnosis of lymphatic malformations, such as CH, and also highlights the embryological basis of the pathogenetic mechanism of this rare disease, which potentiates the role of various treatment modalities in pediatric cases for management considerations.



Vipin Ahuja, Jaya Verma, Ankur Bhargava, Anand Choudhary

“Triple Tooth Synodontia” of Primary Incisors in Triangular Configuration: A Rare Aberrant Case Report

[Year:2022] [Month:November-December] [Volume:15] [Number:6] [Pages:5] [Pages No:779 - 783]

Keywords: Fusion, Primary teeth, Triple tooth, Triplication defect, Triploid teeth

   DOI: 10.5005/jp-journals-10005-2474  |  Open Access |  How to cite  | 


Aim: This case report aims to present triple tooth synodontia of primary teeth and its management. Background: Synodontia refers to the fusion of teeth and is a morphological developmental dental aberration. This anomaly is also acknowledged with different terminologies like fusion, germination, and concrescence. Synodontia with two teeth is not uncommon however it is found sporadic in primary dentition. This type of anomaly can include two or more teeth; if the number is two, it is called as double tooth and if three, is called as triple tooth or triplication defect or triploid tooth. Case Description: In this article, we report an unusual case of triplication of primary teeth occurring unilaterally between the upper deciduous right central, lateral incisor and supernumerary tooth. The triple tooth was extracted under local anesthesia and was sectioned at three levels that are coronal, middle, and cervical one-third, and analyzed by Cone-beam Computerized Tomography (CBCT) respectively. The coronal segment revealed three individual pulp chambers, middle third and apical third revealed one single unified pulp chamber. Conclusion: Triple tooth in a triangular configuration with mixture of incomplete fusion at the coronal portion and cervical third and complete fusion at middle and apical third of root is an elusive anomaly. Clinical significance: This aberrant fusion of two deciduous incisors with supernumerary tooth had been documented as rare anomaly, so its early diagnosis and management protocol is imperative to comprehend.



Varsha Sharma, Abinash Mohapatra

Ternion Cusp: An Unusual Variant of Talon's Cusp: A Case Report

[Year:2022] [Month:November-December] [Volume:15] [Number:6] [Pages:5] [Pages No:784 - 788]

Keywords: Retruded contact position, Talon cusp, Three-cusped structure/ternion, Topical fluoride

   DOI: 10.5005/jp-journals-10005-2476  |  Open Access |  How to cite  | 


Background: Teeth are hard mineralized anatomical components of the dentofacial skeleton that are developed during the gestation period by odontogenesis. This dental development comprises five stages viz. initiation, proliferation, histodifferentiation, morphodifferentiation, and apposition. Excitation to the dental organ during morphodifferentiation is responsible for the formation of a talon cusp, which manifests as a cusp-like structure of hard tissue projecting from the cingulum to a varying measurable length toward the incisal edge of maxillary and mandibular anterior teeth. Various literature has reported that it comprises enamel, dentine, and an inconsistent amount of pulp tissue. Old literature suggests its occurrence in primary and permanent teeth and mostly on the palatal aspect of teeth as one cusp; therefore, known as a talon cusp (eagle's talon). Case description: An exceptional case of three cusped structures projecting from the palatal side of a maxillary central incisor is thus reported. The rare occurrence of an atypical talon cusp with three well-defined mamelon-like cusps on the palatal surface of the permanent maxillary central incisor is coined as ternion cusp, meaning ”three” by authors. Its occurrence is repercussed as attrition of the teeth in the opposite arch. Selective or retruded contact position (RCP) was done, followed by topical fluoride application was rendered. Conclusion: Managing and treating these exceptional cusps depends upon their size, present complications, and patient compliance.



Madhulaxmi Marimuthu, Abhinav Rajendra Prabhu, P Kalyani, Swetha Murali, P Senthilnathan

Complex–compound Odontome with 526 Denticles: A Unique Case Report

[Year:2022] [Month:November-December] [Volume:15] [Number:6] [Pages:4] [Pages No:789 - 792]

Keywords: Complex, Compound, Denticles, Odontome

   DOI: 10.5005/jp-journals-10005-2460  |  Open Access |  How to cite  | 


Aim: To report a unique case presentation of a complex–compound odontome with 526 denticles. Background: Odontoma is a hamartoma of the jaws that has both epithelial and mesenchymal components differentiating to form enamel and dentin. It is of compound and complex types. Rarely, the features of both the types are present together in what is called the compound–complex type of odontoma. Case description: The case report discussed here is that of a 7-year-old boy who presented with a compound–complex odontoma in the right posterior mandibular region. Conclusion: Timely diagnosis and prompt surgical treatment aid in preventing complications and bony expansion. Thus, proper histopathological examination is essential for the confirmation of odontoma. Recurrence of odontoma is rare and usually has a favorable prognosis if diagnosed early. Clinical significance: The odontome contained 526 denticles, the maximum reported in the literature so far, making this a case of extreme clinical significance.



Jonas A Rodrigues, Isabel Olegario, Cristiane M Assunção, Marcelo Bönecker

Future Perspectives in Pediatric Dentistry: Where are We Now and where are We Heading?

[Year:2022] [Month:November-December] [Volume:15] [Number:6] [Pages:5] [Pages No:793 - 797]

Keywords: Dental caries, Dental treatment, Pediatric dentistry, Prevention of dental caries

   DOI: 10.5005/jp-journals-10005-2475  |  Open Access |  How to cite  | 


Oral diseases in children are still a major public health problem that can negatively impact parents and their children's quality of life. Even though oral diseases are largely preventable, initial signs of them can be detected in the 1st year of life, and its severity might increase with time if no preventive measures are taken. Based on this, we aim to discuss ”where is pediatric dentistry now?” and ”where is pediatric dentistry heading?” Early life oral health conditions are a good predictor of oral health status in adolescence, adulthood, and elderly people. A healthy childhood provides the foundation and opportunities for life; therefore, pediatric dentists have the unique opportunity to identify the presence of unhealthy habits in the 1st year of life and educate the parents and family members to change them for life. If all educational and preventive strategies fail or are not put into practice, the child might present oral health problems, such as dental caries, erosive tooth wear (ETW), hypomineralization, and malocclusion, that could have a great impact on other stages of life. At the moment, in pediatric dentistry, there are many alternatives to prevent and treat these oral health problems. However, if prevention fails, minimally invasive approaches, and new dental materials and technologies have been developed recently and will be important tools available in the near future in order to enhance children's oral health.


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