Introduction: Early Childhood Caries (ECC) can affect the health and quality of life of the children. Assessing a patient's risk of developing caries is an important aspect of caries management; however, can assessing the caries risk predict the impact of ECC on the OHRQoL? Few Indian studies have reported association between caries status, risk, and the impact on OHRQoL. Aim: To assess the association between dental caries status, risk assessment, and OHRQoL in 3–6-year-old children. Methodology: A total of 50 healthy children were recruited in a cross-sectional study. Parents filled the ECOHIS questionnaire. Caries status, risk, and OHRQoL were measured as dmft-pufa, CRAFT (Caries Risk Assessment for Treatment- an indigenous tool) and ECOHIS scores, respectively. Results: Moderate correlation was seen between dmft and ECOHIS scores (r = 0.496, p < 0.01), and pufa and ECOHIS scores (r = 0.408, p < 0.05). More number of subjects with higher scores of ECOHIS were in the high-risk category of CRAFT (p < 0.05). Conclusion: Caries status, risk and OHRQoL were associated in 3–6-year-old children. Thus, caries risk assessment may predict poor OHRQoL.

Aim: To assess oral hygiene and dietary patterns in school children participating in a school-based preventive oral health program during the COVID-19 pandemic. Materials and methods: In this cross-sectional study, an anonymous questionnaire exploring oral hygiene and dietary patterns during the COVID-19 pandemic was completed by parents of school children. Data were compared among different schools, school years, and between genders using nonparametric tests. Associations among further nominal and categorical variables related to oral hygiene and dietary habits were also assessed using the chi-square test. Results: Only 26% (n = 32) of parents reported that their children brushed their teeth the recommended amount of twice or more per day during the pandemic. In addition, 17.2% of the parents reported less brushing than before the pandemic. A total of 40 parents (32.8%) reported that their child consumed unhealthy beverages once a day or more. Comparison between genders revealed that male participants were drinking significantly unhealthier than female (p = 0.038). Sugary foods were consumed once a day or more by 63.1% of children. No significant differences were found between public and church schools. Significant direct associations were found between changes in dietary habits and brushing frequency (p = 0.017), between parental concern regarding the interruption of the school program and decreased brushing frequency (p = 0.005), and negative changes in dietary habits (p = 0.013). Clinical significance: Within the limitations of this study, the present significant findings observed during the pandemic support the importance of school programs in promoting oral hygiene and healthy dietary habits of children.

Aim: To evaluate the staining effect of different children's health drinks (Boost, Complan, and Pediasure) on esthetic restorative materials (giomer, nanohybrid composite, and ormocer). Materials and methods: The specimens consist of giomer, nanohybrid composite, and ormocer. Before the discoloration process, 80 disks of each material were fabricated, each measuring 5 mm in diameter and 2 mm in thickness. These disks were then measured for lightness*red/green*blue/yellow (L*a*b*) values. Around 10 samples from each subgroup were then submerged in each of the four staining solutions. Analysis of discoloration levels was done at baseline and 48 hours after immersion in the staining solution. Each specimen's staining effect was evaluated using a spectrophotometer. Each specimen's L*a*b* values were measured three times by placing it on the measurement head. The internal energy (ΔE) unit, which expresses resistance to the staining effect, was derived using each specimen's L*a*b* values. Results: All the tested materials showed a color change. However, giomer showed greater ΔE values compared to nanohybrid composite and ormocer. Of all the immersion media used, Boost samples resulted in the highest color change, followed by Complan, Pediasure, and milk. Conclusion: Out of the three restorative materials used in the study, ormocer showed more resistance to color change than nanohybrid composite and giomer with all the tested media.

Background: The quality of the obturation plays a significant role in the success of endodontic treatment. To date, various technologies have been used to evaluate the quality of obturation, but all of them have their own limitations. In order to overcome those limitations, recent technological advancements like cone-beam computed tomography (CBCT) can be helpful. Aim: To compare and evaluate the efficiency of different root canal obturation techniques in primary teeth using CBCT. Materials and methods: A total of 80 root canals in 30 children aged between 4 and 9 years were selected and divided into four groups, with 20 root canals in each. Obturation in group I was performed using the endodontic pressure syringe; group II—hand spreaders; group III—Lentulo spirals mounted on slow-speed handpiece; and group IV—insulin syringe. The quality of obturation was evaluated using a CBCT scan. Results: Group I samples showed the most optimally filled canals followed by II and III; least in group IV. A maximum number of overfilled canals was exhibited in group III samples. Voids were minimal in all four groups and the values obtained were not statistically significant. Conclusion: Obturation with an endodontic pressure syringe reported the highest number of optimally filled root canals and the insulin syringe showed the least number of optimally filled canals.

Introduction: Preservation of healthy pulp tissue is detrimental for the function and vitality of carious primary teeth. Several hemostatic agents used for pulpotomy in primary teeth showed adverse effects on viable surrounding structures. Aims: To assess the clinical and radiographic success of chitosan (CH) pulpotomy in primary molars and to compare it with ferric sulphate (FS). Materials and methods: A total of 40 carious lower primary second molars in 5–9 years children are selected for conventional pulpotomy technique. Over radicular stumps, FS is placed for 15 seconds in the control group, and CH for 4–5 minutes in the study group, followed by intermediate restoration (IRM). Intraoral periapical radiographs were taken immediately after 1 week and after 3rd and 6th months. The clinical and radiographic success rate is assessed and statistically analyzed. Results: Chitosan (CH) showed a 65% radiographical and 100% clinical success rate, and FS showed 55 and 95%, respectively. Conclusion: Chitosan (CH) showed better results than FS as a pulpotomy agent in primary teeth.

Early childhood caries (ECC) is a multifactorial disease with known etiologic factors and can be very devastating to the oral and general well-being of a child, including psychological impact on a growing child. The irony is among the different factors responsible for milk that is wholesome nutrition, if fed in a wrong pattern, can be the main factor that helps this type of rampant caries spread within no time, leading to pulp exposures and complicating proceedings. Awareness is the mainstay in prevention, and creating it becomes our sole responsibility as a pediatric dentists. A multidisciplinary approach with the involvement of mothers as a main stakeholder in this front becomes a very promising move, so this project is phase two of interprofessional collaboration involving mothers in prevention; the aim of the study is to create awareness among mothers during COVID lockdown so as to prevent ECC in this COVID pandemic. Materials and methods: A total of 222 mothers with 9–24 months old children were selected and added to the e-groups. The allocated mothers were given a pretest questionnaire and collected back with a photo of their child's oral health, and anticipatory guidance and in-depth interviewing were given to them. Follow-up is done in 2, 4, and 6 months. Awareness is evaluated by pre- and posttest questionnaires. Reversal of the white spot is evaluated through indices, and progression is noted. Statistical analysis: The data was analyzed using Statistical Package for the Social Sciences 13. Result: Pretest and postquestionnaire analysis were done using the Chi-squared test. The test shows the marked raise in knowledge, attitude, and practice of mothers on their children after postintervention, which was given through motivational interviewing (MI). Conclusion: In summary, the MI intervention appeared to improve maternal knowledge but had no effect on oral health behaviors or on the progression of early childhood caries (ECC).

Background: This is a preliminary investigation to assess the efficacy of Myristica fragrans (M. fragrans) as pulpectomy obturation material. Objective: To assess the clinical and radiographic efficacy of M. fragrans as pulpectomy obturating material and compare it with zinc oxide eugenol, the gold standard in the obturation of primary teeth. Materials and methods: This is a triple-blind, randomized, and controlled clinical trial performed on children aged between 4–8 years with primary molars requiring pulpotomy. A total of 50 teeth were randomly assigned into two groups—group I received M. fragrans with zinc oxide eugenol, and group II zinc oxide eugenol. Teeth were then filled with glass ionomer cement and were restored using stainless steel crowns. Clinical and radiographic evaluation was done by a blinded calibrated evaluator at 3, 6, and 12-month follow-up periods. The data obtained were subjected to statistical analysis. Results: Clinical and radiographic success in both groups was 100% throughout the follow-up period. Extruded material in the M. fragrans group showed resorption during the follow-up period. Conclusion: Myristica fragrans (M. fragrans) can be suggested as a pulpectomy obturating material for primary teeth. However, further clinical studies with long-term follow-ups are needed to give more affirmative results.

Aim: To evaluate the remineralizing potential of natural substances on artificially induced caries lesions in primary teeth. Materials and methods: A total of 50 primary molar teeth were selected and subjected to a demineralization process. Then samples were randomly divided into five groups for the remineralization process. Group I—colophony, group II—5% sodium fluoride (NaF) + colophony, group III—grape seed extract (GSE) + colophony, group IV—5% NaF + colophony + 10% peptide, and group V— GSE + colophony + 10% peptide. All the groups were subjected to remineralization using a brushing stimulator for 3,000 cycles. Assessment was done using Vickers hardness testing machine for evaluating the enamel surface microhardness (SMH) and scanning electron microscopy-energy dispersive X-ray analysis (SEM-EDX) for evaluating the surface morphology and mineral content, before and after demineralization and after remineralization, the obtained data was analyzed statistically using IBM Statistical Package for the Social Sciences (SPSS) software version 25. Results: The enamel microhardness results of this study revealed that remineralization of enamel was highest in group V (212.83 ± 64.416) and least in group II (137.83 ± 26.324) p-value of 0.038. SEM-EDX analysis revealed high calcium (Ca) and fluoride (F) content in groups II and IV, which was significant (p-value of 0.001) from other groups. Surface morphology evaluated with SEM revealed spherical globular agglomerates and scaffolding deposits on the enamel surface in groups III and V resembling the remineralization process. Conclusion: Grape seed extract (GSE) with colophony and peptide is a superior natural alternative to NaF. Colophony also exhibited remineralizing potential in primary enamel. Clinical significance: Natural remineralizing agents like GSE, colophony, and its combination serves as a potential alternative to overcome the toxic effect on long-term usage of F. These natural substances can be applicable in clinical conditions by incorporating toothpaste and varnish, which can be used as an alternative or adjuvant to the topical application of F.

Aim: To clinically evaluate the overall efficacy and pain perception of ultrasonic oscillating tips and conventional high-speed burs to remove enamel and dentinal caries in children of ages 6–8 years. Materials and methods: Bilateral deciduous canines with caries involving enamel or enamel and dentin were excavated by using a high-speed airrotor on one tooth and ultrasonic oscillating tips on another tooth in the same appointment. The overall response of the patient, both ultrasonic oscillating tips and airrotor along was recorded by Wong–Baker's Facial Pain Rating Scale (WBFPS) along with time taken to make each cavity and noise level generated by high-speed and ultrasonic system. Results: Evaluation of WBFPS after every method of caries excavation showed that 84% of subjects in the ultrasonic group reported score of 0 as compared to only 24% of subjects in the airrotor group. Score 2 was reported by 16% of the subjects in the ultrasonic group and 32% of the subjects in the airrotor group. Score 4 was reported by 44% of the subjects in the airrotor group. Ultrasonic groups reported more time to remove caries as compared to the airrotor group. The ultrasonic group reported less noise as compared to the airrotor group and the difference between the two was significant. Conclusion: Patients preferred the ultrasonic method for caries excavation because of less pain and noise. The use of ultrasonic oscillating tips is as effective in caries excavation, less painful, and more time-consuming than the conventional airrotor. Significance: Ultrasonic oscillating tips can be successfully used in pediatric dentistry to aid patient cooperation and reduce pain during caries excavation.

The oral probiotic Streptococcus salivarius M18 (S M18) offers the potential to confer oral health benefits as it produces bacteriocins which are targeting Streptococcus mutans. Aims: The purpose of this clinical trial was to assess the effect of S M18 probiotics on salivary S. mutans and to identify the correlation between dental caries with salivary S. mutans count. Materials and methods: This clinical trial was conducted in 40 children between the age-group 3–6 years, subjects were randomly selected and the decay extracted filled (due to caries) (def score) was recorded. The presalivary unstimulated saliva was collected and subjected to microbiological examination for S. mutans counts, salivary pH, and buffering capacity. Children were divided into two groups as the control and the experimental group. Bacteriocin like inhibitory substances M18 (M18 is a strain number) (BLIS M18) probiotic was administered in the experimental group, and unsweetened lozenge as a placebo in the control group for 7 days and postsalivary samples were collected and subjected to microbiological examinations for S. mutans count, salivary pH, and buffering capacity. Results: A significant decrease in the S. mutans counts were noticed, an increase in buffering capacity, and no significant change in pH was observed after the intervention of S M18. A linear correlation was observed between the def score and S. mutans count. Conclusion: This clinical trial revealed that S M18 in its 7 days regime can lead to the inhibition of S. mutans counts favorably in the oral cavity by affecting salivary pH and buffering capacity.

Aim: A lot of herbal and medicated toothpastes having natural and antisensitivity properties are creating niches for themselves in the market. However, toothpaste containing high content of abrasives can be harmful to the teeth. The present in vitro study was conducted to assess the abrasiveness of three commercially available dentifrices on human-extracted anterior teeth on sound and demineralized enamel. Materials and methods: A total of 42 freshly extracted teeth were mounted on acrylic resin and randomly divided into three groups (group I, Colgate; II, Glister; and III, Dant Kanti). Each group consisted of one test tooth (partially) and one control tooth (completely) covered with nail varnish. The study had two phases. Phase 1—baseline average roughness (Ra) value was assessed with a profilometer of all the samples. Phase 2—further, teeth were immersed in the demineralizing solution for 4 days to allow the formation of an artificial carious lesion. Tooth brushing was performed by a customized automated toothbrushing model on all the teeth for 28 days. Ra value was again evaluated with Profilometer. Result: Data were analyzed, and a statistically significant result was observed with demineralized teeth in all three groups (p = 0.005). The intragroup comparison showed a significant difference with demineralized teeth of Colgate and Dant Kanti, (p =0.018) and (p =0.027), respectively. However, there was no significant difference in demineralized teeth of glister and sound teeth of all three groups. Conclusion: Glister was found to be the least abrasive of all three toothpastes, followed by Dant Kanti and Colgate. Clinical relevance: The particle size of the ingredients used in manufacturing toothpaste can lead to abrasion of the teeth. This, in combination with the hard bristles, can cause more harm to the teeth than good. The current study has compared the abrasive potential of three commercially available kinds of toothpaste. Hence daily use of these commercially available dental products should be used cautiously.

Aim: EMONO is an equimolar mixture of oxygen and nitrous oxide. Studies investigating its anxiolytic effect mostly used behavioral scales for assessing anxiolysis in children during dental care. Observing this effect objectively in a pediatric population could be very interesting. Materials and methods: We conducted a prospective uncontrolled monocentric pilot study to assess the equimolar mixture of oxygen and nitrous oxide (EMONO) anxiolytic effect in children during dental care by monitoring heart rate (HR) variation. Results: A statistically significant difference could be highlighted between the HR before the dental care and after 5 minutes of EMONO inhalation, illustrating the anxiolytic effect of EMONO in an objective way. HR variation also suggests that the effect of EMONO seems to prevent a return to the initial level of stress, even during anesthesia. Conclusion: All of the data in the literature confirm the essential role of nitrous oxide in pediatric dental care. Demonstrating the effectiveness of EMONO by objective criteria is necessary. Trial registration: Clinical Trials Unique Protocol ID: RC17_0275.

Aim: The aim of the study is to evaluate the impact of parenting style on a child's behavior and caries experience in 3–6-year-old children. Materials and methods: This cross-sectional study included 1,216 parent-child pairs of 3–6-year-old preschool children. Parenting style was determined using Parenting Style and Dimensions Questionnaire (PSDQ). Child behavior was assessed using Frankl's behavior rating scale, and caries experience was recorded using the decayed, extracted and filled deciduous teeth surfaces index. Results: Out of the 1,216 parents, the authoritative parenting style is seen in 70%, authoritarian in 20%, and permissive parenting style in 9.5%. Children with a permissive type of parenting style have shown more negative behavior. Children of authoritative parents had 4.1 times higher odds of exhibiting definitely positive behavior, which is statistically significant (p = 0.004). Children of positive child behavior had 2.4 times higher odds of avoiding caries which is statistically significant (p = 0.0001). Children of authoritarian parents had 1.45 times higher odds of exhibiting caries than children of permissive parents; however, this difference is not statistically significant. Conclusion: Children of authoritative parents demonstrated low caries experience and desirable behavior in the dental office. On the contrary, children of permissive parents exhibited undesirable dental behavior, and children of authoritarian parents had high caries experience. Clinical significance: Twenty-first-century parents are less controlling and are more permissive leading to problematic child behavior in the dental office. Parenting styles have an impact on the effectiveness of behavior management as well as dental treatment. Pediatric dentists should identify different parenting styles and anticipate the child's behavior. This study emphasizes the effect of different parenting styles on a child's behavior and dental caries experience.

Context: Molar incisor hypomineralization (MIH) is an emerging clinical problem as the affected tooth is prone to dental caries with the lapse of time. Aims: To assess the prevalence, severity, and associated risk indicators of MIH amongst 8–13 years of children of Vadodara District, Gujarat, India. Materials and methods: A cross-sectional study with a sample size of 3,000 government schoolchildren. A total of 1,500 children each from urban and rural areas were randomly selected and examined. Only permanent incisors and first molars were examined. MIH was diagnosed clinically based on the diagnostic criteria established by the European Academy of Paediatric Dentistry (EAPD), 2003. To check the relation between the two variables—Pearson's Chi-squared test was applied. Fisher's exact test was applied when less than five expected values were found. Results: A total of 286 children (9.6 %) had MIH, with 189 (rural) and 97 (urban) children. MIH was significantly higher in the rural population as compared to the urban. In the rural area, the cause was found to be a child suffering from an illness (>15 days) which was 35.98%, and in the urban area was due to prolonged use of antibiotics before 4 years of age, which was 28.87%. Conclusion: The overall prevalence rate of MIH among the screened children between the age-group 8 and 13 was found to be 9.6%. Males were more affected. The severity of MIH was more in molars compared to incisors and more in children of rural areas. Clinical significance: Protocol for early diagnosis and follow-up to access the squeal of breakdown should be undertaken along with parents and health workers.

Aim: The aim of the study was to evaluate the anxiety levels in children while using rubber dam and OptraDam isolation techniques. Materials and methods: This study was a crossover trial conducted on 27 selected 6–12-year-old children. The procedure of placement of either of the isolation techniques was told and demonstrated using audiovisual aid. The sequence of the proceedings on each child (rubber dam or OptraDam) was determined randomly using toss of coin. Second demonstration was carried out 7 days after the first demonstration. The anxiety experienced was recorded using Venham's anxiety scale at two time points—after verbal explanation and after the audiovisual demonstration. The study also objectively assessed the anxiety by measuring the salivary malondialdehyde (MDA) levels of two patients. Results: When mean values of Venham's anxiety scores after verbal explanation and after audiovisual demonstration were compared for each of the two techniques using paired Student's t test, there was statistically significant decrease in the anxiety score following audiovisual demonstration in both the techniques. When the scores between two groups after verbal explanation and after audiovisual demonstration were compared using repeated measures of analysis of variance (ANOVA), the reported anxiety scores were significantly lesser for the OptraDam technique (p = 0.000). Conclusion: Audiovisual demonstration reduced the anxiety of children when compared to verbal explanation for both isolation techniques. OptraDam isolation was found to be less anxiety generating in children compared to rubber dam isolation. Clinical significance: When using modern adhesive techniques, a good isolation of the working field is an important requirement for better prognosis. OptraDam being the latest addition to the rubber dam family, if found to be more children friendly can solve majority of the problems related to isolation in pediatric dentistry.

Objectives: The study was conducted to assess the prevalence of incidental paranasal sinus pathologies in children on computed tomography (CT) scans. Materials and methods: A nonrandomized retrospective study was done on CT scans of 232 pediatric patients taken in the past 6 months duration. These scans were evaluated in different age groups from 0–13 years who had visited or were admitted to the hospital for various other head and neck-related problems. Each scan was examined for incidental pathologic findings in all the paranasal sinuses. The data were analyzed using descriptive statistics and Fisher's exact test to determine non-random associations between variables. Results: A total of 232 subjects were examined, amongst which 72 (31.03%) had incidental sinus pathologies. Multiple sinus pathologies were found in 36 subjects, 28 had single sinus involvement, and four showed no development of frontal sinus at the age of 11 years. Four subjects had pathology in multiple sinuses as well as no development of frontal sinus at the age of 6–7 years age range. Conclusion: Sinus pathologies are not unusual in the asymptomatic children population, and the incidence is almost equivalent to that of the adult population. Early identification can aid in diagnosing orofacial pain of unknown origin and also if children are susceptible to upper respiratory tract infections and their secondary effects like sleep apnea, mouth breathers, etc.

Background: Preservation of necrotic primary teeth is important. Pulpectomy is the gold standard treatment in this situation. Reinfection is the main cause of failure in pulpectomy. The application of regenerative endodontic therapy in mature teeth has the rationale of restoring dental-pulp-like tissue and preventing reinfection. Aims and objectives: The current study was designed to clinically and radiographically assess regenerative endodontics therapy in necrotic primary molars in comparison to zinc oxide eugenol (ZOE) pulpectomy. Materials and methods: A double-blinded randomized controlled trial with three parallel arms and a 1:1:1 allocation ratio was conducted. A total of 54 necrotic primary molars in 39 healthy children aged 4–7 years old were randomly allocated as follows group I—control group, in which ZOE pulpectomy was performed. Group II and III—experimental groups, in which regenerative endodontic therapy (RET) was performed. Modified triple antibiotic paste (mTAP) and Metapex™ were used as intracanal medicaments in groups II and III, respectively. Clinical and radiographic assessments were recorded at baseline, 6 and 12 months. Chi-squared and Fisher's exact tests were used to compare the qualitative data, while Friedman's test was used to study the changes by time within each group. Results: Nonstatistically significant differences were reported between the three groups at the 6 and 12 months follow-ups regarding the clinical or radiographic assessment (p-value = 0.327 and effect size = 0.22), (p-value = 0.055 and effect size = 0.118), respectively. Conclusion: Regenerative endodontic therapy (RET) yielded comparable results to pulpectomy. However, the use of 5 mg/mL mTAP in RET represented the highest level of clinical as well as radiographic insignificant failure. Clinical significance: Regenerative endodontic therapy (RET) provides an acceptable biological alternative to pulpectomy. Trial registration: The protocol was registered at ClinicalTrial.gov with the registration number (NCT04190914). 12/5/2019.

Aim: The study aimed to assess the anxiety and stress levels on acceptance of dental treatment in child patients approaching dental extraction procedures before and after nitrous oxide (N₂O) inhalation sedation (IHS) by measuring serum amyloid A (SAA) and salivary cortisol (SC). Materials and methods: A total of 32 children, ages ranging from 6 to 10 years, were randomly grouped as TI (before N₂O IHS) and TII (after N₂O IHS). Saliva samples were taken for biochemical evaluation of SAA before and after the procedure. Subjectively anxiety and stress levels were evaluated using modified child dental anxiety scale (MCDAS). Wilcoxon rank-sum test was used to compare the means of dental anxiety, SAA, and SC before and after N₂O IHS. The Karl Pearson correlation coefficient was employed to determine the correlation between dental anxiety and SAA and SC before and after N₂O IHS. Results: There were significant differences in the dental anxiety level in child patients after administration of N₂O IHS, and it also showed an increased rate of acceptance of dental treatment. Conclusion: This study showed that N₂O is a safe and effective method in reducing dental anxiety and increasing acceptance of dental treatment in child patients with improved behavior and with no adverse effects. Clinical significance: Anxiety and stress will always hinder the acceptance of dental treatment in child patients, especially during extraction procedures. N₂O IHS is a safe and effective technique to overcome anxiety and stress in child patients and as well as allows them to undergo dental treatment with improved behavior.

Aim: Parafunctional habits cause movements indicating their effect as functional and structural disorders such as malocclusion and temporomandibular joint changes in the oral and dental organs. This cross-sectional study was conducted to investigate the prevalence and factors associated with parafunctional habits in 6–12-year-old children in Qom, Iran. Materials and methods: This analytical cross-sectional study was performed on 403 6–12-year-old schoolchildren of Qom, Iran. Data collection tools included a demographic questionnaire and a checklist prepared along with a clinical examination. Data were analyzed using the Statistical Package for the Social Sciences (SPSS), with Chi-square and analysis of variance (ANOVA) tests. Results: The mean age of children was 8.9 ± 2.03 years. Bruxism was more common than other parafunctional habits (22.6%). There was a significant relationship between oral habits with children's gender and age (p <0.001). However, there was no significant relationship between oral habits and other variables such as underlying disease, economic status and parent's smoking (p >0.05). Conclusions: Given the relatively high prevalence of parafunctional habits in children, it seems that children should be investigated for the presence of such habits in order to provide the necessary education to parents and perform dental interventions to prevent complications from oral habits. Dental interventions at a younger age are easier to conduct and have a more effective preventive role.

Context: The ineffective disinfection potential of conventional intracanal medicaments to eliminate enteropathogens from root canal systems leads to their persistence contributing to endodontic treatment failures. Hence, the use of appropriate intracanal medicament becomes the essential phase to accomplishing comprehensive decontamination of the root canal system. When applied topically as an intracanal medicament, antibiotics eradicate residual microorganisms from tortuous endodontic spaces, minimizing the risk of systemic toxicity. Aims and objectives: To evaluate the prevalence of various bacterial species associated with signs of irreversible pulpitis and pulp necrosis with/without abscess in primary teeth root canals and their susceptibility against three antimicrobial agents. Materials and methods: The pulp tissue and organic debris were retrieved from deciduous teeth (n = 50) from children between the age of 3–10 years and cultured. The bacterial identification and antibacterial profiling of isolated bacteria were done against clindamycin, metronidazole, and doxycycline through minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) assay. The MIC and MBC of each antibiotic were expressed as mean ± standard deviation (SD), range, and standard error (SE of the mean). The intergroup comparisons were done by the Kruskal–Wallis test, while intragroup pair-wise comparisons were done using the Wilcoxon signed-rank test. The confidence level will be set at 95%. Results: Aerobic bacteria were found in 54%, microaerophilic bacteria in 76%, facultative anaerobes in 26%, and obligatory anaerobes were isolated from 30% of teeth. The intragroup and intergroup comparisons of test agent MIC revealed a nonsignificant difference (p > 0.05). The intragroup MBC comparisons of all the test agents revealed statistically nonsignificant (p > 0.05), while intergroup comparisons demonstrated nonsignificant (p > 0.05) to highly significant difference (p < 0.001). Conclusion: Clindamycin demonstrated promising antibacterial activity against most of the isolated bacteria, while against metronidazole and doxycycline, most of the bacteria were moderate to highly resistant. Clinical significance: Determining the antibacterial agents efficacy along with modifications can help to target maximum pathogenic microbes and reduce catastrophic endodontic therapy failures.

Introduction: Eruption of first primary teeth is a normal physiological process. Antenatal nutritional deficiency and prenatal and neonatal factors play an important role in eruption of primary teeth. Neonatal factors, such as gestational age (GA), degree of prematurity, severity of neonatal illness, and birth weight are primarily related to eruption of primary teeth. The relation between neonatal factors and the timing of eruption of primary teeth has not been studied prospectively among Indian preterm infants. Aims: To evaluate the influence of neonatal factors on the eruption of primary teeth in children born preterm. Materials and methods: A prospective longitudinal cohort study design was adopted. A total of 150 subjects were recruited by simple random sampling. Each child was followed up from birth up to 36 months. Intraoral examination was done and the teeth present in each visit were recorded. Data were statistically analyzed and interpreted. Statistical analysis used: Descriptive statistics, t-tests for independent sample, and Pearson's chi-squared tests were applied. Tooth showing statistically significant difference in mean age of eruption between term and preterm categories was studied for the effect of maternal and neonatal characteristics on eruption using multivariate regression analysis. Results: The mandibular central incisor was the first tooth to erupt. Significant determinant of eruption of mandibular incisor in term children was found to be parity, weight for GA, and complementary feeding, whereas for preterm children, significant determinants were parity, birth weight birth length, weight for GA, and complementary feeding. Conclusion: Neonatal factors, such as birth weight, birth length, weight for GA, and introduction of complementary feeding have a strong significant association with the eruption of primary teeth. Clinical significance: The findings of this study will guide in the preventive management of oral health in preterm children.

Aim: Growth measurement has always been essential to identify the best time to employ orthopedic or orthodontic appliances. Optimal timing for orthodontic treatment is strictly linked to the identification of periods of craniofacial growth when treatment is more effective. The aim of this study was to compare two different methods, middle phalanx maturation (MPM) and cervical vertebrae maturation (CVM), used to evaluate the stage of facial growth. Materials and methods: The research data was collected from July 2018 to April 2019 at the Dental Clinic of the San Gerardo Hospital in Monza. The study included a sample of 98 patients—46 males and 52 females. For each patient, a latero-lateral teleradiography of the skull and an X-ray on the middle finger of the right hand were obtained. The statistical analysis of the comparison of the stages of skeletal maturation obtained by the MPM and CVM methods was performed using the correlation coefficient for ranks of Spearman. Results: A descriptive statistical analysis of the entire sample of 98 patients was performed (mean age of 12.2 years and median of 12.2 years). The average age of females in every single stage of MPM was significantly lower than the average age of males. Of the total sample, 87 patients (88.8%) showed complete agreement between the two methods. Conclusion: The results obtained from the statistical analysis of this study allowed us to confirm a satisfactory agreement between the two methods. The intermediate phalanx method is a valid and alternative indicator to CVM for the identification of the puberty growth peak. We can, therefore, consider the MPM method a valid indicator of skeletal maturity.

Aim: To evaluate the relationship between body mass index (BMI) and dental development in the children in age-group of 6–13 years of Malwa region. Materials and methods: A total of 250 orthopantomograms (OPGs) of children aged 6–13 years (130 males and 120 females) collected from the Department of Paediatric and Preventive Dentistry, Government College of Dentistry, Indore, Madhya Pradesh, India, who came for their routine dental treatment. The chronological age, height, and weight were recorded, followed by calculating the BMI of each patient using Centers for Disease Control and Prevention (CDC) growth charts. The dental age was calculated using Cameriere's method. The comparison of the dental and chronological age was done using Wilcoxon signed-rank test. Results: The dental age of underweight patients was significantly lesser than that of the normal, overweight, and obese patients (p-value of <0.05). The dental age of the obese patients were greatest and significantly greater than that of the underweight, normal, and overweight patients (p-value of <0.05). Conclusion: Dental age is significantly associated with the BMI of children aged 6–13 years. The dental age of obese and overweight children is significantly greater than the chronological age. Clinical significance: Predicting the stage of dental development and eruption periods in children with mixed dentition can help with the sequencing and timing of orthodontic, prosthodontic, and surgical procedures.

Aim: This study assesses the instrumentation time and quality of obturation of three pediatric rotary endodontic systems—GT nickel-titanium (NiTi) (Prime Pedo), controlled memory (CM) NiTi (Pro-AF-Baby Gold) and NiTi-titanium oxide (NiTi-TiO) (Kedo SG Blue). Materials and methods: A total of 60 children aged 4–8 were chosen at random for the study based on inclusion criteria that required pulpectomy in any of the primary molars and were separated into three groups of 20 samples, each based on the file system employed. The instrumentation time during the preparation of the canal is recorded using a stopwatch. An expert dentist was blinded to the instrumentation type and showed the periapical radiograph, which he or she graded depending on the quality of the obturation by categorizing it as underfill, optimal fill, or overfill. The observations were then recorded, tabulated, and statistically analyzed for the results. Results: The least amount of instrumentation time was needed for NiTi-TiO (group III) files, followed by NiTi-CM (group II) and NiTi-GT (group I). NiTi-TiO (group III) has the most optimally filled and least underfilled obturations among the three rotary endodontic systems mentioned. Also, NiTi-TiO (group III) and NiTi-CM (group II) have the least similar overfilled obturations when compared with NiTi-GT (Group I). Conclusion: We conclude that NiTi-TiO needed the least amount of instrumentation time and generated the maximum optimally filled obturations based on our observations. Clinical significance: Pediatric rotary endodontic systems are more convenient to use and reduce chairside time; thus, their use in children with behavior control issues might be more suitable.

Aim: The aim of our study was to check the safety and efficacy of plaque removal using manual and powered toothbrush in cerebral palsy children by parents/caregivers. Materials and methods: This was a single blinded, crossover randomized control trial conducted on 60 cerebral palsy children between the age of 6 to 14 years. They were randomly divided using a flip coin method into two groups: group A—manual toothbrush and group B—powered toothbrush. The plaque index (PI), gingival index (GI), and gingival abrasion (GA) score were measured at baseline, then at an interval of 3, 6, 9, and 12 weeks. This was followed by a crossover between two groups with a washout period of 1 week. Results: Both manual and powered toothbrush showed a significant reduction in plaque and gingival score before and after crossover when compared to baseline (p < 0.05). The GA score was reduced to 100% in both groups. However, there was no statistically significant difference between both the groups before and after the crossover. Also, through the questionnaire it was observed that both child (86.6%) and parent (70%) showed positive feedback towards powered toothbrush. Conclusion: It can be concluded from the present study that the efficacy of a powered toothbrush is comparable to that of a manual toothbrush. Parents and caregivers, on the contrary, displayed a favorable attitude towards the use of powered toothbrushes due to their ease of use. Clinical relevance: Cerebral palsy is one of the most common neurological disorders among children. It is associated with poor motor skills and manual dexterity that hampers their ability to brush and thus leads to poor oral hygiene. A powered toothbrush seems more appealing and is specially designed for patients with poor neuromotor coordination.

Introduction: Deep pits and fissures are more prone to caries development due to their complex morphological anatomy. Preventive measures, such as pit and fissure sealants, can help in the reduction of dental caries. Conventional sealants being hydrophobic in nature, require isolation. Sealants which are hydrophilic have been introduced as an alternative where isolation is difficult to achieve. Aim: To compare and evaluate the retention and marginal integrity of hydrophilic pit and fissure sealant (Embrace WetBond) with hydrophobic pit and fissure sealant (Clinpro) in permanent first molars. Materials and methods: Sealants were applied randomly using the split-mouth design technique on 80 permanent first molars in children aged between 6 and 9 years and evaluation was done at 3, 6, 9, and 18 months. Results: The difference in retention rates between the groups was not significant using the Chi-squared test, though the WetBond group exhibited better results with 40% complete retention at the end of 18 months while in the Clinpro group, it was 37.50%. The marginal integrity in both the sealant groups was also found to be statistically insignificant. Caries incidence was found to be slightly higher in the Clinpro group. Conclusion: The clinical performance of Embrace WetBond was better when compared to Clinpro because of its moisture-tolerance capacity. Embrace Wetbond pit and fissure sealant can be the choice of material in cases where moisture control is a challenging issue.

Aim: The aim of the study is to find indicators of crowding in primary and mixed dentition that may lead to occurrence of dental crowding in future dentition using dental measurements. Materials and methods: A sample of 300 children was selected and divided into two groups based on their age primary dentition and mixed dentition. Dental arch impressions were made and casts were poured. The study was then divided into two phases for assessment of degree of crowding by Little's irregularity index (LII) and by measurement of tooth size-arch length discrepancies. Appropriate statistical analysis was used to assess the correlation of measurements in crowded and noncrowded groups. Results: It was found that Little's index is less dependable as an indicator of anterior crowding. In the primary dentition, there is significant difference in inter-canine width between lower noncrowded and crowded dentition. In the mixed dentition, there is significant difference in Intermolar width between upper noncrowded and crowded dentition and in sum of incisors between noncrowded and crowded dentition in both the arches. Conclusion: Little's index is not a reliable indicator of crowding in both primary and mixed dentition. Inter-canine width of lower arch can be considered as an indicator of crowding in primary dentition. The intermolar width of upper arch, sum of incisors in upper and lower arch and the intercanine width of upper and lower arch can be considered indicators of crowding in the mixed dentition.

Aim: To evaluate and compare for remineralization potential of enamel at three different time intervals using commercially available MI Varnish and Duraflor Halo varnish [5% sodium fluoride (NaF) varnish] incorporating bioactive glass, dicalcium phosphate dihydrate (DCPD), and biomimetically modified mineral trioxide aggregate (MTA). Materials and methods: For the study, a buccolingual division into equal halves was done for 64 decoronated premolar crowns. Among these 64 crowns, we mounted 32 in acrylic discs to be used for microhardness and induced white spot lesions (WSLs) measuring 5 × 5 mm on the exposed enamel surface. These samples were divided into four groups of 24 each depending upon the varnish used. Varnish application was done, followed by immersion of these samples for 24 hours in artificial saliva, followed by peeling off of varnish. A pH cycling of 28 days was done after the varnish application before assessing the remineralization of the samples. Evaluation of all these samples was done at three different time intervals, baseline, after demineralization, and post remineralization for microhardness on the enamel surface. Raman spectroscopy was utilized for the measurement of phosphate (P) ion release. Sectioning of these samples to a thickness of 100 µm approximately was done to be viewed under a polarized light microscope. Results: Bioactive glass incorporated varnish showed the highest microhardness values, mineral content levels, and least depth of lesion posttreatment. Conclusion: All the experimental varnish showed significant remineralizing potential with the best potency seen with bioactive glass incorporated varnish. Clinical significance: The nonfluoride agents can be appropriately used in 2 wt% amount to augment the benefits of fluoride.

Aim: The present cross-sectional study was done to evaluate the attitudes and knowledge of caregivers toward oral health and early childhood caries (ECC) in preschool children in the Jazan population. Materials and methods: The present cross-sectional study was carried out on 105 study subjects, including parents of children, using a self-administered structured questionnaire. The demographic variables and information regarding the awareness and knowledge of caregivers were recorded. The data gathered were analyzed using statistical analysis using IBM Statistical Package for the Social Sciences (SPSS) version 20.0 software. Result: Among 105 children, 66.7% were male, showing male predominance regarding ECC. Among parents, 52.4% were with a bachelor's degree. Most parents lack awareness in regard to dental caries affecting their children. Parents lack knowledge regarding various preventive and treatment options available. Conclusion: The study revealed that caregivers had very less knowledge and clinical practice concern with the oral well-being of preschool kids. The study's results reveal that promotion programs in relation to oral health are required to cover the gaps of knowledge among mothers of kids related to the care of oral health in their young kids. Clinical significance: Different health-concerned behaviors are being affected by awareness and knowledge, and the health of the oral cavity is not an exemption. It has been postulated that diseases of the oral cavity are affected by social factors. Thus, this study was conducted to find the connection between the knowledge of parents regarding their oral health and the status of the health of their children's oral cavities.

Aim: The success of the pulpectomy depends on adequate access, cleaning, shaping, and good-quality obturation. Evaluating the quality of obturation is the major tool that determines the success of the procedure. The present study aimed to assess the quality of obturation in all the canals of primary teeth and suggest a new classification. Materials and methods: A total of 1,000 radiographs of the pulpectomy procedure performed in primary molars were evaluated. The quality of obturation was assessed for each canal using the criteria given by Coll and Sandrian. The prevalence of each obturation criterion in every canal was represented in the form of a percentage. Results: It was observed that among the mandibular primary molars, most of the mesial canals were underfilled, and in the distal canal, most of the canals were overfilled. Among the maxillary primary molars, most of the mesial canals were overfilled, more distal canals were underfilled, and with respect to palatal canals, optimal obturation was seen. Conclusion: The pitfalls of the previous classification were revised, and a new classification for assessing the quality of obturation was proposed, which is arch, segment, and canal specific. Clinical significance: The new classification will give a more precise assessment for the evaluation of various techniques and materials used for pulpectomy in primary teeth.

Background: In particular, when it comes to systemic diseases like hemophilia, good dental health is crucial to a person's overall health and wellness. Through the means of this study, we aim to assess the prevalence of various dental anomalies in children suffering from hemophilia in comparison to healthy children and assess their treatment needs. Materials and methods: This was a descriptive, case-control study with 400 subjects, 200 each in the study (hemophilic) and control (nonhemophilic) groups. The subjects ages ranged from 5 to 15 years. Utilizing the oral hygiene index-simplified (OHI-S), the state of oral hygiene was documented (OHI-S). Using decaying extracted filled tooth (DEFT) and decayed, missing, and filled tooth (DMFT) for the primary and permanent dentition, respectively, teeth afflicted by dental caries and teeth restored/extracted as a result of dental caries were assessed. Statistical Package for the Social Sciences (SPSS) software (version 27.0) was used for statistical analysis. Results: Hemophilic people had a considerably greater incidence of dental caries. Furthermore, even though their DMFT/DEFT and OHI-S scores were barely poorer than those of healthy people, children with hemophilia had a significantly larger percentage of dental treatment needs across all age categories than the other group. Conclusion: The percentage of hemophilic children who needed dental treatment across different age groups was significantly higher than the other group, which supports our observations that the dental health status of hemophilic children was poor and treatment requirement was high among them as well. This is true even though the DMFT/DEFT scores and OHI-S scores in hemophilic children were only slightly worse than in healthy individuals.

Hypodontia is an inherited condition involving the absence of one to six teeth. The permanent dentition is the most frequently affected; however, it may also affect the primary dentition. A congenitally missing tooth (CMT) is the most common dental abnormality, with the missing mandibular second premolar, maxillary lateral incisor, maxillary second premolar, and mandibular central incisor accounting for 90% of CMT in hypodontia studies. The etiology of CMT has been attributed to environmental and genetic contributing factors, with the latter having a strong influence. It may occur in isolation or in association with syndromes. Congenitally missing mandibular incisor is more common in the Asian population and females. Depending on the number and location of missing teeth, hypodontia may be a considerable issue for the clinician since it may impact occlusal balance, mastication, speech, and esthetics and often requires a multidisciplinary approach. Missing mandibular incisors are of particular interest to orthodontists because of the possibility of mandibular retrognathism, the potential for the development of malocclusion, and difficulty in achieving a balanced occlusion. This case report describes the skeletal and dental features of a nonsyndromic familial occurrence of missing mandibular incisors in three generations. A comprehensive literature search was also performed to review the familial cases with missing mandibular incisors.

Aim: White opacities have always been a major esthetic concern in young patients reporting for dental treatment. We aimed to achieve an esthetic noninvasive immediate correction of these lesions. Background: These discolorations of enamel have a multifactorial etiology and are mainly caused by dental fluorosis, early enamel caries, developmental defects, etc. Conventionally available treatment options for these white opacities include noninvasive and invasive approaches. Recently, a novel “microinvasive” technique has been introduced as an alternative therapeutic technique to manage these opacities esthetically and in a painless way, in a single sitting with no complications. Case description: This paper illustrates the use of resin infiltration to esthetically treat white spot lesions (WSLs) on the anterior maxillary teeth in a 24-year-old female caused due to orthodontic treatment. Conclusion: Resin infiltration can be an effective treatment option for the correction of WSLs on the labial surface of anterior teeth seen after orthodontic treatment. Clinical significance: The resin infiltration technique can be a preferred option for treating superficial WSLs and has a high patient acceptance rate with minimal risk of postoperative sensitivity.

Aims and background: The success of endodontic treatment in open apex teeth depends on the establishment of an ideal apical barrier so that apical canal space between the periodontium and the root canal system is filled. Biodentine is a calcium silicate-based cement having several advantages over mineral trioxide aggregate (MTA), glass ionomer cement (GIC), and calcium hydroxide in the treatment of teeth with open apices. Orthograde delivery of biodentine is technique-sensitive and requires multiple radiographs for verification, as well as retrograde placement of biodentine requires surgical intervention. To use the advantages of biodentine and to overcome the disadvantages of placement techniques, an innovative technique was done to obturate the tooth with an open apex using a custom-fit prefabricated BioRoot inlay in this case report. Case description: In the present case, biodentine has been used as a BioRoot inlay to overcome the disadvantages of various management options of open apex with parallel dentinal walls. BioRoot inlay is an intraradicular custom-made prefabricated restoration which provides the three-dimensional seal of the root canal space and promotes an apical barrier formation in a wide-open apex. This BioRoot inlay, placed passively in the canal, had a good seal laterally and apically along with the Biodentine as sealer forming a monoblock. This sealer helps in sealing milder discrepancies between the plug and the root, providing a three-dimensional seal which had resulted in good healing of periradicular bone. Conclusion: Biodentine, when used as BioRoot inlay, has been shown to induce faster periapical healing. It provides promising results when used in open apices with parallel walls. It establishes three-dimensional obturation and proper apical seal, which promotes effective root-end induction. Clinical significance: It can be considered as the effective and definitive alternative for nonsurgical and surgical approaches to treating open apex.

Aim: This article describes a peripheral oral giant cell granuloma (POGCG) in a pediatric patient and its surgical management and histological characteristics. Background: Peripheral oral giant cell granuloma (POGCG) is a hyperplastic reactive lesion formed by a proliferation of mononuclear cells and osteoclast-type giant cells in vascular tissue, occasionally with bone formation. Generally found in women and adults, POGCG has rarely been described in children. Case description: An 8-year-old girl was consulted for an exophytic lesion in the anterior area of the upper jaw, which had increased in volume in the preceding weeks. An excisional biopsy of the tumor was performed with an electrosurgical pencil. The pathological diagnosis was POGCG. Conclusion: Excision followed by additional therapy, such as scaling and curettage, should be the first option in the treatment of POGCG. Clinical significance: Early detection of these lesions involving the periodontium is important in order to reduce bone loss and avoid pathological dental migration.

Aim: The aim of this case report is to describe the dentofacial manifestations of achondroplasia and highlight concerns associated with dental management of pediatric patients with achondroplasia. Background: Achondroplasia is the most common form of skeletal dysplasia (dwarfism) with clinical manifestations including disproportionate limb shortening and stunted stature. The craniofacial characteristics of achondroplasia are relative macrocephaly, depression of the nasal bridge, and maxillary hypoplasia. Special precautions are necessary during dental management of pediatric patients with achondroplasia due to a large head size, implanted shunts, airway obstruction, and difficulty in head control. Case description: A 6 years and 7 months male, the patient was diagnosed with achondroplasia, currently receiving vitamin D, no known drug allergy, and a mixed dentition stage with multiple caries, mouth breather, and a high risk of further caries based on a caries risk assessment due to poor oral hygiene. As the patient was uncooperative and required extensive dental care, dental rehabilitation was conducted under general anesthesia using oral intubation due to nasal obstruction. Future examinations were planned for every 3 months. Conclusion: The current case demonstrated that the characteristics of achondroplasia might cause respiratory, neurological, skeletal, orthodontic, and psychological difficulties. Pediatric dentists who treat these patients must be able to detect these characteristics and difficulties, as dental treatment is limited by practical issues associated with this condition. Clinical significance: The characteristic features of achondroplasia are attributed to skeletal, respiratory, neurologic, orthodontic, and psychosocial issues. The dentist should be aware of the features of achondroplasia, which can potentially restrict dental management.

Background: This is a case report presenting the behavioral and dental management of a 9-year-old child recently diagnosed with autoimmune encephalitis, seizure disorder, and psychosis and treated with anticonvulsant and antidepressant medications. In this case, seizure semiology was presented as eye blinking during the attack, and the child was usually not conscious. It is absorbed by itself and associated with a post-sleeping attack that lasts for minutes. Case description: Parents presented to the pediatric dental clinic with a chief complaint of decayed teeth that needs to be restored. The child has mixed dentition and is diagnosed with anterior crossbite and single posterior crossbite. The child was cleared by the pediatric neurologist and psychiatrist and had no contraindications to dental treatment under local anesthesia. The child's treatment was completed on the dental chair without any seizure attacks, and the patient's chief complaint was resolved. Conclusion: Pediatric dentists should be educated about dental precautions and consider drug interactions when treating children with autoimmune encephalitis. Various types of non-pharmacological behavior guidance techniques and pharmacological methods of behavior management techniques can aid in the behavioral management of children with psychosis.