Aim: The present case–control study was planned to assess the comparative efficacy of resin-modified calcium silicate, resin-modified glass ionomer, and Dycal as pulp capping agents in indirect pulp therapy for deeply carious young permanent molars. Materials and methods: Thirty deeply carious young posterior teeth were treated by indirect pulp therapy. During the treatment, the cavity floor was lined with TheraCal or resin-modified glass ionomer cement (RMGIC) in the study group and with Dycal (control group) followed by GC IX and composite restoration. The teeth were reviewed and evaluated clinically and radiographically after 6 and 12 months. Results: None of the study subjects experienced pain in any of the three study groups up to 12 months. Maturogenesis was seen in all 30 study teeth. Maximum% gain in dentin formation was seen in group I (TheraCal), that is, 16.100 ± 2.42, followed by group II (RMGIC), that is, 11.6000 ± 1.42, and group III (Dycal), that is, 9.6000 ± 0.96, and the difference between group I and group II and group I and group III was highly significant (p < 0.0001). Dentin formation was observed earlier at 6 months in 82.5% of cases with mesio-occlusal (MO) cavities as compared to 62.5% of cases with disto-occlusal (DO) extension. Conclusion: TheraCal LC may be preferred as a pulp capping agent in the management of deeply carious young permanent molars for better healing in less time.

Aims and background: The golden proportion is based on the premise that there is a link between natural beauty and mathematics. The study aimed to analyze the mesiodistal width of maxillary anterior teeth in primary and permanent dentition to determine whether a golden proportion exists among them. Materials and methods: Sixty subjects were randomly selected in accordance with inclusion and exclusion criteria. Participants were divided into two groups, each comprising 30 children with primary dentition between 3 and 6 years old, and 30 children with permanent dentition between 12 and 13 years old. Intraoral photographs were taken using a smartphone (in-built sensor: Sony IMX890, focal length: 24 mm, aperture: f/1.8) and a cheek retractor, with the head upright and the occlusal plane parallel to the floor. The distance between the participant and the camera was fixed at 4 cm. The digital photographic images were transferred to a computer, and the perceived mesiodistal width was measured for anterior teeth using Adobe Photoshop CS (version 8) software. Results: The ratio of lateral incisor to central incisor was not found to differ significantly between permanent and primary dentition (p-value > 0.05). However, the ratio of canine to lateral incisor was significantly greater in primary dentition compared to permanent dentition (p-value < 0.05). Conclusion: The study revealed that the golden proportion was inconsistent in terms of relative tooth width in primary dentition. Clinical significance: The golden proportion existing in permanent dentition serves as a guide for restoring severely mutilated anterior teeth, so it is important to assess whether the golden proportion exists in primary dentition.

Introduction: Utilizing 38% silver diamine fluoride (SDF) has been demonstrated in clinical trials to prevent and halt early childhood caries (ECC). Based on a research evaluation, it has been found that 38% SDF can effectively prevent new tooth decay and stop existing tooth decay in children's primary teeth. Objective: This study aimed to assess the survival of teeth treated with repeated applications of 38% SDF in children with ECC and to compare the outcomes between single and multiple applications. Materials and methods: A split-mouth, double-blind, active-control, parallel-arm randomized controlled trial was conducted following Consolidated Standards of Reporting Trials (CONSORT) guidelines. Children aged 4–5 years with bilateral ECC were recruited from a primary government school in Maharashtra, India. Treatment involved applying 38% SDF to carious lesions, with lesions randomized into two groups: single application and double application. Follow-ups were conducted at 6 and 12 months to assess lesion progression, depth, and survival. Results: Eighty-four primary carious teeth from 42 female participants were included. Lesions were predominantly occlusal or proximal, with varying sizes and depths. After 12 months, 12 lesions failed in group I (single application) and 3 in group II (double application). The intergroup comparison of mean levels at 12 months showed a statistically significant difference (p = 0.01). Intragroup comparisons showed an increase in lesion depth and level from baseline to 6 months, with a subsequent rise from 6 to 12 months in group I. The mean survival rate of teeth after SDF application at the end of 12 months was around 94% for group II, while for group I it further decreased from 70 to 58%. Conclusion: Repeated applications of 38% SDF showed improved survival rates of teeth in children with ECC compared to single applications. Double application of SDF demonstrated superior efficacy in maintaining tooth survival over 12 months.

Aim: The purpose of the study is to evaluate how well the Endovac system and conventional needle irrigation work to remove smear layers (SR) from primary teeth root canals. Materials and methods: Fifty extracted human primary teeth were divided into two equal sections vertically, then positioned within an acrylic model that was secured with screws. Group A (Endovac), n = 25, and group B (traditional needle), n = 25. Next, a uniform irrigation technique was used in every tooth embedded in the study model. Sections were examined with a 100× magnification stereomicroscope and electron microscope. Statistical tests were used to analyze the data. Results: Endovac removed the SR from the apical third of the root canal system more successfully than a traditional needle (<0.05). Conclusion: Endovac has better performance than conventional needle irrigation in the removal of the SR in the deciduous teeth root canal system. Clinical significance: (1) Removing the SR allows for more cleaning and disinfecting of root canal walls and better adaptation of root canal filling materials. (2) It is essential to remove the entire SR from the root dentin for successful endodontic treatment.

Aims and background: Failure of the endodontic treatment might be due to various reasons like zipping, apical blockade, ledging, debris extrusion, etc. Apical debris extrusion in primary teeth is of major concern as it does not have a proper well-developed apex, that is, mature apex. This study aims to compare and evaluate the apical debris extrusion in primary molars using three different pediatric rotary file system. Materials and methods: Thirty freshly extracted teeth primary molars were divided into three experimental groups according to the used file systems as group I—NT Pedo Gold, group II—Pedo Flex, and group III—Kedo-S. Debris extruded during canal shaping were collected in preweighed vials. Each canal was irrigated with 6 mL of saline and 2 mL of sodium hypochlorite. The amount of debris extruded from each tooth was calculated by subtracting the preinstrumentation from the postinstrumentation measurement. Data were analyzed using analysis of variance (ANOVA) and post hoc Tukey tests with α = 0.05. Results: Kedo-S showed statistically significant lesser apical debris extrusion than Pedo Flex and NT Pedo Gold (p-value < 0.001) while comparing Pedo Flex and NT Pedo Gold insignificant difference. Conclusion: All three pediatric rotary file systems extruded debris apically; while Kedo-S can be safely used as a rotary file in pediatric dentistry with minimal apical debris extrusion. Clinical significance: An ideal rotary instrument should not extrude debris apically, the lesser the extrusion greater the endodontic treatment success. Kedo-S can be securely used as a rotary file with less apical debris extrusion than the other two rotary systems.

Aim and background: Glass ionomer cement (GIC) serves as a widely used restorative dental material, known for its direct bonding to tooth structures and fluoride-releasing properties. This study aims to investigate the enhancement of GIC through the incorporation of a green-mediated nanocomposite comprising chitosan, titanium, zirconium, and hydroxyapatite, with a focus on evaluating the wear resistance of the modified GIC. Materials and methods: A one-pot synthesis technique was utilized to prepare a green-mediated nanocomposite incorporating chitosan, titanium, zirconium, and hydroxyapatite nanoparticles. Forty extracted teeth fulfilling the inclusion criteria were chosen for the study. Each tooth received a class I cavity preparation, and then they were divided into groups. Each group, comprising 10 teeth, received a restoration using green-mediated nanocomposite-modified GIC in varying concentrations: 3% for group I, 5% for group II, and 10% for group III. Additionally, there was a control group (group IV) consisting of conventional GIC without any modifications. To assess the wear resistance of the samples, they underwent a testing protocol, followed by placement in a chewing simulator for 30,000 cycles. Surface scans before and after chewing simulation were conducted, and deviations were superimposed using Geomagic software. The interim of root mean square (RMS), maximum deviation, and average deviation were analyzed to quantify the wear levels. Then the data obtained were subjected to statistical analysis, one-way analysis of variance (ANOVA), followed by Tukey's post hoc analysis to identify any significant differences among the groups. Results: The least deviation of RMS (0.292 ± 0.063), maximum deviation (0.664 ± 0.076), and average deviation (0.263 ± 0.049) were observed in the 5% nanocomposite-based GIC group, followed by the 10 and 3% groups. The nanocomposite-modified GIC groups exhibited superior wear resistance compared to the conventional group. This outcome addressed the limitations of traditional GIC, signifying a substantial advancement in dental restorative solutions. Conclusion: The incorporation of green-mediated chitosan, titanium, zirconium, and hydroxyapatite nanocomposite into GIC demonstrated a remarkable improvement in wear resistance. This study paves the way for future advancements in dental materials, representing a significant stride toward the creation of environmentally conscious and efficacious dental restorations.

Aims and background: Local anesthetics play a crucial role in pain management in pediatric dentistry, where anxiety and fear are common among young patients. This study aimed to compare the anesthetic efficacy of 2% lignocaine with a 20-gauge needle in an inferior alveolar nerve block (IANB) and 4% articaine with a 24-gauge needle in a buccal nerve block (BNB) during the extraction of dentoalveolar abscesses in children aged 5–11 years. Materials and methods: A 12-month randomized controlled trial involving 100 healthy children was conducted following ethical standards. Patients were assigned to receive either lignocaine or articaine anesthesia. Pain assessments were conducted using the Wong–Baker Faces Pain Rating Scale (W–BFRS) and visual analog scale (VAS). Postoperative follow-ups were performed to evaluate pain, biting incidents, and numbness duration. Results: The study demonstrated a strong positive correlation between W–BFRS and VAS ratings, indicating effective pain assessment. While both techniques showed efficacy, the BNB + local infiltration (LI) technique exhibited lower rates of reanesthesia and discomfort compared to IANB + LI. Follow-up assessments revealed shorter numbness duration and reduced biting incidents with the BNB + LI technique. Conclusion: This study underscores the importance of considering patient comfort and experience when selecting anesthesia techniques in pediatric dentistry. Articaine emerges as a favorable option, offering improved pain management and patient satisfaction compared to lignocaine. Both the IANB + LI and BNB + LI techniques are viable options, with the choice influenced by adverse events and patient preferences. This research contributes valuable insights into optimizing pain management for pediatric dental procedures, particularly in cases of dentoalveolar abscesses.

Aim and background: Although local anesthesia (LA) eliminates pain and instills a positive dental attitude, the physical appearance of its syringe is highly fear provoking and often intolerable. Therefore, the purpose of this study was to evaluate the pain and fear perception in camouflaged syringe (CS) and vibration-assisted syringe (VA) when compared with conventional syringe and with each other (VACS) during local anesthetic administration in pediatric patients aged between 6 and 12 years. Materials and methods: Eighty-five subjects were randomly assigned into three groups: CS group (n = 7), VA group (n = 26), and VACS group (n = 27). Physiological and psychometric scale readings were noted before and after injection. The primary outcome was to assess the change in patients’ fear and pain levels using CS and VA vs conventional injection techniques, using the above scales. The secondary outcome was to learn the preference for a particular injection technique by the subjects. Results: Based on the changes seen in the physiological and psychometric scales, pain and fear control was better in CS in the CS group (p < 0.00 for heart rate, VAS, and SEM score), vibration-assisted syringe in the VA group (p < 0.00 for VAS and SEM score), and vibration-assisted syringe in the VACS group (p < 0.00 for VAS score). The majority preference was CS in the CS group (64%), vibration-assisted syringe in the VA group (60%), and CS in the VACS group (52%). Conclusion: VA followed by CS is better than the conventional syringe in terms of reducing pain and fear perceived during LA administration. Children preferred CS over VA or the conventional syringe. Clinical significance: Children's disruptive behavior due to dental fear and pain often results in difficulty in providing effective dental treatment, which is frequently caused by the syringe used in LA delivery. Thus, techniques used to minimize this fear and pain are essential to provide safe, efficient, and quality dental care to children. Trial registration: The trial was registered with the Clinical Trial Registry of India (CTRI/2023/11/059505).

Context: Pulpectomy is recommended for primary teeth when both the coronal and radicular pulp tissues are irreversibly damaged. Biomechanical preparation of root canals is essential for the success of endodontic treatment. Achieving the optimal length during obturation while minimizing voids and ensuring a hermetic seal is crucial for the success of pulpectomy procedures. Aims: The aim of this in vitro study is to compare the root canal obturation quality among Lentulo Spiral, Pastinject, and Dispo Van syringe in primary teeth using cone-beam computed tomography (CBCT) scanning. Settings and design: The selected extracted primary teeth were from the age-group of 4–7 years. Teeth indicated for pulpectomy with at least two-thirds of the total root length present were included. The study was conducted over a duration of 6 months. Methods and materials: The study examined 60 primary tooth root canals, divided into three groups. Endoflas was used for obturation with Lentulo Spiral, Pastinject, and Dispo Van syringe. Postoperative CBCT was used to assess the presence of voids. Statistical analysis used: The values were analyzed for the success rate of obturation using an independent t-test with MedCalc for Windows. Results: In this study, three different filling techniques were evaluated and compared based on the presence of voids in the canals. Pastinject exhibited superior performance with the fewest voids, followed by the Lentulo Spiral and Dispo Van syringe. Conclusion: The findings indicated that the most effective technique for obturating primary teeth was the Pastinject method.

Aim: The aim of this study was to evaluate and compare the apical microleakage of zinc oxide (ZOE) eugenol and Endoflas as obturating materials using different root canal irrigants in primary teeth. Materials and methods: A total of 80 extracted primary anterior teeth were divided randomly into four groups with different irrigants and obturating materials used. Group I [ZOE + sodium hypochlorite (NaOCl)], group II [ZOE + NaOCI + ethylenediaminetetraacetic acid (EDTA)], group III (Endoflas FS + NaOCI), group IV (Endoflas FS + NaOCI + EDTA). Cleaning and shaping of the root canals were done using specified irrigants, followed by obturation with ZOE eugenol and Endoflas as per the respective groups. Specimens were then immersed in 2% methylene blue dye solution and stored for 24 hours. The specimens were split longitudinally into two halves and observed under a stereomicroscope. Apical microleakage was measured from the apex to the most coronal extent of dye penetration. Results: The highest dye penetration was recorded for teeth filled with ZOE, group I (ZOE + NaOCl), with mean values of 1.924 ± 0.925. Endoflas group IV (Endoflas + NaOCI + EDTA) showed the lowest dye penetration with mean values of 0.901 ± 0.255. There was a statistically significant difference between the ZOE and Endoflas groups (p < 0.001). The result showed a statistically nonsignificant difference between the two Endoflas groups (p = 1.000). Minimum microleakage was found in group IV (Endoflas + NaOCI + EDTA). Conclusion: Endoflas FS exhibits less apical microleakage than ZOE eugenol as an obturating material in primary teeth. Hence, Endoflas could be a potential alternative to ZOE eugenol with better sealing ability as an obturating material in primary teeth. Also, the addition of EDTA to irrigation protocol has shown a statistically nonsignificant improvement in microleakage reduction with both obturating materials.

Background: Orofacial cleft is among the most common craniofacial malformations. It presents a complex and multifactorial etiology that involves genetic and environmental factors. One of the etiological factors is consanguinity (marriage between blood relatives). Multiple environmental risk factors, such as advanced maternal age, parity, maternal smoking, radiation, alcohol consumption, diabetes mellitus, and maternal use of drugs (i.e., anticonvulsants), folic acid deficiency, etc., have also been linked to the development of cleft lip and/or palate (CL/P). There is a dearth of literature reporting the occurrence of cleft due to consanguinity and other risk factors. Aim: The aim of this study is to describe the orofacial cleft demographics and to determine the influence of parental consanguinity and other associated risk factors on the occurrence of orofacial clefts (OFC) at a tertiary healthcare hospital in Jammu Province. Materials and methods: This was a hospital-based case-control study. In the present study, data collection was specifically done regarding demographic features, history of consanguinity, degree of consanguinity, and other associated maternal risk factors in both the cleft and control groups. Result: This study elucidates a significant association between parental consanguinity, degree of consanguinity, and other associated risk factors (i.e., maternal age ≥30 years, birth order ≥3, maternal smoking, alcohol consumption, and lack of folic acid consumption) with the occurrence of OFC. Conclusion: Prevention is better than cure. Awareness programs and appropriate counseling should be conducted to educate the community about the risk factors and the anticipated genetic consequences of consanguinity to prevent the development of cleft anomalies in such populations.

Background: When it comes to reducing children's fear, anxiety, and discomfort during dental procedures, substantial local anesthetic delivery promotes adequate intervention. In the dental operatory, local anesthetic injections are the most anticipated or feared stimuli. The application of topical anesthetics, cryotherapy, and transcutaneous electrical nerve stimulation (TENS) to the oral mucosa prior to local anesthetic injections can alter pain perception in children. Aim: To compare the efficacy of cryotherapy application, 2% benzocaine gel, and TENS therapy at reducing pain perception during local anesthesia (LA) administration in pediatric patients. Materials and methods: In this randomized clinical trial, 75 pediatric patients between 4 and 8 years of age who needed LA for dental treatment were selected. They received cryotherapy (EXOCOOL) externally, 2% lignocaine topical gel (intraorally), or TENS therapy extraorally on the area of treatment. A pediatric dentist blinded to the study assessed Faces, Legs, Activity, Cry, and Consolability (FLACC) (subjective method), pulse rate, and SpO₂, and patients were instructed to use a visual analog scale (VAS) to rate their distress during injection and Venham's Picture Test for anxiety assessment. Statistical analyses were performed using the Wilcoxon and Mann–Whitney U tests. Results: The EXOCOOL group had significantly reduced pain scores on the VAS scale (3.80) when compared with the topical anesthetic gel group (4.08). The TENS group had reduced pain scores on the FLACC scale as well (2.84) when compared with the topical anesthetic gel group (3.72), which was statistically significant (p = 0.003). Conclusion: According to our study on pain and anxiety alleviation in children during LA administration, we found that TENS therapy demonstrated the highest effectiveness, surpassing both EXOCOOL and LA gel in providing relief.

Aim: To compare the microleakage in class V cavities restored with Activa Bioactive Restorative, Activa Pronto, and nanohybrid composite. Materials and methods: Standardized class V cavity preparations (mesiodistal: 3 mm; occlusocervical: 2 mm; axial depth: 1 mm) were made on the buccal surface of 60 extracted intact maxillary premolar teeth. The preparations were divided into three experimental groups (n = 20) depending on the restorative material used. Group I: Nanohybrid composite resin, group II: Activa Bioactive Restorative, and group III: Activa Pronto. Samples were polished and thermocycled at 5–55 °C with a dwell time of 60 seconds for 1,000 cycles. The apices were sealed with sticky wax and two coats of nail varnish applied 1 mm away from the restorative margins. Teeth samples were placed in 2% of methylene blue for 24 hours washed and processed for dye extraction method. Teeth samples were placed in a test tube containing 1 mL of concentrated nitric acid (65%wt) for 3 days. Test tubes were centrifuged at 14,000 rpm for 5 minutes, and 100 µL of the supernatant from each was transferred to a plate. The dye absorption was measured by an automated UV spectrophotometer at 550 nm using concentrated nitric acid as the blank. Statistical analysis: One-way ANOVA test followed by Tukey's post hoc analysis was performed to compare the mean microleakage scores between the three groups. Results: There was a statistically significant difference (p < 0.001) in mean microleakage scores between Activa Pronto (0.024 ± 0.002), Activa Bioactive Restoratives (0.045 ± 0.003), and nanohybrid composite resin materials (0.069 ± 0.003). The Activa Pronto group (0.024 ± 0.002) showed least microleakage values as compared to nanohybrid composite resin and Activa Bioactive Restorative group. Conclusion: Activa Pronto and Activa Bioactive Restorative materials may be considered as replacement to the routinely used nanohybrid composites especially in class V cavities due to their bioactive properties and better esthetics. Clinical significance: Based on the results of our study and that found in the literature, it is evident that newer bioactive restorative materials, Activa Pronto and Activa Bioactive Restoratives showed significantly less microleakage in class Vcavities when compared to conventionally used nanohybrid composite resins.

Background: This case report examines the efficacy of intentional reimplantation (IR) in endodontics and explores the increased interest driven by recent advancements in regenerative techniques. Case presentation: A 14-year-old male patient reported pain in the lower left back tooth (tooth #36). The radiographic assessment revealed a 4 mm × 4 mm periapical cyst. The patient chose an innovative approach, undergoing root canal therapy, atraumatic extraction, and immediate replantation using leukocyte and platelet-rich fibrin (L-PRF). A year later, radiographs confirmed cyst resolution with no new dental concerns. Conclusion: IR with L-PRF and Biodentine™ was successful in the treatment of periapical cysts, offering a less invasive but effective alternative for complex endodontic cases.

Aims and background: Myiasis is an infestation of live humans or animals with dipterous larvae that feed on the host's live or dead tissue. The incidence of oral myiasis is rare and even less common in children. Poor oral hygiene, neurological disabilities, bedridden or locomotor disabilities, low socioeconomic status, malnutrition, etc., are shown as important predisposing factors. Case description: A 6-year-old female child reported a chief complaint of swelling, pain, and bleeding in the upper front teeth region for 1 day. Extraoral examination showed swelling of the right anterior region involving the upper lip and persistent mouth opening. Intraoral examination revealed ulceration on the anterior labial gingiva and crawling of maggots on the anterior labial aspect with seeming communication with the palatal aspect. Mechanical removal of maggots and debridement followed by antibiotic application and resorbable suture placement was done. Fourteen-day follow-up showed satisfactory healing. Conclusion: Myiasis is a serious condition that requires public measures aimed at controlling flies, along with the implementation of basic sanitation and maintaining good oral and personal hygiene, for its eradication. Clinical significance: Oral myiasis is a rare condition. The mean age of affected individuals at diagnosis is usually 41.9 ± 27.2 years. The age of the patient in this case report is 6 years with a comorbidity of cerebral palsy.

Aim and background: Angioedema is a nonpruritic swelling that typically affects the skin, mucous membranes of the face, and perioral soft tissues. It can be life-threatening, but it is usually not and can be treated conservatively unless the airway is compromised. This paper seeks to illuminate a rare case of hereditary angioedema (HAE) onset following dental procedures in a 9-year-old Indian boy. Case description: A 9-year-old male patient reported a chief complaint of spacing in the upper anterior region, which was diagnosed to be due to impacted supernumeraries. Two days after the oral surgical procedure, the child developed symptoms of periorbital edema with facial swelling. A second episode occurred a day after the delivery of the orthodontic appliance. This was also associated with facial swelling, respiratory distress, and gastrointestinal (GI) symptoms. A diagnosis of angioedema was confirmed and was treated appropriately. Conclusion: Dental professionals must be aware of the possibility of triggering AE, a potentially fatal condition in patients. This case highlights the importance of comprehensive medical history intake and timely physician collaboration when confronting unexpected symptoms following a dental procedure. Clinical significance: Awareness of rare conditions like HAE can aid dental professionals in early identification and appropriate management, preventing dangerous exacerbations and contributing to safer dental care.

Aim and background: The applications of artificial intelligence (AI) are escalating in all frontiers, specifically healthcare. It constitutes the umbrella term for a number of technologies that enable machines to independently solve problems they have not been programmed to address. With its aid, patient management, diagnostics, treatment planning, and interventions can be significantly improved. The aim of this review is to analyze the current data to assess the applications of artificial intelligence in pediatric dentistry and determine their clinical effectiveness. Materials and methods: A search of published studies in PubMed, Web of Science, Scopus, and Google Scholar databases was included till January 2024. Results: This review consisted of 30 published studies in the English language. The use of AI has been employed in the detection of dental caries, dental plaque, behavioral science, interceptive orthodontics, predicting the dental age, and identification of teeth which can enhance patient care. Conclusion: Artificial intelligence models can be used as an aid to the clinician as they are of significant help at individual and community levels in identifying an increased risk to dental diseases. Clinical significance: Artificial intelligence can be used as an asset in preventive school health programs, dental education for students and parents, and to assist the clinician in the dental practice. Further advancements in technology will give rise to newer potential innovations and applications.

Background: Dental fear and anxiety have become a major obstacle for children to accept dental treatment. Dental anxiety ranks fifth among common fears. Aim: The aim of this current systematic review is to assess the effect of thaumaturgical distraction in reducing anxiety in children undergoing dental procedures. Materials and methods: This current systematic review was registered in Prospero (CRD42023411750) following PRISMA guidelines. Electronic searches were performed in the databases: PubMed, Scopus, Web of Science, and Google Scholar. The search was conducted from inception to March 1, 2024. A broader search strategy was used to prevent missing articles. The search was performed using broad terminology: ((thaumaturgy) OR (magic)) AND (dental). ResearchGate was also consulted, and cross-references were reviewed on this topic to extract all available literature. Only randomized controlled trials are included for data synthesis. Narrative and systematic literature reviews are excluded. Evaluation of the risk of bias is planned using the ROB2 criteria of the Cochrane Collaboration. Results: A total of 798 titles were screened by title and abstract rigorously by three independent evaluators. After duplicate exclusion and removal of irrelevant titles, 11 articles were included for full-text analysis, of which 6 qualified for final data synthesis. Conclusion: Within the limits of the available studies, significantly lower anxiety is exhibited in the children treated under the thaumaturgical distraction group as opposed to the control group.

Background: Hand-over-mouth exercise (HOME) is an aversive technique for child behavior management in a dental office. HOME has been omitted from various guidelines and certain teaching curricula due to legal and ethical issues. This systematic review meta-analysis (SRMA) was undertaken to understand the acceptance of parents toward HOME in comparison with that of other behavior management techniques (BMTs). Objectives: This SRMA compared parental acceptance for HOME and other BMTs from observational studies reported in the literature from 1^st January 2000, to date. Methodology: Two authors independently searched data from the Cochrane Library, PubMed, Google Scholar, Semantic Scholar, and others. Twenty-one studies remained in the systematic review, of which eleven could be included in the meta-analysis. Based on the summary findings of 1,034 participants from 10 studies, we compared parents’ acceptance for HOME vs other BMTs [voice control (VC), tell-show-do (TSD), physical restraint-active (PR-A), physical restraint-passive (PR-P), parental separation (PS), conscious sedation (CS), general anesthesia (GA), oral premedication (OP), and positive reinforcement (PR)]. Data analyses were carried out using RevMan 5.3. The Joanna Briggs Risk of Bias (JB-ROB) tool for cross-sectional analytical studies was used for bias assessment. A funnel plot was used to detect publication bias. Results: Of 20 studies, nine studies reported higher acceptance for GA than HOME; seven reported higher acceptance for HOME than GA, and the remaining four appeared inconclusive. The meta-analysis results (eleven studies) based on forest plots with fixed effects models in terms of OR (CI) indicated no statistically significant difference in the acceptance for HOME vs GA [1.03 (0.84, 1.25)], CS [0.77 (0.60, 1.00)], and PR-P [1.21 (0.92, 1.59)]. In comparison with the acceptance for HOME, CS (NO) [0.65 (0.51, 0.84)], VC [0.48 (0.39, 0.59)], TSD [0.04 (0.03, 0.05)], PR-A [0.65 (0.50, 0.84)], PS [0.28 (0.22, 0.36)], OP [0.55 (0.39, 0.78)], distraction [0.11 (0.09, 0.15)], and PR [0.06 (0.04, 0.08)] were preferred; these being statistically significant. Heterogeneity values (I²) for all comparisons were high (above 80%), with the exception of one (comparison of HOME vs OP) having 50%. ROB across studies was judged to be moderate. The publication bias using the funnel plot analysis for all studies on the basis of SE [Log (OR)] showed marked and fairly equal dispersion on either side of the central line. Conclusion: No statistically significant difference was seen in the acceptance for HOME vs GA, CS, and PR-P. BMTs such as TSD, VC, PR-A, PS, CS (NO), OP, distraction, and PR were preferred to HOME; the difference in acceptance being statistically significant. The differences in acceptance between HOME vs CS (NO) and PR-A did not remain statistically significant when random effects models were used. The heterogeneity was high, the ROB was moderate, and the publication bias was minimal.