Background and aim: A new concept of antibiotic sterilization has come into existence which can be used to sterilize the demineralized portion of the teeth with minimal or ultraconservative excavation of caries in deep dentinal carious lesions as an alternative for indirect pulp therapy (IPT) and pulpotomy to avoid further complications. This study was undertaken to compare the success rates of antibiotic sterilization, indirect pulp treatment, and pulpotomy in the management of primary teeth with deep carious lesion. Materials and methods: Ninety teeth involving deep carious lesions approaching pulp in primary molars were selected and randomly divided into three groups containing 30 teeth. Group I was treated with antibiotic sterilization using 3Mix-MP paste, group II was treated with indirect pulp treatment using calcium hydroxide, and group III was treated with conventional pulpotomy using 15.5% ferric sulfate (FS) solution. Clinical and radiographic analysis of all three groups was performed at 1, 3, 6, 9, and 12 months to evaluate the success of treatment procedures using predetermined criteria. Pearson's Chi-squared test and McNemar test were used for statistical analysis. Results: At the end of the 12-month follow-up period, the overall clinical and radiographic success was determined to be 96.3% for group I, 100% for group II, and 96.4% for group III. There were no statistically significant differences observed between the success of three groups, suggesting that either of the procedures can be adopted for the management of deep carious lesions approaching pulp in primary teeth. Conclusion: Antibiotic sterilization can be introduced as a newer modality in the management of deep carious lesions approaching pulp in primary teeth which is ultraconservative in nature and reduces the risk of pulp exposure in comparison with indirect pulp treatment and pulpotomy procedures.

Aim: Compare the efficacy of triple antibiotic paste (TAP), herbal extracts, and camphorated monochlorophenol (CMCP) as intracanal medicaments against Enterococcus faecalis (E. faecalis) in deciduous molars. Materials and methods: A total of 60 samples were collected from canals of first and second molars of 4–10-year-old children, with more than two-thirds root length, and fitting the inclusion criteria. Samples were collected at three intervals—S1 was collected just after access opening, S2 was collected after biomechanical preparation (BMP) and irrigation, and just before placement of medicament. Randomization was done to place the medicaments into three groups: group I—CMCP, group II—TAP, and group III—herbal combination. Sample S3 was taken 48 hours after removal of medicament from the canals. The collected samples were transported via Amies media to the laboratory, where they were anaerobically incubated for 24 hours. Growth of E. Faecalis was observed, and manual counting of the colony-forming unit (CFU) was done. The change in CFU in all samples was calculated, and the results were statistically analyzed. Results: The results show that there is a change from S1 (TAP = 118.67 ± 122.48, herbal = 109.07 ± 106.43; CMCP = 110.73 ± 120.53) to S2 (TAP = 34.13 ± 63.47; herbal = 27.67 ± 39.39; CMCP = 16.40 ± 26.32) and S3 (TAP = 12.33 ± 24.82; herbal = 4.73 ± 12.78; CMCP = 3.40 ± 7.12). It is seen that there is a significant difference seen from S1 to S2 in all three groups (p ≤ 0.05) using repeated measure analysis of variance (ANOVA) test. This shows that all three medicaments were effective in reducing bacterial counts of E. Faecalis from sample S1 (pre) to S3 (post) significantly after exposure to root canal bacterial flora for 48 hours (2 days). The pairwise comparison of the change in CFU within each group, S1–S3, also shows significant changes. There is a significant decrease in CFU seen from S1 to S2 and S1 to S3 but not from S2 to S3 for all three groups, which was evaluated using the post hoc Bonferroni test. It was also observed that in between the canals, although there was a change from S1 to S3 in terms of the CFU, there was no significant difference in the decrease in the bacterial count when intercanal comparison was made. There was, however, a change that was seen to be significant when values from each canal were compared from S1 to S3. Conclusion: All three medicaments have successfully shown a decrease in the numbers of E. faecalis, which the study aimed at checking. Although the effect varied intergroups, it was mild, so herbal alternatives could be used instead of antibiotics and CMCP. Also, because the local application is effective in controlling interappointment flare-ups, the medicaments can be successfully given without having to prescribe systemic antibiotics.

Background: Mentally disabled children have been found to have poor oral hygiene, a greater prevalence of periodontal disease, and higher caries prevalence. Flossing is an important oral hygiene skill adjacent to toothbrushing in plaque removal than brushing alone in children. GumChucks is a novel flossing device designed to assist children with easy and proper flossing techniques. To compare the efficacy of the GumChucks flossing system and string floss (SF) for plaque removal in mentally disabled children. Materials and methods: Participants were randomly assigned to either GumChucks or SF. At baseline, a toothbrushing and flossing demonstration was given to all the participants. Gingival index (GI) and plaque index (PI) were recorded at baseline, 1 week, and 4 weeks postusage. Results: Overall, there was a significant reduction in GI and PI after first use with children using GumChucks compared to SF floss. After 1 week and 4 weeks of postusage, children in the GumChucks group demonstrated significantly greater improvement in GI (1.03 ± 0.60), (1.12 ± 0.66), and PI (0.97 ± 0.53), (1.10 ± 0.54) from baseline p ≤ 0.05. Conclusion: GumChucks was an effective alternative plaque removal, with recommended caretakers’ supervision for mentally disabled children.

Aim: Socially handicapped children face a number of challenges including limited access to basic health including oral healthcare. The aim of this study is to determine the oral health status and treatment needs of socially handicapped children and to assess the effectiveness of the Comprehensive Dental Health Program (CDHP) on their oral health-related quality of life (OHRQoL). Materials and methods: A total of 97 children in the age-group of 7–14 years were enrolled in the study. Prior to the implementation of CDHP, the collection of baseline data including basic demographic data, dentition status, decayed, missing, and filled teeth (DMFT), and treatment needs [World Health Organization (WHO) 1997] was done. CDHP was instituted based on their assessment and treatment needs. The evaluation of OHRQoL was done at baseline as well as a postintervention intervention at the end of 12 months. Statistical analysis: Kolmogorov–Smirnov test was applied to find normality. Paired t-test and Wilcoxon sign rank tests were applied for item analysis in the questionnaire. The value of p < 0.05 was considered statistically significant. Results: The mean domain scores of OHRQoL at baseline and following CDHP showed a statistically significant difference. There was a consistent overall increase in the postintervention domain scores with respect to all the components. Conclusion: The oral health status of socially handicapped children was found to be fair requiring minimal dental treatment. CDHP instituted among them was beneficial in improving their OHRQoL. Clinical significance: Assessing the impact of oral diseases using a multidimensional constraint and planning appropriate interventional measures that improve the general well-being of socially handicapped children.

Aim: The aim of the study was to determine the efficacy of commercially available immunoglobulin Y (IgY) chewable tablets on Streptococcus mutans (S. mutans) count in patients undergoing orthodontic treatment. Materials and methods: Participants aged between 12 and 19 years who had fixed, nonextraction orthodontic treatment with no carious lesion were included in the study and advised to take IgY chewable tablet for 15 days (one course) and saliva samples were collected from the patients on day 61, 91, and 121 days from the placement of fixed appliance, to assess its ability in reduction of S. mutans count. The collected samples were processed, and S. mutans levels were estimated. The results were tabulated and subjected to statistical analysis using Statistical Package for the Social Sciences (SPSS) version 20, and the repeated measures test was used to compare different groups. Results: Immunoglobulin Y (IgY) chewable tablet was found to be significantly effective in decreasing S. mutans counts in patients undergoing orthodontic treatment during the study period. Conclusion: Oral passive immunotherapy via egg yolk antibody IgY effectively decreased the S. mutans level, which was found to increase during orthodontic fixed appliance treatment. Clinical significance: The IgY chewable tablets can be used as an adjuvant to reduce S. mutans counts and provide basic oral hygiene measures.

Aim: To compare the impact of fifth- and seventh-generation bonding agents on the microleakage between Embrace WetBond sealants and Ionoseal. Materials and methods: Forty extracted human premolar teeth were used for the study and grouped according to different sealants and bonding agents—group I: Embrace WetBond sealant with fifth-generation bonding agent; group II: Embrace WetBond sealant with seventh-generation bonding agent; group III: Ionoseal with fifth-generation bonding agent; group IV: Ionoseal with seventh-generation bonding agent. For microleakage evaluation, all the teeth were subjected to invasive sealant placement using the respective sealant materials in combination with bonding agents as specified. The treated teeth were stored at 37°C for 24 hours and then thermocycled for 100 cycles at temperatures of 5°C and 55°C with a dwell time of 30 seconds. In order to assess microleakage, the samples were immersed in 0.2% methylene blue dye for 24 hours, then sectioned in buccolingual direction, and evaluated under stereomicroscope. Results: The mean microleakage scores in group III were highest at 0.90 ± 0.57, while the least was in group IV at 0.30 ± 0.68, indicating that Ionoseal with seventh-generation bonding agent was the most effective. However, when the mean microleakage scores of the four groups were compared using Kruskal–Wallis test, it indicated that the differences were not statistically significant.

Physical development and growth are significantly influenced by adequate nutrition. Enamel, dentin, and dental pulp are among the tissues that contain iron, which is regarded as a necessary element for human health. The disadvantages of the available iron drops include bad taste and black discoloration of primary teeth. In areas that are decalcified and hypomineralized, this discoloration is more noticeable. Therefore, efforts are being made to create iron drops that have a more pleasant taste and minimal adverse effects (i.e., no or minimal tooth discoloration). Liposomes are minuscule vesicles made of the bilayer of phospholipids that can encase both hydrophilic and hydrophobic drugs to boost their effectiveness and lessen side effects (color staining). Therefore, the goal of the study is to compare the color stability of cosmetic materials with that of pediatric liposomal iron supplements and regular pediatric iron supplements.

Purpose: The idea of psychological ownership (PO) has been utilized in a variety of contexts, but the significance and lessons learned from using PO in dental clinical education have not been investigated. A detailed long-term study of PO in dental clinical education will allow us to understand the effectiveness of this practice. The purpose of this paper is to compare undergraduate (UG) student's clinical performance before and after the PO system was implemented. Materials and methods: A retrospective study was conducted with around 70–80 students in an academic year from June 2012 to June 2019. Through ownership quality, four-handed dentistry, observation and assistance, supply of must-haves, and measurable outcomes, the clinical performance of students in pre- and post-PO systems was compared. Results: The quantum of overall clinical procedures performed by the UG students was 8,214 and 13,753 in pre-PO and post-PO, respectively. Chi-squared tests performed unveil that there exists a statistically significant difference in the quantum of clinical procedures performed by UG after the implementation of PO. Conclusion: The results of our study clearly state that there was a significant increase in the quantum of clinical procedures performed by UG students after the implementation of the PO system.

Purpose: The purpose of the study is to compare and evaluate the efficacy of herbal extracts over modified triple antibiotic paste (MTAP) as intracanal medicaments against Enterococcus faecalis (E. faecalis). Ginger, turmeric, and nutmeg extract were checked for antibacterial activity by agar disk diffusion method at 100, 50, 25, and 12.5% concentration. Combination groups were prepared, and the combination group showing the best zone of inhibition was further evaluated. Materials and methods: A total of 103 samples were taken and divided into five groups: group I—MTAP, group II—ginger, group III—turmeric, group IV—nutmeg, and group V—saline. Based on different concentrations, the groups were again subdivided into subgroups at 100, 50, 25, and 12.5%. Combination groups of ginger + nutmeg, ginger + turmeric, and turmeric + nutmeg were made and evaluated. The combination group showing the best zone of inhibition was again divided into 100, 50, 25, and 12.5% and further evaluated. Results: Modified triple antibiotic was effective in the elimination of E. faecalis. Herbal extracts showed a reduction in the number of E. faecalis. Nutmeg showed a reduction in E. faecalis, followed by ginger, followed by turmeric. Conclusion: This study shows that the combination of ginger + nutmeg at 12.5% concentration (35 mm) showed the highest zone of inhibition among all the herbal combinations, which is almost equal to that of MTAP.

Aim: To determine the effectiveness of distraction with virtual reality (VR) distraction devices in comparison with mobile phone video games in the management of pain and anxiety during dental treatment in 6–9-year-old children. Materials and methods: It was a comparative observational study. A total of 33 children aged 6–9 years who reported to the department for their first dental visit were selected and the subjects were divided into three groups. Group I patients were in a normal clinical environment without any distractions. Group II patients were given mobile phone video games. Group III patients were given a VR distraction device as a means of distraction. The anxiety levels of patients before treatment, after using a distraction device preoperatively, during local anesthesia injection, and after dental treatment were assessed. Pain after local anesthesia injection in each group was assessed. The easability of handling the patient and carrying out the procedure was assessed using a questionnaire. All data were collected and analyzed. Results: The results showed when compared to the children in groups I and II, children in group III obtained significantly lower anxiety scores after treatment, and they also reported significantly decreased pain perception during dental treatment (p < 0.001). The pain while administering local anesthesia was greater for the control group and lowest for the VR group. It was observed that VR group patients were easier to handle and easier to carry out procedures than those in the mobile phone group. Conclusion: Virtual reality distraction is an effective distraction technique for reducing pain and anxiety in children during various treatment procedures. Clinical significance: Virtual reality distraction can be used effectively in clinics. It is a patient-friendly technique and is more comfortable for both patients and dentists during treatment. It does not require any previous education and training and has a positive impact on memories of the treatment, leading to behavior modification.

Aim: To compare and evaluate the efficacy of transcutaneous electrical nerve stimulation (TENS) and a vibrational precooling system in reducing pain and anxiety during the administration of local anesthesia in children aged 6–12 years old. Materials and methods: A total of 60 children aged 6–12 years old participated in this randomized controlled trial and were randomly allocated to three groups: the conventional method group, the vibrational precooling system group, and the TENS group. The Modified Dental Anxiety Scale (MDAS), pulse rate, and oxygen saturation were recorded to assess the preoperative anxiety of the participating children. Sound, motor, and eyes (SEM) and face, legs, activity, cry, and consolability (FLACC) scores were recorded during the procedure, along with pulse rate and oxygen saturation, to measure pain during the procedure. This was followed by a self-administered visual analog scale (VAS) to assess the discomfort felt by the child. Results: A statistically significant reduction in pain was observed with the usage of the vibration system and TENS, as measured by the FLACC scale, compared to the conventional method group. Similarly, statistically significant differences in SEM scores were noted between the vibrational precooling system group and the conventional method group, as well as between the TENS group and the conventional method group, with the highest scores observed in the conventional method group. The children reported the highest comfort levels with the usage of the vibration system, as indicated by the self-administered VAS. However, no statistically significant difference was observed within any group. Conclusion: The new vibrational precooling system as well as TENS can be effectively used to alleviate the pain experienced during the administration of local anesthesia.

Introduction: The preferred treatment for primary teeth that are necrotic has been pulpectomy. Despite being the gold standard for years, using hand files can be difficult because of the longer chairside periods. Technology advancements have made it possible to reduce the need for manual dexterity and enhance pulpectomy care. Pediatric rotary files are now available specifically for use with primary teeth. This study's goal was to assess and contrast the instrumentation time and obturation quality of manual H files and pediatric rotary file systems (Prime Pedo™ and DXL-Pro™ rotary file systems) in primary mandibular molars. Materials and methods: A total of 51 deciduous mandibular molars that were evenly distributed for instrumentation were subjected to pulpectomy. Group I included the Prime Pedo™ rotary file system, group II included the DXL-Pro™ rotary file system, and group III included manual H files. A stopwatch was used to record the instrumentation time, and a postoperative radiograph was used to record the obturation quality. Results: When comparing pediatric rotary file systems to manual H files, there was a statistically significant reduction in instrumentation time (p = 0.000). When comparing the pediatric rotary file systems to the manual H files, there was no discernible difference in the obturation quality (p = 0.534). Conclusion: In all three file groups, the quality of obturation produced results that were comparable. On the other hand, a significant difference was observed in the instrumentation time between rotary and manual instrumentation for deciduous teeth.

Aim: The aim of the study is to evaluate and compare the antibacterial efficacy and remineralization potential of acidulated phosphate fluoride (APF) gel with herbal dental gel containing Zingiber officinale, Salvadora persica, and Cinnamomum zeylanicum. Materials and methods: Ethanolic extracts of Z. officinale, S. persica, and C. zeylanicum were prepared. Minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of these extracts were determined against Streptococcus mutans and Lactobacillus acidophilus using the resazurin method and agar plate streaking method, respectively. The herbal dental gel was formulated, and its cytotoxicity was evaluated using an 3-(4,5-dimethythiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay. The antibacterial susceptibility of APF gel and the herbal dental gel was assessed using the agar well diffusion method and time-kill assay. The remineralizing potential was evaluated using a stereomicroscope. Results: Herbal dental gel showed better antibacterial efficacy as depicted by the zone of inhibition of 20 and 21 mm obtained against S. mutans and L. acidophilus, respectively, compared to 11.50 and 16.50 mm zone of inhibition obtained by APF gel. The herbal dental gel also showed better remineralization potential than APF gel after a time interval of 24 and 48 hours, as depicted with a statistically significant p-value of 0.0061 and 0.0219, respectively. In the cytotoxicity test, the fibroblasts showed 100% viability in the presence of both study groups. Conclusion: The results of our study concluded that herbal dental gel is safe and nontoxic, having anticariogenic potential due to its good antibacterial action and remineralization potential as compared to conventional APF gel.

Background and objectives: Early childhood caries (ECC) remains one of the most prevalent diseases mutilating the primary dentition. It is a multifactorial disease that severely affects the quality of life of affected children. One of the risk indicators reported in the literature is the presence of viable mutans streptococci (MS) and protective factors such as salivary immunoglobulin A (SIgA). Hence, it is important to identify such risks and protective factors associated with ECC using simple yet reliable methods supported by advanced technology and a fully automated platform to improve the results. Materials and methods: A retrospective analysis was done on 40 children who were divided into two groups: group I (experimental) and group II (control). Group I comprised 30 healthy children who were further divided into three subgroups of 10 children each. Group IA with decayed, missing, filled teeth/decayed, extracted, filled teeth (dmft/deft) = 1–2, group IB with dmft/deft = 3–4, group IC with dmft/deft ≥5, and group II, comprising 10 healthy children having no caries by using World Health Organization (WHO) 2013 Oral Health Survey criteria. Unstimulated saliva was collected by drooling saliva into a sterile container. The samples were transported to the central research laboratory for SIgA by the immunoturbidimetry method by a fully automated Abbott Architect c system. The data obtained was subjected to statistical analysis. Results: On comparison of SIgA in between varying severities of dental caries and caries-free children between age-group of 3 and 6 years, it was found to be below the grand median 0.20 mg/mL for subgroups IA and control group II. A significant negative statistical correlation (r = −0.948) was present between the SIgA and varying severities of ECC and the control group. Interpretation and conclusion: The low dmft/deft group was found to be relatively closer to the caries-free groups as their mean dmft was 1.50, standard deviation (SD) ± 0.53. A slight change in dmft/deft score and SIgA could be used as a potential biomarker for assessing the severity of ECC in children between age-group of 3 and 6 years.

Aim: This study was designed to compare the clinical efficacy of two esthetic restorative materials, nanoceramic (Magma NT^®) and giomer (Beautifil II^®), as full coronal restoration in primary maxillary incisors. Materials and methods: A total of 15 patients aged 3–5 years presenting with mutilated primary maxillary incisors due to caries or trauma were selected for the study using randomized simple sampling. A total of 40 maxillary incisors were randomly divided into two equal groups, with 20 teeth in each group. Teeth in group I (GP I) were restored with nanoceramic (Magma NT^®) and group II (GP II) with giomer (Beautifil II^®). The full coronal restorations were done using strip crowns (3M ESPE). The restorations were evaluated for gross fracture, marginal integrity, and secondary caries according to modified Ryge's criteria [United States Public Health Service (USPHS)] at baseline (immediate postoperative), 3, 6, and 9 months. Parental satisfaction with each type of restoration was also evaluated using the Likert 5-point scale. Results: The data obtained was statistically analyzed using the Chi-squared test, and the level of significance, that is, the p-value, was determined. The Chi-squared test showed no significant changes to all modified USPHS criteria for each material at baseline and 3-month evaluation period. The changes recorded were after a 3-month follow-up between the two materials; nanoceramic (Magma NT^®) restoration demonstrated marginally better than giomer (Beautifil II^®) in terms of gross fracture and marginal integrity; however, there was no statically significant difference between them (p > 0.05), while giomer (Beautifil II^®) was better than nanoceramic in terms of secondary caries (p < 0.05). Parental satisfaction for both entities was comparable in terms of color and durability; however, they were cost-ineffective. Conclusion: Nanoceramic restoration demonstrated better results in terms of gross fracture and marginal integrity, while giomer was better in terms of secondary caries. Clinical significance: Nanoceramics and giomers can serve as an alternative to conventional restorative materials in primary anterior teeth because of their improved qualities.

Aim: The aim of our pilot study is to analyze the relationship between dental caries and albumin and calcium levels in serum and saliva in adolescent patients with varying caries experience as determined by their caries progression between the age-group of 9 and 19 years. Materials and methods: A total of 20 subjects were selected based on their level of caries progression and divided into four groups of subjects, five in each as follows: group I—enamel caries, group II—dentinal caries, group III—pulpal caries, and group IV—control group. The saliva and serum were collected under standardized conditions from selected patients and analyzed for the presence of albumin and calcium, and then they were correlated to the same level in serum. The statistical analysis was done using the Chi-squared test. Results: According to the present study, there is an increase in the levels of caries with a decrease in the levels of salivary albumin and calcium. Serum albumin and calcium levels were also found to be decreased in caries-prone individuals; hence, a significant correlation between serum and salivary albumin and calcium levels was found. Conclusion: According to a review of the literature, we found an inverse relationship between the levels of albumin and calcium in serum and saliva with dental caries patients. So, it confirms the importance of albumin and calcium levels in inhibiting carrier progression. So it may be used as a biochemical indicator to evaluate the susceptibility of caries.

Background and objectives: Early childhood caries (ECC) is the most common chronic disease of childhood in many developing countries, which is associated with local, systemic, psychological, and social consequences. Multiple variables are shown to be associated with an increased risk of ECC. The knowledge regarding the role of saliva in the pathophysiological process of ECC still remains controversial and unexplored. Scanty studies focused on probing the role of salivary flow rate, pH, buffering capacity, and secretory immunoglobulin A (sIgA) in unstimulated whole saliva of children with ECC and children without ECC. Aim: To assess the salivary flow rate, pH, buffering capacity, and sIgA levels in children with ECC and caries-free children and to evaluate their role in caries risk assessment. Materials and Methods: The study was carried out among 64 children aged between 24 and 71 months. Clinical examinations were carried out according to the criteria by the World Health Organization, and carious status was recorded. Subjects were categorized as group I with ECC (dmfs-Decayed, Missing or Filled Surfaces (Deciduous dentition) of ≥5), and group II included children without ECC (dmfs = 0). Unstimulated whole salivary samples were collected in a sterile vial and stored at −70°C by draining. Estimations of salivary flow rate, pH, buffering capacity, and sIgA levels were done. Digital pH meters were used for the estimation of pH and buffering capacity. A human IgA enzyme-linked immunosorbent assay (ELISA) kit was used to estimate sIgA levels. Statistical software IBM Statistical Package for the Social Sciences (SPSS) statistics 20.0 (IBM Corporation, Armonk, New York, United States of America) was used to analyze the data. Results: The mean salivary flow rate decreased in group I children with ECC (0.15 ± 0.05) when compared to group II children without ECC (0.67 ± 0.14), which was statistically significant. In caries active children, no statistically significant correlation was found between salivary flow rate and the dmfs scores [r-value (−0.247)] and p-value (0.147). The mean level of salivary pH is decreased in group I children with ECC (4.65 ± 0.4) when compared to group II children without ECC (7.28 ± 0.18). In the caries active group, the levels of salivary pH decrease as the dmfs scores increase, and this correlation is found to be statistically significant (r-value of 0.547 and p-value of 0.002). The mean level of buffering capacity is decreased for caries-active children (5.45 ± 0.49) when compared to caries-free children (8.94 ± 0.42). In caries active children, as the dmfs scores increase, the salivary buffering capacity decreases, and this correlation is found to be not statistically significant (r-value of −0.334 and p-value of 0.161). The mean levels of sIgA in group I children with ECC were higher (10.61 ± 0.90) than that in group II children without ECC (6.11 ± 1.22). In the caries-active group, the salivary sIgA levels were comparatively higher than in the caries-free children. As the dmfs scores increase, the level of the sIgA increases in caries-active children, and this correlation is noted to be highly statistically significant (r-value of 0.769 and p-value 0.008). Conclusion: Children with ECC showed decreased salivary flow rate, pH, buffering capacity, and increased sIgA levels, while children without ECC showed increased salivary flow rate, pH, buffering capacity, and decreased sIgA levels. The salivary parameters, such as salivary flow rate and buffering capacity, showed no correlation with the dmfs score, while salivary pH and sIgA levels have a positive correlation in caries-active children.

Introduction: The cycles of demineralization and remineralization result in a dynamic process of caries development. Caries are prevented by the shift in the balance from demineralization to remineralization at the tooth-oral fluid interface with the help of salivary fluoride levels (in parts per million). The advantages of fluoride varnish application over other substitutes like dentifrices, mouthrinses, gels, or foams are that varnishes are well tolerated by infants, young children, or children with special healthcare needs and have prolonged therapeutic effects. This study was formulated to evaluate and compare the longevity of fluoride release from different fluoride varnishes, namely Fluor Protector, Enamelast, and Enamel Pro varnish. Aim: To evaluate and compare the longevity of fluoride release from three different fluoride varnishes. Materials and methods: The study samples comprised 72 healthy permanent maxillary anterior teeth. The teeth were divided into four groups, with eighteen teeth in each group. The surfaces of all teeth were then covered by different colored nail varnish according to the respective group, except for a 3 × 3 mm window on the facial (labial) surface of the crown, where the test materials were applied according to their respective group. In group I, Fluor Protector varnish; in group II, Enamelast varnish; and in group III, Enamel Pro varnish was applied. Group IV was the control group; hence, no test material was applied. All specimens were then stored in plastic containers with a pH of 7.2 in artificial saliva at room temperature. The specimens were transferred into new plastic containers after 1 day, containing fresh artificial saliva, and solutions from previous plastic containers were taken for fluoride analysis. This process was repeated sequentially to analyze the amount of fluoride released in ppm from the specimens at the end of 1, 3, and 6 months. Statistical analysis: Analysis was performed on Statistical Package for the Social Sciences (SPSS) software (Windows version 22.0). Results: Conventionally used 1.5% ammonium fluoride varnish, that is, Fluor Protector varnish, showed the least release of fluoride (0.03 ± 0.0 ppm), while resin carrier-based 5% sodium fluoride varnish, that is, Enamelast varnish showed a good amount of fluoride release for 6 months continuously, that is, (0.16 ± 0.06 ppm) at last follow-up. Enamel Pro varnish, which has 5% sodium fluoride with amorphous calcium phosphate (ACP) formula, was found to be the best varnish as it released the maximum amount of fluoride in ppm in artificial saliva for up to 3 months (0.32 ± 0.08) but less than Enamelast varnish only at 6 months follow-up that is 0.09 ± 0.03 ppm. Conclusion: The present study concludes that based on the amount of fluoride released for 6 months duration, Enamel Pro varnish, followed by Enamelast varnish and Fluor Protector varnish, are advisable to apply for caries prevention.

Background: Dental fear and anxiety are important issues in the practice of pediatric dentistry because they interfere with both the provision and receipt of dental care in children and adolescents. Behavior guidance is a dynamic part of child management. It starts from the preappointment level, where a negative attitude of the mother will be trained to become positive for improved child behavior in the pediatric dental clinic. The use of anticipatory guidance (AG) as parental counseling, where the information on what the parents should follow before their child's dental appointment was provided to the mothers. Aim: To assess the effect of preappointment parental counseling on dental fear and anxiety in children. Materials and methods: The study was a randomized, parallel-group, active-controlled trial, wherein the dyad of mother and child was randomly divided into two groups: (1) the test group and (2) the control group. At baseline, fear and anxiety assessment was done using fear and anxiety assessment scales and physiological parameters in both groups. Dental fear and anxiety were assessed using the children fear survey schedule dental subscale, Venham pictorial test in children and state-trait anxiety subscale in mothers. Parental counseling instructions were given verbally, in written format and by videos only in the test group on the same day of the initial appointment. The same subjects in both groups were checked for fear and anxiety scales and physiological parameters after 6 months from the first appointment. The effectiveness of parental counseling on dental fear and anxiety was correlated at the end of the study. Statistical analysis: The mean dental fear and anxiety scores between the test and control groups at baseline and at 6 months were compared using the Chi-squared test. Chi-squared test was used to compare the dental fear and anxiety in children and mothers in the study and control groups. Spearman's rank correlation test was used to assess the relationship between Children's Fear Survey Schedule-Dental Subscale (CFSS-DS), Venham Picture Test (VPT), state-trait anxiety inventory (STAI) scores, and clinical parameters in the study and control group of both populations. Results: The results showed that there was a significant improvement in the dental fear and anxiety levels in the dyads of mother and child postcounseling. The control group scores did not show any significant change. Conclusion: Preappointment parental counseling clarified and guided parents about the child's fear and anxiety and was effective in alleviating the dental fear and anxiety among parents and children attending pediatric dental clinics.

Aim: The aim of this case report is to present three different patients who had horizontal and vertical root fractures of young permanent teeth, its diagnosis, clinical and radiographic findings, treatment, and long-term follow-up and success rate. Background: Root fractures are relatively rare with the prevalence of 0.5–7% in permanent and 2–4% in deciduous dentition. Timely intervention and accurate treatment procedures are the main concerns for long-term success of root fractures. Case description: Case I and case II had horizontal fracture of immature permanent tooth. Patients reported with a chief complaint of pain in their upper central incisors. As a result of radiographic examination, horizontal root fractures were diagnosed. Teeth were treated with a mineral trioxide aggregate (MTA) plug (case I and case II) and repositioning and splinting (case II). Case III had vertical root fracture of immature permanent tooth. Tooth was treated with apexification (sectional obturation) and sealed with resin-modified glass ionomer cement (RMGIC) till the fracture site and flowable light cure restoration. Patients were scheduled for follow-up visits at different time intervals. Radiographic evidence indicated ongoing root development in these immature teeth. Normal color and mobility were observed, and no pain was noted during horizontal and vertical percussion tests. Conclusion: The present case report shows a favorable and stable outcome of timely treatment and sound healing of various types of root fracture. Long-term follow-up of patients with trauma is essential because pathological changes can occur several years following injury. Clinical significance: The latest treatment modalities and long-term follow-up showed clinical success.

Background: The crown is considered the most effective restoration for the management of dental caries. It reproduces the morphology and contour of the damaged coronal portion of the tooth while maintaining its function. The esthetic needs of children and the demands of parents bring advancement in dentistry toward a new era of esthetic crowns. In this era of esthetic crowns, the newly introduced preformed BioFlx crown seems to be an effective esthetic treatment option. Case description: In the present case series, full coverage restoration for the management of carious and pulp therapy-treated primary molars was done by esthetic and flexible BioFlx crown (Kids-e-Dental, LLP, Mumbai, India). Over a 6 months period, the crowns have demonstrated good retention and esthetic results. Conclusion: Dealing with the esthetic needs of children and managing primary molars using BioFlx crowns would be practical and successful. Clinical significance: The treatment described in the case series is a new advancement in pediatric dentistry with promising esthetic alternatives.

Aim: The aim of this current case series is to propose various design modifications of the conventional distal shoe space maintainers in relation to complex clinical scenarios. Background: Primary dentition plays a significant role in preserving space for underlying unerupted permanent teeth; early childhood caries (ECC) is a serious public health problem in both developing and developed countries, and it is often left untreated. Its consequences can have an immediate and long-term impact on the child's quality of life and overall health. Premature loss of primary dentition can result in loss of arch length, thereby hampering the eruption of the succeedaneous tooth, which can further lead to malalignment, crowding, rotation, and impaction of the permanent teeth. Space maintainers are advocated in cases where extraction of primary molars is inevitable. In the early loss of the second primary molar, a distal-shoe space maintainer is advocated to guide the eruption, as well as prevent mesial migration of the first permanent molar (FPM) during the eruption. In clinical scenarios where multiple losses of deciduous molars occur bilaterally, obtaining adequate anchorage is questionable and futile. The following clinical modifications, however, are useful in overcoming the problems related to the same. The following case series intends to project various modifications of distal shoes in complex scenarios. Case description: Various modifications of the distal shoe have been proposed in our current case series. The appliances were adjusted individually on a case-to-case basis depending on the clinical scenario. A 1-year clinical follow-up was carried out on all the patients. Conclusion: All the clinical modifications were successful in guiding the eruption of a FPM; there were no complications during any follow-up visit. Clinical significance: In cases where the traditional design is not indicated, certain modifications in distal shoes by adding new components to the appliance will allow the appliance to be placed and the space to be maintained effectively. Along with this, reinforcement of parents and the child for oral hygiene maintenance will maintain the remaining healthy tooth structure and increase the success of treatment.

Aim: This article aims to report a case of face mask therapy and comprehensive orthodontic treatment for skeletal class III malocclusion in a 16-year-old girl. Background: Treating skeletal class III malocclusion in a growing patient is crucial, as it can help avoid the need for additional surgery. Early treatment also lessens the negative impacts of the patient's facial abnormality on their social life because surgery is only done later. Case description: In this case report, a 14-year-old female patient presented with skeletal class III malocclusion with primary complaints of anterior crossbite. There was no relevant medical history. Face mask therapy and fixed appliance therapy were components of the treatment approach that successfully corrected the malocclusion. The total period of treatment was 20 months. Conclusion: The treatment resulted in a harmonious face, a well-aligned smile arch, stable dental and skeletal relationships, and significant esthetic improvements, including improved facial symmetry and profile. Significance: A growing teen who has a skeletal class III malocclusion and a maxillary deficit may be helped by a combination of face mask therapy and thorough orthodontic treatment. This case report outlines the use of the aforementioned technique to successfully treat a 14-year-old child with class III malocclusion and maxillary deficiencies. Early management of skeletal class III malocclusion in developing adolescents is vital as it can potentially eliminate the necessity for future surgical intervention, leading to improved treatment outcomes. Careful case selection, patient cooperation, and long-term stability enable a successful, stable, and esthetically pleasing treatment outcome.

Purpose: The purpose of our study was to perform a systematic review to assess and compare the effectiveness of the air abrasion technique with that of the conventional acid-etching technique performed before the placement of pit and fissure sealants. Materials and methods: A search of studies was conducted in May 2021 using PubMed, Cochrane Library, and Google Scholar databases. Clinical trials in the English language between 1997 and 2019 were included. The quality of the studies was analyzed using the Cochrane Collaboration tool. Results: The search retrieved 276 references, out of which seven studies were included for a qualitative analysis. In these seven studies, the risk of bias across the Cochrane tool's domains varied from low to high. All the included studies considered acid-etching as a comparator to air abrasion technique either used alone or as an adjunct to acid-etching technique. Conclusion: When coverage of sealants or their retentivity was compared at different time intervals, it was more in the acid-etching group than in the air abrasion group. Similarly, carious lesions were seen more in the air abrasion group than in the acid-etching group. The air abrasion technique followed by acid-etching brought superior retention properties of sealants than the acid-etching technique alone.