Background: Resin infiltration is a technique in which a low-viscosity resin penetrates the proximal carious lesions and stops caries progression. Aim: This study aimed to compare the progression of proximal enamel caries of primary molars following the application of resin infiltrant clinically and radiographically vs Tooth Mousse. Materials and methods: This case–control split-mouth study evaluated 64 proximal surfaces of primary molars in 32 patients. Each patient had one pair of noncavitated proximal caries in two primary molars from different quadrants with radiographic evidence of enamel involvement. The carious lesions in each patient were randomly treated with resin infiltrant and Tooth Mousse. Progression of carious lesions was evaluated clinically and radiographically after 12 months. The two groups were compared by Fisher's exact test. Results: No caries progression was noted in the resin infiltrant group at 12 months, and all 32 surfaces (100%) showed cessation of caries. Four surfaces (12.5%) in the Tooth Mousse group showed caries progression. The two groups were not significantly different in this regard (p = 0.242). Conclusion: Resin infiltrant and Tooth Mousse were both effective in stopping the progression of proximal enamel caries of primary molars.

Background: Management of white spot lesions (WSLs) using resin infiltrants, like ICON®, is a novel technique that emphasizes the concept of minimally invasive dentistry. Aim: Evaluate penetration depth and its effect on caries progression of ICON® in natural WSLs of primary molars. Design: A total of 30 human primary molars with natural WSLs were selected. A total of 15 samples each were randomly selected to evaluate penetration depth and caries progression. To evaluate penetration depth, lesion surfaces were sectioned into two halves, wherein one half served as control, while the other half received ICON® infiltration treatment. To evaluate the effect on caries progression, samples were sectioned into two halves, wherein one half served as a control to its experimental counterpart, which received ICON® infiltration. The initial depth of the subsurface lesion (baseline data) was measured, and all the sample subsets underwent pH cycling. Confocal laser fluorescence microscope (CFLM) evaluation was performed, and penetration depth was assessed using a laser scanning microscopy (LSM) image reader, while caries progression was evaluated using PhotoScape® software. Results: ICON® resin infiltrant penetrated to significant depths into the WSLs (p < 0.001) and demonstrated significant inhibition of caries progression (p < 0.001). Conclusion: The novel technique using ICON® could be an invaluable tool in the management of WSLs in primary teeth.

Background: Pediatric dental crowns play an integral role as they maintain the form and function and prolong the life of the affected tooth. However, placing a crown in the oral cavity creates a new niche for the adhesion of microorganisms that can lead to plaque accumulation, gingival inflammation, and the development of secondary caries, which in the long term might determine the clinical success of the restored tooth. The present study allowed us to assess the changes caused by the full coverage restorations at a clinical, immunological, and microbiological level using enzyme-linked immunosorbent assay (ELISA) and microbial analysis. Materials and methods: The in vivo analysis consisted of a total of 26 children aged 3–10 years. They were divided into two groups, group I (n = 13) children receiving preformed zirconia crowns and group II receiving stainless steel crowns (SSCs). Plaque index (PI) scores, gingival index (GI) scores, and interleukin-6 (IL-6) levels were assessed at baseline and at 45 days of follow-up. The in vitro part of the study consisted of 13 preformed zirconia crowns and 13 SSCs which were immersed in artificial saliva containing strains of Lactobacillus casei which were then processed for their microbial analysis. Results: On mean comparison, preformed zirconia crowns performed superiorly both clinically and immunologically compared to SSCs. Microbial analysis using independent t-test revealed that the colony-forming units (CFU) per milliliter was statistically significantly higher for the SSCs, and the mean difference among the groups was statistically significant (p < 0.01). Conclusion: Preformed zirconia crowns can be a relative replacement for SSCs in primary teeth with the advantage of esthetics and superior periodontal health.

Introduction: Local anesthetics are used to alleviate pain, but the prick of the injection delivering anesthesia is known to cause anxiety and pain that affect dental treatment. The most difficult aspect of pediatric dentistry is minimizing discomfort while the intraoral local anesthetic is administered. This pain has been treated using physical, psychological, pharmacological, and combinations of these approaches. Recently, the idea of vibration, which is based on the gates control theory, has gained popularity as a way to reduce discomfort while local anesthesia (LA) is being administered. Aim: The aim of this trial was to evaluate the efficacy of mucosal vibrators in children aged 6–10 years to alleviate pain associated with LA administration. Materials and methods: A total of 60 patients aged 6–10 years requiring inferior alveolar nerve block were enrolled for this randomized, single-blind clinical trial. In group I, before and during LA administration, the customized mucosal vibrator was placed at the injection site. In group II, the topical local anesthetic gel was applied to the injection site prior to the administration of LA. Then, the local anesthetic solution was deposited using a disposable syringe needle on both groups. The pain was evaluated using the physiological scale (pulse rate and oxygen saturation), the subjective scale (Wong–Baker scale), and the objective scale [Face, Legs, Activity, Cry, Consolability (FLACC) scale] by an experienced assistant who was unaware of the procedure. Results: A customized mucosal vibrator along with local anesthetic injections resulted in significantly less pain (p = 0.001*) when compared with the injections with topical anesthetic gel. Conclusion: The results show that the customized mucosal vibrator is an effective and inexpensive means to reduce pain during LA administration.

Aim: The purpose of the present study is to evaluate the effect of nanosilver fluoride (NSF), chlorhexidine (CHX), and sodium fluoride (NaF) when used as a varnish on Streptococcus mutans levels in children with dental caries. Study design: A total of 120 children (age range 8–12 years) with incipient caries were randomly assigned to four groups (n = 30): group I—NSF varnish, group II—CHX varnish, group III—NaF varnish, and group IV—control. Varnish application at baseline was performed once. To assess the levels of S. mutans using the culture method [colony-forming units (CFUs)] and optical density (OD), plaque and samples were taken at baseline (T0), 1 month (T1), and 3 months (T3). Additionally, the oral hygiene index-simplified (OHI-S) was noted for clinical assessment. Results: By the end of 3 months, a statistically significant reduction in plaque CFU and salivary CFU was found in group II. At the conclusion of the 3 months, group I had the greatest decrease in OHI-S. After 3 months, the plaque CFU score did not differ significantly across groups I, II, and III. However, a statistically significant difference in OD values (p-value of 0.00) was discovered between group I and all other groups. Conclusion: Children with early caries can effectively lower their S. mutans count by using NSF varnish.

Background and objective: Malocclusion is a manifestation of normal biological variability, defined as a misalignment of the teeth or an incorrect occlusion between the upper and lower dental arches. This study aimed to evaluate the mandibular intercanine primary, mixed, and permanent dentition in school children of Shimla, Himachal Pradesh. Materials and methods: This cross-sectional study was conducted on 1,392 children between the ages of 4 and 18 years from schools that fulfilled the inclusion criteria. The dental casts were poured and further divided based on the dentition stage, i.e., primary, mixed, and permanent dentition stages. Mandibular arch widths—interincisor and intercanine were measured on the casts by a digital vernier caliper. Results: The statistically significant difference was found as the interincisor width increased from primary to mixed dentition and between males and females for permanent dentition. Intercanine width significantly increases from primary to mixed dentition and gradually from mixed to permanent dentition stages. Conclusion: The present study found that there is a significant increase in interincisor and intercanine width in the lower dental arch from primary dentition to permanent dentition.

Background: Despite the introduction of several anticaries products, dental caries continues to be a global problem. In recent years, there has been a rise in interest in noninvasive treatment for noncavitated caries lesions by employing remineralization concepts. Each remineralizing agent has its own drawbacks. Therefore, it is desirable to seek new agents that offer the advantages of earlier counterparts with lower detrimental reactions. Aim: The purpose of this research is to evaluate the remineralization efficacy of nanoparticle-based materials on white spot lesion (WSL) in children. Materials and methods: A total of 45 children between the age-group of 4 and 8 years with WSLs were selected and randomly divided into three groups. At baseline, the teeth with WSLs were confirmed and identified using International Caries Detection and Assessment System II (ICDAS II) criteria, and the dimensions of the lesions were measured using photographic methods. Then, they were randomly placed into three groups of 15 samples each—group I nanosilver fluoride (NSF), group II nanohydroxyapatite (nano-HAP) serum, and group III MI varnish. Following that, the varnish was applied, and follow-up was done in the 2nd, 4th, 12th, and 24th week. Results: By the 4th week, all three groups had a statistically significant difference (p < 0.05). Baseline measurements for groups I, II, and III showed that their respective mean WSL dimensions were 4.9 ± 0.66, 4.27 ± 0.69, and 5.44 ± 2.95. The dimensions of each group were reduced by the 24th week to 1.22 ± 0.46, 0.93 ± 0.41, and 2.19 ± 1.40, respectively. Overall, group II (nano-HAP serum) showed a statistically significant decrease in the dimension of the lesion at the end of the 24th week, followed by groups I and III. Conclusion: The remineralization of enamel was induced by all three agents. Nano-HAP serum is more successful than MI Varnish and NSF.

Background: In pulpectomy, to remove the inflamed or diseased pulp tissues and smear layer, the root canal is disinfected with mechanical instrumentation and copious irrigation. Aim: The purpose of this present study is to evaluate the antibacterial efficacy of etidronic acid as an irrigant in primary teeth. Materials and methods: A total of 60 necrotic primary teeth in children aged 3–8 years were included. Of these, 30 were irrigated with 2% chlorhexidine (CHX) gluconate (group I) and 30 with 9% etidronic acid (group II). Two microbiological samples were collected with sterile paper points from the canal in both groups during the pulpectomy process—first after access opening and before the first irrigation (S1), and second after instrumentation and final irrigation, before filling (S2). The presence of Enterococcus faecalis was determined using colony-forming units per milliliter (CFU/mL) in all samples (S1 and S2). Results: After analyzing the samples before and after irrigation in groups I and II, there was a statistically significant reduction in CFU/mL (p < 0.05). Group II had a statistically significant advantage when the two groups were compared after irrigation. Conclusion: As a result, etidronic acid can be recommended as a pulpectomy irrigating solution for necrotic primary teeth.

Background and objectives: Due to decreased manual dexterity, a lack of motivation, and difficulty on the part of the caregiver conducting efficient oral hygiene measures at home, patients with Down syndrome (DS) are badly affected. The objective of this study is to compare the efficacy of 0.1% octenidine (OCT) hydrochloride and 0.12% chlorhexidine (CHX) gluconate on plaque control and oxidative stress in institutionalized children with DS. Materials and methods: In 20 children, salivary samples were collected for analysis of the inflammatory marker high-sensitive C-reactive protein (hsCRP) and oxidative stress markers, specifically malondialdehyde (MDA). Plaque index (PlI) and gingival index (GI) were scored. After oral prophylaxis, the participants were randomly assigned to two groups, each consisting of 10 individuals (octenidol and CHX). Salivary oxidative stress marker assays were carried out using a modified version of Yagi's (1984) method, and absorbance was measured at 540 nm using an ultraviolet-visible spectrophotometer at 535 nm. hsCRP assays were conducted via latex turbidimetric immunoassay. Results: On comparison between the two groups, the OCT group showed a statistically significant reduction in GI, PlI, and MDA values (p < 0.05). Conclusion: It was seen that the use of 0.1% OCT hydrochloride could facilitate the maintenance of good oral hygiene and periodontal status, especially in patients with motor difficulties. Clinical trial registration: PMS/IEC/2016/02.

Purpose: Evaluation of survival rates for three space maintainers (SMs) of different designs compared to the standard one. Materials and methods: A total of 52 extraction sites in children aged 4–7 years with prematurely lost primary molars were selected for this study. The whole sample was divided into four groups of 13 each. In group I, Band and Loop (B&L); group II, single-sided Band and Loop (Ss B&L); group III, Direct Bonded Wire (DBW); and group IV, Tube and Loop (T&L). Children were recalled at 3, 6, 9, 12, and 15 months. Cumulative survival rates of SMs were estimated using the Kaplan–Meier method with a logrank test. Results: Although there was a nonsignificant difference in the number of failed cases among all groups, the overall survival rate for group I was 69.2%, group II was 53.8%, group III was 38.5%, and group IV was 30.8% at the end of the study. The failure types for B&L were solder breakage (75% of the total failure rate) and cement dissolution (25%); for Ss B&L, they were solder breakage with lost loop (50%), soft tissue impingement (33%), and dislodgment (17%); for DBW, they were composite-wire interface debonding (75%) and enamel-composite interface debonding (25%); and finally, for T&L, they were lost T&L (56%), soft tissue impingement (22%), and total loss (22%). Conclusion: Banded SMs survived for a longer time than bonded ones, with superior performance for B&L compared to Ss B&L. In addition, bonded SMs required strict isolation conditions. DBW could be used in the maxilla rather than the mandible and was preferable for older children.

Background: There is limited literature comparing the remineralization potential of these two dentifrices, Elsenz™, which contains fluoro calcium (Ca) phosphosilicate, and Shy-NM™, which contains Ca sodium phosphosilicate, are a few of the remineralizing agents. Aim: To assess and compare the remineralization potential of Elsenz™ and Shy-NM™ dentifrices on artificially induced carious lesions on permanent teeth, using the Vickers microhardness measuring method and scanning electron microscope (SEM) connected to energy dispersive X-ray analysis after laboratory stimulation of the oral environment employing the pH cycling model. Materials and methods: A total of 30 sound human premolar teeth were divided into six groups for both parameters. Group I—Elsenz™ dentifrice, group II—Shy-NM™ dentifrice, and group III—control. The surface microhardness (SMH) of the test specimens was evaluated followed by a scanning electron microscope with energy dispersive analysis (SEM-EDAX). The specimens were tested at baseline, demineralization, and remineralization. The collected data were subjected to statistical analysis. Results: Surface microhardness following remineralization with Elsenz™ was 359 Vickers hardness number (VHN), and with Shy-NM™ was 312 VHN. Elsenz™ showed significantly higher remineralization compared to Shy-NM™ (p = 0.002). The SEM-EDAX of the tooth specimens after remineralization revealed an increase in the Ca weight percentage (wt%) compared with demineralization values, which was statistically significant for both Elsenz™ (45.95 ± 3.55%) and Shy-NM™ (47.24 ± 1.99%), along with an increase in the phosphorus wt%, which was statistically significant for Elsenz™ (20.25 ± 0.95%) compared to Shy-NM™ (19.95 ± 0.59%). Conclusion: Within the scope of this study, the incorporation of fluoride in bioactive glass (BAG) in Elsenz™ had the potential to remineralize enamel better than Shy-NM™ dentifrice. It can, therefore, be concluded that Elsenz™, when compared with Shy-NM™, would be effective in inhibiting demineralization.

Aim: The aim of this study was to determine whether the intake of cheese, paneer, and yogurt may help in reversing the acidogenic challenge after the consumption of chocolate at different time intervals. Materials and methods: A total of 120 caries-free children between the ages of 4 and 13 years, with no decayed, missing, and filled teeth (DMFT), were randomly selected from the school. Baseline pH was obtained, and the subjects were asked to eat chocolate. pH was measured again after 10 minutes. Following chocolate exposure, the subjects were then randomly assigned to three groups—cheese, paneer, and yogurt. Salivary pH was measured at intervals of 15, 30, and 60 minutes using the same procedures for all subjects. The data thus obtained were subjected to statistical analysis, which included analysis of variance (ANOVA) test, post hoc tests for multiple comparisons using Tukey's test, and paired t-test. Results: The highest pH value after 15 minutes was seen in cheese (6.43), followed by paneer (6.31) and yogurt (6.30). After 30 minutes, the maximum pH value was seen in the cheese group (6.63), followed by yogurt (6.46) and paneer (6.34). The mean pH value 60 minutes after the consumption of dairy products was highest in paneer (6.53), followed by cheese (6.43) and yogurt (6.37). Conclusion: All the categories were observed in the zone of remineralization. It should be noted that the maximum pH value overall was seen in the cheese group. Clinical significance: Dairy products help maintain salivary pH, which aids in improving enamel health. Hence, dietary dairy recommendations can be incorporated into patient education and caries prevention plans.

Aim: The in vitro study aimed to evaluate and compare the antimicrobial efficacy of Elettaria cardamomum (0.5%) mouthwash, Camellia sinensis (0.5%) mouthwash, and 0.12% chlorhexidine gluconate mouthwash against Streptococcus mutans. Materials and methods: A total of 60 samples of the five mouthwash preparations were prepared to check for their antimicrobial efficacy. The zone of inhibition (ZOI) against S. mutans was measured as a diameter in mm, and the minimum inhibitory concentration (MIC) of mouthwash preparations was measured as μg/mL. All the groups were compared statistically using the Mann–Whitney U test and the Kruskal–Wallis test. Results: The highest ZOI was observed in group V chlorhexidine gluconate [mean: 20.8, standard deviation (SD): 0.58], followed by group III C. sinensis (alcohol-free) (mean: 15.5, SD: 0.67), group IV C. sinensis (alcohol-based) (mean: 14.08, SD: 0.66), and group II E. cardamomum (alcohol-based) (mean: 13.2, SD: 0.45). The least ZOI was observed in group I E. cardamomum (alcohol-free) (mean: 10.7, SD: 0.45). This difference was statistically significant (p < 0.01). The MIC was similar in all the groups (p = 0.13). Conclusion: Chlorhexidine gluconate 0.12% mouthwash showed the best antimicrobial action; however, C. sinensis mouthwash showed potential against S. mutans. E. cardamomum mouthwash exhibited limited antimicrobial activity.

Introduction: The thermal changes during light curing of resin-based composites (RBCs) are recognized, but there is a lack of information about temperature changes in pulp tissue under different curing protocols, especially during bonding of orthodontic brackets onto the tooth surface. In the present study, pulpal temperature (PT) variation induced by the use of four different light cure intensities and different durations of cure among different classes of teeth was measured. Materials and methods: A total of 80 different classes of human extracted teeth (maxillary and mandibular central incisor, lateral incisor, canine, premolar, and molar) were irradiated at the same distances with four visible light curing intensities. Brackets (3M Unitek) were bonded with Transbond XT (3M Unitek, Monrovia, California) adhesive and light cured with a light-emitting diode (LED) light cure unit (LCU) (Bluephase). A J-type thermocouple wire was positioned in the center of the pulp chamber to assess the temperature difference. The results were analyzed with analysis of variance (ANOVA) and the Tukey's honestly significant difference (HSD) test. Results: Light-emitting diode with higher intensity induced significantly higher intra-PT changes than did the LED with lower intensity (p < 0.001). Mandibular central incisors had the highest intra-PT of about 45°C at 3000 mW/cm², 3 seconds. Maxillary central incisors had the highest intra-PT of about 40°C at 3000 mW/cm², 3 seconds. Mandibular and maxillary canines and molars had the lowest intra-PT of about 10°C at 800 mW/cm², 20 seconds. Conclusion: Pulp chamber temperature changes were influenced by the intensity and duration of curing and the anatomy of the tooth (class/type of tooth).

A borderline case presents with mild skeletal disharmony or orthodontic problems due to arch length discrepancy and migration of teeth or a combination of these but is masked by a balanced soft tissue relationship. This case report describes one such borderline case of a 13-year-old girl who complained of irregularly placed upper and lower front teeth. Extraoral examination revealed balanced soft tissue with a mild convex profile, competent lips, and an average nasolabial angle. Intraorally, she had mixed dentition with flush terminal in primary molars and a class I relation in the permanent molars, severe crowding in the lower anterior, and congenitally missing permanent right laterals. A nonextraction protocol was followed, harnessing the pubertal growth spurt to alleviate the crowding and thereby preserving the soft tissue harmony.

It is a well-known saying that the eyes are “windows to the soul.” The absence or loss of any facial part, particularly the vision, can lead to severe physical as well as emotional trauma. Losing any part of the face causes the patient societal, physical, and psychological anguish. An ocular prosthesis aims to improve social acceptance and boost self-confidence by restoring the facial appearance. A pediatric dental specialist should be a part of the maxillofacial prosthesis team since maxillofacial prosthetic rehabilitation in young children can be challenging, especially with the less cooperative ones. The following case report describes these challenges in relation to a 5-year-old boy who had his eye enucleated due to trauma. The purpose of the case was to provide custom-built, acrylic ocular prostheses in as comfortable and atraumatic manner as possible by the maxillofacial prosthetic team.

Aim: To report a rare case of cheilitis granulomatosa (CG) with pica disorder presented as chronic persistent lip swelling with an unusual eating disorder. Background: Cheilitis granulomatosa or Miescher's cheilitis is a rare, persistent, or recurring nontender chronic painless swelling of one or both the lips due to granulomatous inflammation, which was first described by Miescher in 1945. It can present as a monosymptomatic form or as a part of other entities of Melkersson–Rosenthal syndrome (MRS). Case description: A 14-year-old female patient presented with persistent diffuse swelling of the upper lip for 1 year. She also had an unusual habit of eating clay, mud, and potentially harmful items like flakes of paint for 1.5 years. Clinically, chronic persistent lip swelling involving upper lip and gingival enlargements were present along with systemic manifestations. Patient counseling with combination therapy showed excellent response with no signs of relapse at 6 months of follow-up. Conclusion: Cheilitis granulomatosa is a unique rare inflammatory disorder with many possible contributory factors and exact etiology is poorly understood. Clinical significance: This case report draws attention to constant exposure to an allergen that could be one of the possible etiological factors to CG secondary to pica eating disorder. Though it is a rare disease, research on the pathogenesis of CG and clinical trials evaluating the efficacy of the various treatments are needed to enhance our understanding of this disease, to improve the quality of life, as patients are very disturbed by the unsightly and distressing nature of macrocheilitis.

Aim: To present a case with skeletal class II malocclusion and mandibular retrusion treated using Carriere Motion Appliance (CMA). Background: Management of class II malocclusion in adolescent patients by growth modulation is one of the most debated topics in orthodontics. Fixed functional appliances are generally used in the patients who are at the end of the postpubertal growth spurt. However, most of the fixed functional appliances are placed only after the initial alignment and leveling, which takes up considerable duration of time. The Carriere Motion 3D is an efficient and effective way of correcting the sagittal component of class II malocclusion within the first half year of treatment followed by comprehensive therapy using fixed appliances. Case description: A 15-year-old male patient reported with the chief compliant of forwardly placed upper front teeth and functional jaw retrusion. It was treated initially with CMA and class II elastics for mandibular advancement. Simultaneously, lower arch was bonded with MBT 0.022” prescription for alignment and leveling. After 6 months, class I molar and canine relationship was achieved before proceeding with full orthodontic treatment. After 12 months of fixed orthodontics, the treatment goals were achieved. Conclusion: Carriere Distalizer appears to be more comfortable, offer a more positive overall experience, and has fewer side effects. The changes were mainly dentoalveolar in nature, but there were some skeletal changes, particularly in the sagittal and vertical dimensions. Clinical significance: A significant forward displacement of the mandible was the principal element for successful correction of class II malocclusion. CMA provides the best results for class II management, enabling us to treat such cases with a nonextraction approach rather than contemplating extractions.

Aim: This case report aims to describe the importance of early diagnosis, clinical features, and timely management of multiple odontomas in pediatric patient. Background: Odontoma is a benign odontogenic tumor of epithelial and mesenchymal origin. Odontomas can occur in multiples and can be associated with other dental anomalies. It may adversely affect the normal development and eruption of the permanent succedaneous teeth. Case description: We report a case of multiple odontomas in association with unerupted permanent incisor and its surgical management. Conclusion: The efforts in diagnosing and managing odontomas at an early age hold a good impact on a child's oral health status. Clinical significance: Early diagnosis, proper treatment planning, appropriate management, and regular follow-ups of odontomas hold great importance for pediatric dentists as well as general dentists in routine dental practice.

Foreign bodies may access the oral cavity by trauma or iatrogenically. Iatrogenic foreign bodies that are frequently encountered include amalgam, obturation materials, shattered equipment, needles, broken teeth, and so on. Impaction of a tooth or bone fragment in the soft tissues is one type of dental trauma. When foreign bodies are found in the teeth, it's a highly grave scenario that requires prompt diagnosis. Thorough case histories, clinical assessments, and radiographic analyses are required to draw conclusions regarding the type, dimensions, location, and challenge of the foreign body retrieval. Due to the well-known tendency of children to put foreign objects in their mouths, it is more frequently observed in them. From time to time, children get strange items lodged in their teeth, which they are afraid to tell their parents about. These foreign objects might store possible infections, which could eventually result in a painful condition. This paper discusses the presence of unusual foreign bodies—a broken pencil and tooth fragment—and their management.