Background: Calcium silicate cement like mineral trioxide aggregate (MTA) and Biodentine are known for their biocompatibility and are effectively used as retrograde filling materials. During their placement, the materials interact with oral tissue fluids like saliva and blood, so the aim of the present study was to assess the effect of distilled water, saline, and blood on the surface microstructure and compressive strength of MTA and Biodentine. Materials and methods: In this experimental study, a total of 84 custom-made cylindrical molds were randomly allocated into two main cement groups (n = 42) MTA and Biodentine. Each group was further subdivided into three subgroups (n = 14) as per the testing conditions, that is, samples exposed to distilled water, saline, and fresh blood. Around 10 samples from each subgroup were tested for compressive strength using a universal testing machine (UTM), and the remaining four samples were used to examine the surface characteristics of MTA and Biodentine using a scanning electron microscope (SEM). One-way analysis of variance (ANOVA) and Tukey's post hoc tests were employed to calculate the mean compressive strength and standard deviation values. Results: There was a significant difference in the compressive strength between MTA and Biodentine, especially in the presence of blood. During the SEM analysis, it was found that samples contaminated with blood or saline were devoid of acicular crystals in both groups. MTA group showed a more porous matrix with few hexagonal crystals than Biodentine. Conclusion: Biodentine may be advantageous as a root-end filling or root repair material in the presence of blood.

Purpose: To clinically evaluate whether 4% articaine administered alone as a single buccal infiltration in deciduous maxillary tooth extraction can provide favorable palatal anesthesia compared to buccal and palatal infiltrations using 2% lidocaine. Materials and methods: A prospective, double-blind, split-mouth, randomized controlled clinical study was carried out on 60 children comprising 36 females and 24 males in the age group of 5–10 years. During two separate appointments, children randomly received either 4% articaine with 1:1,00,000 epinephrine (group I—experimental) as buccal infiltration alone, or 2% lidocaine with 1:80,000 epinephrine (group II—control) as buccal plus palatal infiltration. Second local anesthetic agent was administered at least 1 week apart from first administration. Efficacy of anesthesia was assessed using subjective [Wong–Baker Faces Pain Scale (WBFPS)] and objective [sound, eye, motor (SEM)] scales along with occurrence of any adverse effects. Results: For infiltration procedure, 4% articaine (group I) had statistically highly significant (p < 0.001) pain scores on WBFPS as well as on SEM scale compared to 2% lidocaine (group II). According to WBFPS (p = 0.43) and SEM (p = 0.32) scores, the pain on extraction between 4% articaine and 2% lidocaine was statistically insignificant. Conclusion: About 4% articaine buccal infiltration showed better clinical anesthetic efficacy, thus providing effective palatal anesthesia due to its enhanced vestibule-palatal diffusion with no significant postanesthetic complications. Hence, articaine can be used as an alternative to lidocaine in children for extractions of deciduous maxillary teeth.

Aims and objectives: Evaluating the antimicrobial efficacy of the novel combinations of zinc oxide mixed with ajwain oil (ZNOA) and combination of ajwain and eugenol (ZNOAE) vs conventionally used zinc oxide eugenol (ZNOE) against endodontic pathogens like Escherichia coli and Enterococcus faecalis. Materials and methods: The pure cultures of E. coli (MTCC 443) and E. faecalis (MTCC 439) were revived and grown on selective cultural media. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of the test materials were determined correspondingly through sequential dilution and agar well diffusion methods, as per Clinical and Laboratory Standard Institute (CLSI) guidelines. The data values were presented as mean ± standard deviation (SD). The comparisons among groups were completed through the one-way analysis of variance (ANOVA) test, whereas intragroup pairwise comparisons were completed using the unpaired t-test (p < 0.05). Results: Minimum inhibitory concentration values against E. coli and E. faecalis of ZNOE were 250 and 500 µg/mL, ZNOA was 250 µg/mL, and ZNOAE were 125 and 250 µg/mL, correspondingly. MBC values in the form of inhibition zone against E. coli by ZNOE were 21.33 ± 1.53 mm, ZNOA 18.67 ± 1.53 mm, and ZNOAE 20.33 ± 1.53 mm. The E. faecalis inhibition zone for ZNOE was 14.33 ± 2.08 mm, ZNOA 18.67 ± 2.08 mm, and ZNOAE 24.33 ± 1.53 mm. Conclusion: All test materials demonstrated good antibacterial efficacy. However, between the novel combinations of test materials, ZNOA showed better antimicrobial efficacy against resistant endodontic pathogens than ZNOE.

Aims and objective: To compare and evaluate the antifungal efficacy of 3% sodium hypochlorite (NaOCl), 2% chlorhexidine (CHX) gluconate, 4 mg/mL ozonated water, and 2M alum water against Candida albicans (C. albicans). Materials and methods: A total of 35 patients were selected from those attending the outpatient department of Pedodontics and Preventive Dentistry at Santosh Dental College and Hospitals, Ghaziabad. Their salivary samples were taken and cultured on a Sabouraud's dextrose agar (SDA) plate. The antifungal efficacy of 3% NaOCl, 2% CHX gluconate, 4 mg/mL concentration of ozonated water, and 2M alum water was assessed against clinical strains of C. albicans with the help of agar well diffusion method. The microbial isolates were inoculated into 10 mL of sterile peptone water and incubated at 37°C for 8 hours. The cultures were swabbed on the surface of sterile Mueller–Hinton agar plates using a sterile cotton swab. Five wells of 6 mm diameter were punched in each Petri dish. Around 100 µL of each test solution was poured into the designated wells. Further, the plates were incubated in an upright position at 37°C for 24 hours. The antifungal activity of the test solutions was determined by measuring the diameter of the inhibition zone in mm produced against the Candida isolates, and means were calculated. Results: It was observed that all test solutions used in this study were inhibitory against C. albicans but with a variation in the size of inhibitory zones. According to the means of the diameter of inhibitory zones for all test solutions, the 3% NaOCl represented the statistically significant largest average zones of inhibition against C. albicans, followed by 2% CHX when compared with the other two test solutions alum water and ozonated water. Ozonated water produced the smallest mean inhibitory zone.

Aim: This study aimed to evaluate and compare the clinical and radiographic success of platelet-rich fibrin (PRF) and mineral trioxide aggregate (MTA) as direct pulp capping (DPC) agents in primary molars. Materials and methods: In this study, 50 primary first and second molars from healthy children aged 5–9 years requiring pulp therapy were randomly allocated into two groups. In the PRF group, after coronal pulp removal and hemostasis, the remaining pulp tissue was covered with PRF preparation. In the MTA group, after coronal pulp removal and hemostasis, MTA was placed, followed by a zinc oxide eugenol (ZOE) base and glass ionomer cement (GIC) in both groups. Clinical and radiographic evaluations were undertaken at 1-, 3-, 6-, 9-, and 12-month intervals. Results: By the end of the 12th month, the overall success rate was 82.6% in the PRF group, whereas it was 61.9% in the MTA group. Conclusion: Platelet-rich fibrin can be used successfully as an appropriate alternative material in DPC of primary teeth when compared with MTA.

Background: A major drawback of traditional pulp testing procedures is that they depend on neural responses rather than vascular circulation. Hence, this study aimed to develop a custom-modified dental sensor using a finger pulse oximeter (PO) that is applicable to any type of tooth so as to test its ability and accuracy in evaluating the oxygen saturation (SaO₂) values of teeth at different developmental stages as a measure of pulp vitality. Materials and methods: A customized finger PO was employed to determine the systemic and pulp SaO₂ levels in 300 children. A total of 600 teeth (primary and permanent) were divided into group I (100 primary molars), group II (200 permanent molars), group III (200 permanent incisors), and 100 endodontically treated (primary and permanent) teeth were included in group IV. The mean SaO₂ values thus obtained in various groups were compared. Results: Intragroup comparison of mean SaO₂% of the patient's finger (systemic), test teeth, and control teeth showed significant differences (p ≤ 0.001). Intergroup comparisons also revealed significant differences in most of the groups. Conclusions: The modified PO probe can be applied to any type of tooth. It was found to be accurate and sensitive enough to detect changes in SaO₂ levels in various clinical situations irrespective of developmental stage. It proved to be a direct method of evaluation of pulp vitality by objective means.

Background: White spot lesions occur when the pathogenic bacteria have broken through the enamel layer. White spot lesions (WSLs) can be treated using a complex approach. The most crucial step is to stop demineralization and biofilm formation and use assorted strategies for remineralization of lesions, thinning, microabrasion, erosion infiltration, adhesive composite resin restorations, and the bonded facets. Aim: To evaluate and compare the fluoride, calcium, and phosphorus ion release, remineralizing efficacy, and microhardness of zwitterionic material, self-assembling peptide, and bioactive glass (BGA) incorporated with MI Varnish. Materials and methods: The original study was conducted on 60 extracted premolars; the sample size calculated was 10 per group. All samples were divided into four groups—group A, MI Varnish (control), group B, MI Varnish + zwitterionic material, group C, MI Varnish + self-assembling peptide, and group D, MI Varnish + BGA. All these groups were further evaluated and compared for fluoride, calcium, and phorphorus ion release, remineralizing efficacy, and surface microhardness (SMH). Results: Zwitterionic material, when incorporated with MI Varnish showed high fluoride and calcium ion release and high remineralizing efficacy under polarized light microscopy (PLM). BGA, when incorporated with MI Varnish showed high phosphorus ion release and higher values in the evaluation of SMH, followed by zwitterionic material and self-assembling peptide. Conclusion: MI varnish alone had remineralizing properties of WSLs, but when novel materials like zwitterionic ion, self-assembling peptide, and BGA are incorporated, its efficacy increases. Among all zwitterionic ions showed superior results for fluoride and calcium ion release and remineralization and BGA for phosphorus ion release and SMH.

Aim: The present randomized clinical trial is aimed at evaluating clinical efficiency of two different types of esthetic crowns—polymethyl methacrylate crowns and vacuum formed thermoformed crown as an alternative to full-coverage coronal restoration for deciduous molars. Materials and methods: A total of 45 primary molars in pediatric patients were selected using randomization and split into three groups based on the technique used for preparation of crowns: group I—polymethyl methacrylate crowns; group II—thermoformed crown; and group III—stainless steel crowns (SSC). All crowns were clinically and radiographically evaluated at baseline, 1st month, and 3rd month for gingival health, retention, marginal integrity, proximal contacts, occlusion, alignment, and staining. Statistical analysis: The data was tabulated and analyzed by Statistical Package for the Social Sciences (SPSS) Version 23.0 software. The intergroup comparison was done by Kruskal–Wallis test, analysis of variance (ANOVA), and Mann–Whitney U test for continuous data. The intragroup comparison was done by Friedman test and Wilcoxon signed-rank test for categorical data. All p-values < 0.05 were considered statistically significant. Results: With regard to the parameters of plaque score, gingival index score, occlusion, interproximal contacts, retention, alignment, and marginal adaptation, no statistical significance was noted between the three groups. However, with regard to the discoloration (staining) when the polymethyl methacrylate acrylic (PMMA) group was compared with thermoforming group, statistical significance was noted in 1st month with p-values of 0.04 and 0.03, respectively. On intragroup comparison, statistically significant values were obtained in SSC group for plaque score and thermoforming group for gingival index score. Clinical significance: The study concluded that the PMMA and thermoforming crowns can be used as an alternative to SSC for restoring the primary molars as they showed equivalent results to that of standard SSC.

Objective: To enhance the survival rate of atraumatic restorative treatment (ART) restorations using (class I and class II) bilayer technique of placing glass ionomer cement (GIC) along with nanofilled coating (NC) over the restorations, thereby improving longevity. Study design: A total of 178 primary molars in 67 children were selected and randomly divided into four groups. Group IA was treated with a single layer of GIC, followed by a protective layer of petroleum jelly in class I restoration. Group IB was treated with a single layer of GIC, followed by a protective layer of petroleum jelly in class II restoration. Group IIA was treated with bilayer GIC restoration followed by NC of GC-Coat Plus in class I, whereas group IIB was treated with bilayer GIC restoration followed by GC-Coat Plus in class II. Clinical 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-square and Kaplan–Meier estimates were utilized to evaluate the success of all four treatment procedures (p < 0.05). Results: Out of 178 teeth, 33 teeth were in group IA, 36 teeth were in group IB, 43 teeth were in group IIA, and 40 teeth were available for evaluation at the end of the 12-month follow-up period. The overall success was determined to be 81% for group IA, 79.2% for group IB, 79.5% for group IIA, and 88.6% for IIB. At 6th-month follow-up, one clinical failure was observed in groups IA and IB. At 9 months follow-up, two clinical failures were observed in both group IA and group IB and three failures were observed in group IIB. At 12 months follow-up, four clinical failures were observed in group IA, three in group IB and one clinical failure was observed in group IIB. There was no statistically significant difference observed between the success of the four groups, suggesting that either of the techniques can be utilized for ART. Conclusion: No statistically significant difference was observed between the survival of class I and class II restorations of both the groups, indicating that either single-layer or bilayer technique along with NC can be adopted for the management of dental caries in primary molars using the ART approach.

Aim: To evaluate the stress distribution of calculated standardized force on maxillary and mandibular jaw bones with proclined maxillary anterior teeth with and without the use of a mouthguard. Materials and methods: It's a finite element analysis (FEA) study. Maxillary and mandibular jaw models with and without mouthguard (4 mm) were created using a cone-beam computed tomography (CBCT) scan of a 13-year-old male patient with proclined maxillary anterior teeth. Calculated standardized forces were applied on the maxillary central incisors in the horizontal direction of the created model. The von Mises stresses (MPa) were analyzed on the maxillary and mandibular jaw. Results: Higher von Mises stresses were analyzed in the maxillary and mandibular jaw model without a mouthguard compared to the model with a mouthguard. Forces were more evenly distributed in the maxillary and mandibular jaw models with a mouthguard. Conclusion: A mouthguard can be used to reduce and evenly distribute the stress on the maxillary and mandibular jaw with proclined maxillary anterior teeth when exposed to real-life situation forces. Clinical significance: The force of injury is influenced by the size of the object or the velocity at which the athlete hits the object/individual. There is a need to evaluate the force at which the individual athlete hits the object/surface based on average height, weight, and velocity/performance at that particular age. As the age of the athlete's advances, there is a change in the height, weight as well as performance. This factor will influence the impact and severity of the trauma caused during sports activities. So, these parameters should be considered while designing the mouthguard for its better effectiveness.

Background: No data is available on hypomineralization in the full complement of primary dentition. Aim: To report on the prevalence and clinical presentation of enamel hypomineralization (EH) in the primary dentition. Design: A cross-sectional observational study with a random sample of 948, 4–6-year-old schoolchildren of Gautam Buddh Nagar, Uttar Pradesh, India, was conducted after approval from the Institutional Ethics Committee. European Academy of Paediatric Dentistry (EAPD) (2003) criteria were employed to score EH in all primary teeth. A single experienced examiner conducted an entire clinical examination of the study population. Data were expressed as the prevalence, type, extent, and distribution. Further analyses were conducted to compare the prevalence and distribution of different types of lesions in affected subjects using student t-tests and analysis of variance (ANOVA). Results: An overall prevalence of 7.51% (71/948) was reported. A total of 2.75 ± 1.735 teeth/subject were reported to be affected. The most common lesion was creamy white opacity (p = 0.002), while posteruptive breakdown (PEB) was observed in 40.85% (29/71) of affected subjects. Conclusion: The prevalence of EH in primary dentition was 7.51%. Further studies mapping the prevalence as well as possible links with molar incisor hypomineralization (MIH) in other geographical locations of the world are required.

Aim: To compare and evaluate the survival rate, gingival health, and patient acceptance of traditional band and loop (B&L) and company-made B&L space maintainers in deciduous teeth—an in vivo study. Materials and methods: A total of 50 patients between 4 and 9 years of age-group, having loss of deciduous first molar in any of the arches, were included in the present study, which was divided into two groups. Group I consisted of the conventional B&L group, and group II consisted of the prefabricated B&L group. Results: The two groups showed no statistical significance in the 1st month, 3rd month, and 6th month in cement loss, failure of soldering, distortion of B&L fracture. The survival rate for the conventional group was 92%, whereas for prefabricated group was 100% at 6 months of follow-up. Company-made B&L showed significantly better gingival health (p = 0.004) at 6 months of follow-up and a better patient's acceptance rate. Conclusion: Prefabricated B&L appliances are newly developed space maintainers that are superior to conventional B&L appliances as they have a higher success rate and are more rational in design.

Background: Herbal medicines are both promotive and preventive in inhibiting dental caries. Most commonly used natural plant extracts like mango (Mangifera indica) and pudina (Mentha arvensis) as an entire or together are scientifically well proven to be safe and effective against various oral health problems, especially in preventing dental caries and periodontal diseases. Aim: The present study aims to comparatively evaluate the effect of Mangifera indica, Mentha arvensis, and Chlorhexidine (CHX) (0.2%) mouthwashes on Streptococcus mutans (S. mutans) and Candida albicans (C. albicans) in children. Materials and methods: By random allocation, 45 healthy children were selected between the age-group of 7 and 10 years of both genders from a residential school. They were divided into three study groups of 15 in each; group I—CHX (control group), group II—Mangifera indica mouthwash, and group III—Mentha arvensis mouthwash. Stimulated whole saliva sample collected for the amount of colony forming units and cultured for S. mutans and C. albicans. The data was tabulated, and statistical analysis was done with one-way variance analysis of the variance (ANOVA), Tukey's post hoc honestly significant difference (HSD) test, and Bonferroni and Kruskal–Wallis test. Results: Mangifera indica (group II) and Mentha arvensis (group III) showed a significant reduction of salivary counts at baseline, 14th day, and 21st day period and minimal effect on C. albicans for Mangifera indica. Among the three types of mouthwash, the CHX was the most superior; it showed a statistically significant reduction overall. When compared to Mangifera indica with Mentha arvensis, Mentha arvensis showed a statistically significant reduction in S. mutans and C. albicans and had an almost equivocal effect like CHX. Conclusion: Both herbal mouthwashes had a significant reduction in the S. mutans and C. albicans in children. So, it can be considered an active ingredient in mouthwashes. It may serve as a natural antimicrobial mouthwash with no adverse effects.

Background: The heart of childhood nurtures an array of immature emotions. Through this rollercoaster of childhood emotions, from tears to laughter, it is the sole responsibility of a pediatric dentist to help the children navigate through their emotions with their empathetic actions. Whenever a child is anxious or fearful in the dental chair, the child may put forth his emotion through crying or taking up a flight response. Dental caries is a disease that is aggravated when a child refuses to cooperate with dental treatment. The tiny holes in the tooth, when unfilled, may lead to bigger problems, which in turn may lead to tooth loss in future. It is the comprehensive responsibility of the pediatric dentist to support health and emotional development and provide a complete, fulfilling oral rehabilitation to the child patient. Aims and objectives: The purpose of this study was to determine the anxiety levels of pediatric patients visiting the dental Outpatient Department at a Dental College and Hospital in Kavalkinaru. This study unveils a novel technique wherein birds were used in the form of CHRISS Birds Assisted Therapy to reduce anxiety in pediatric dental patients. Results: Results showed that intervention with birds through CHRISS Birds Assisted Therapy significantly reduced the anxiety levels in children. Conclusion: Thus, CHRISS Birds Assisted Therapy is shown to be a promising method of anxiety control, a key to a successful pediatric dental practice.

Aim: This case report aims to describe the management of a maxillary lateral incisor with a palatogingival groove (PGG) associated with a complex lesion. Background: The PGG is a rare developmental anomaly that involves the lingual surface of the maxillary incisors and extends for varying distances and depths on the root surface. This anomaly is usually inconspicuous and funnel-shaped, which forms a niche where bacterial plaque and calculus can accumulate to levels significant for pathological changes resulting in endodontic and periodontal lesions. These grooves are easily overlooked as etiologic factors, as they are concealed by the periodontal tissues. Case description: This paper describes the successful management of a rare case of maxillary lateral incisor with an accessory root, two canals, and a complex or type III PGG with a endodontic–periodontic lesion using a multidisciplinary approach. Conclusion: Recognizing PGG as the initiator of pathology is critical for the successful treatment and favorable prognosis of the affected tooth. Clinical significance: This case report highlights the importance of three-dimensional (3D) imaging using cone beam computed tomography (CBCT) that can provide accurate and sensitive information to assess and plan the treatment of the teeth with PGG. It also emphasizes that with the development of newer materials and diagnostic tools, clinicians need a detailed understanding of the characteristics, treatment, and prognosis of PGG to successfully manage the condition.

The primary aim of this study was to evaluate the effectiveness of herbal mouthrinses (HMR) on caries prevention in children and adolescents. In addition, this systematic review assessed its effectiveness in remineralization of white spot lesions, reduction of halitosis, and improving gingival and periodontal health in orthodontic patients and patients with special healthcare needs (SHCN). A comprehensive bibliographic search was conducted in PubMed, Cochrane Central, EMBASE, AMED, ProQuest, CINAHL, AYUSH, Digital Helpline for Ayurveda Research Articles (DHARA), and Clinical Trial Gov databases. A total of 3,918 titles were identified during the initial search. Of these, 32 studies were selected for quality assessment. A total of 5,038 participants from 10 countries were thus included in this review, with 22 (66.7%) studies conducted in India. All included studies were published between 2004 and 2021. Included studies investigated the effect of HMR on caries increments, which record decayed, missing, filled (DMF) [International Caries Detection and Assessment System (ICDAS)], decayed, missing, filled teeth/surfaces (DMFT/S), and incipient caries. Changes in bacterial count (Streptococcus mutans and Lactobacillus) and alterations in levels of Candida albicans from saliva or plaque samples were also reported. The effect of HMR on gingival and plaque indices among adolescents undergoing orthodontic treatment and children with SHCN was reported in two studies. The variance in the HMR formula across studies, short follow-up period, and limiting grade of evidence do not allow for conclusive evidence of the efficacy of HMR. This warrants high-quality randomized controlled trials (RCTs) with longer intervention periods involving children under 6 years to yield more conclusive results.