Orthodontic management of faciolingual horizontally impacted maxillary central incisor.

This paper describes the successful alignment of a horizontally impacted maxillary central incisor positioned high in the vestibule, in a 15-year-old girl, by purely orthodontic means. A unique and innovative technique for traction was employed so as to cause minimal injury to the neighboring soft tissue. The article is a step forward in establishing the predictability of orthodontic alignment in management of such cases, which may become the method of choice over extractions or surgical repositionings.

Early class III occlusal tendency in children and its selective management.

Class III malocclusion may develop in children as a result of an inherent growth abnormality, i.e., true class III malocclusion, or as a result of premature occlusal contacts causing forward functional shift of the mandible, which is known as pseudo class III malocclusion. These cases, if not treated at the initial stage of development, interfere with normal growth of the skeletal bases and may result in severe facial deformities. The treatment should be carried out as early as possible with the aim of permitting normal growth. This paper deals with the selection of an appropriate treatment approach from the various current options available for early intervention in children developing class III occlusal tendencies; the different clinical features are depicted in the three case reports.

Evaluation of a mixture of zinc oxide, calcium hydroxide, and sodium fluoride as a new root canal filling material for primary teeth.

Endodontic treatment was performed on 25 pulpally involved mandibular primary molars in 4 to 9-year-old children; the root canals were obturated with a new root canal filling material consisting of a mixture of calcium hydroxide, zinc oxide, and 10% sodium fluoride solution, using hand-operated lentulo-spirals. All cases were evaluated clinically every 3 months and also radiographically every 6 months to assess the success of the treatment; we also examined the resorption of the root canal filling material from the root canals and the status of overpushed material, if any, as the tooth resorbed with the passage of time. At 6 months, endodontic treatment in 2 of the 25 teeth had failed and one tooth had exfoliated; the remaining 22 teeth were without any signs or symptoms. At the end of 2 years, 14 teeth could be evaluated; out of these 12 had physiologically exfoliated. It was observed that the rate of resorption of this new root canal obturating mixture was quite similar to the rate of physiologic root resorption in primary teeth. In three cases, where there was an overpush of the mixture, a gradual partial resorption was noted.

Distribution of malocclusion types among thumb suckers seeking orthodontic treatment.

The present study was conducted to evaluate the influence of thumb sucking and its duration on the type of malocclusion. A total of 410 North Indian individuals between ages 12-30 years, 161 males and 249 females were examined. A specially designed proforma was used to record the detailed history of the individual. Among the etiological factors it was found that history of thumb sucking was present in 13.9% and significantly related to Class II div 1 malocclusion. When thumb sucking exceeded 18 months, it was found statistically significant (P < 0.1) in Class II skeletal malocclusion, in open bite (P < 0.1) and in extreme overjet (P < 0.5). CONCLUSION: If thumb sucking is not treated early, it can cause skeletal Class II malocclusion, anterior open bite and excessive overjet.

Epidemiology of dental caries in Chandigarh school children and trends over the last 25 years.

The prevalence of dental caries in 6, 9, 12 and 15-year-old school children of Chandigarh, selected on a randomized basis was evaluated using Moller's criteria (1966) and correlated with the various risk factors. The mean deft was found to be 4.0 +/- 3.6 in 6 year old and 4.61 +/- 3.14 in 9 year old, whereas the mean DMFT in 12 and 15 year old was found to be 3.03 +/- 2.52 and 3.82 +/- 2.85 respectively. The high prevalence of dental caries in these children was attributed to the lack of use of fluoride toothpaste (80% children), lack of knowledge about etiology of dental caries (98%) and frequency of sugar exposures up to more than five times per day (30%).

Is tongue thrust that develops during orthodontic treatment an unrecognized potential road block?

The role of tongue thrust has often been suspected, long debated and largely dispelled as a primary etiological factor of malocclusion. However, tongue thrust may contribute to poor occlusal intercuspation both during and after treatment. A tongue thrust may also develop during orthodontic mechanotherapy as a result of the transient creation of intra and interarch spaces and this little recognized phenomenon was found to occur in many randomly followed cases. In many instances, this seemingly adaptive and secondary response of the tongue posture and function may persist and thereafter impede the resolution of intra and interarch problems.

Folic acid and phenytoin induced gingival overgrowth--is there a preventive effect.

The role of folic acid (5mg/day) in combination with oral hygiene measures (group II) vis-a-vis oral hygiene measures alone (group I) in prevention of phenytoin-induced gingival overgrowth was investigated in a one-year follow-up study on sixty, 8-13-year-old epileptic children receiving phenytoin. The allocation of the children to the two groups was done alternately. In these children, at baseline, plaque (Silness & Löe), gingivitis (Löe & Silness) and probing depths of gingival sulcus were recorded. These parameters were re-evaluated at 3-monthly intervals when gingival overgrowth was also recorded (Modified Harris & Ewalt Index). It was seen that, after a period of one year, gingival overgrowth occurred in 60 and 50 percent children of groups I & II respectively and its development, too, was delayed in group II. More cases (93 percent) in group II exhibited minimal overgrowth as against 78 percent in group I. The study concluded that systemic folic acid prescribed along with phenytoin delays the onset and reduces the incidence and severity of gingival overgrowth induced by phenytoin.

Incidence of phenytoin induced gingival overgrowth in epileptic children: a six month evaluation.

Thirty children aged 8-13 years with epileptic disorders and receiving mono-drug therapy with Phenytoin, were selected from the Departments of Pediatrics and Neurology of PGIMER, Chandigarh to evaluate the development of gingival overgrowth induced by phenytoin over a period of six months. These children were evaluated at baseline at three monthly intervals for a period of six months for plaque (Silness and Loe, 1964), gingivitis (Loe and Silness, 1963) and probing depth of the gingival sulcus. Gingival overgrowth was noted as and when it developed using modified version of Harris and Ewalt Index, 1942. No attempt was made to modify the childrens' prevailing oral habits. The results indicated that gingival overgrowth in 57% of the children was in the mesio-distal dimension of the gingival papillae and occurred within six months of initiation of therapy with Phenytoin.

Prevalence and severity of dental caries and treatment needs among population in the Eastern states of India.

The present epidemiological investigation was conducted on a total sample of 2067 individuals in the age groups of 5-6, 15-16 and 30-35 years belonging to urban (U) and rural (R) areas of three states of eastern region of India viz. West Bengal (U & Rn = 361 & 359), Orissa (U & Rn = 351 & 351) and Sikkim (U & Rn = 323 & 321). Dental caries recording was done according to WHO index 1983. The point prevalence of dental caries, deft/DMFT and defs among all the three age groups in the urban and rural areas of three states revealed common pattern i.e. (i) Dental caries was higher in 5-6 year old children (U & R - W.B. = 52.4% & 48.3%, Orissa = 56.0% & 48.7% and Sikkim = 61.8% and 22.0% exception) as compared to 15-16 years (U & R.- WB. = 21.0% & 15.2%, Orissa = 18.3% & 19.8%, and Sikkim = 30.1% & 17.9%) and 30-35 year old individuals (U & R WB = 19.4% & 18.1% Orissa = 24.3% & 20.1% and Sikkim 29.9% & 24.5%) in West Bengal, Orissa and Sikkim respectively, (ii) dental caries was higher in urban as compared to rural areas. The decayed (d/D) component contributed maximum to total deft/DMFT and defs/DMFS score, followed by e/M (missing due to caries) and f/F component (filling) which was negligible or absent. Teeth requiring various type of treatment found that one or two surface fillings were maximum followed by others. Fluoride content of drinking water was negligible (0.004 - 0.011 ppm).

A mixture of Ca(OH)2 paste and ZnO powder as a root canal filling material for primary teeth: a preliminary study.

The present pilot study was conducted on five primary mandibular second molars requiring endodontic treatment to evaluate the clinical and radiographic success of root canal filling material which was a mixture of calcium hydroxide paste (1 cm), Zinc oxide powder (15 gms) and distilled water using hand operated lentulo spirals. All the five cases on clinical evaluation after 2,4,6,9, and 12 months were found to be asymptomatic with no history of pain, tenderness or abnormal mobility. Immediate post-operative radiographic evaluation revealed adequate root canal filling in all cases. The obturated material remained upto the apex of root canals till the beginning of physiologic root resorption. The roots of the primary teeth as well as the filling material mentioned above were seen to resorb at the same rate in one case.

Silver amalgam versus resin modified GIC class-II restorations in primary molars: twelve month clinical evaluation.

The purpose of this study was to compare the clinical efficacy of resin modified GIC with amalgam as a restorative material, in Class-II cavities of primary molars. Restorations were evaluated at four, eight, and twelve months for their marginal integrity, anatomic form and development of recurrent caries. When each parameter was considered separately, there was no difference in the success rate between the two groups, except development of recurrent caries significantly less (p<0.05) in RMGIC group(4.7%) compared to amalgam group (12.5%) at twelve month follow up. However, the cumulative success rate at 12 month was found to be significantly higher (p<0.05) in RMGIC (Fuji II LC) group(83.1%) compared to amalgam(72%).

Trend of dental caries in children of Chandigarh over the last sixteen years.

The trend of dental caries in Chandigarh school children over a sixteen year period, studied by almost the same authors and using the same recording criteria of WHO reveals a continuous decline in 12 and 15 year children but a slight increase in the dental caries status of 5-6 year children. In 1977, the mean DMFT of 12 and 15 year children was 3.88 and 4.74 respectively. In 1985, it decreased to 1.38 in 15 year olds (12 year children not recorded) and in 1993 it marginally decreased to 1.12 +/- 1.35, much lower than the figure of 3.88 in 1977. In 5-6 year children, mean dmft/dmfs of 2.69 +/- 1.45 and 6.06 +/- 9.77 was found to be slightly higher as compared to the earlier caries prevalence figures (deft + DMFT-2.6 in 1977 and 2.26 in 1985).

Remineralizing efficacy of a mineral enriched mouth rinse and fluoridated dentifrice on artificial carious lesions: an in vivo scanning electron microscopic study.

This comparative investigation was carried out to evaluate the remineralization potential on early artificial carious lesions under Scanning Electron Microscope (SEM) of a Mineral enriched mouthrinse and a fluoridated dentifrice using an in-vivo intra-oral removable appliance model. This findings revealed that the remineralization was found to have occurred in almost all the samples (in children) using non-fluoridated, fluoridated dentifrices as well as those using mineral enriched mouthrinse. However the qualitative analysis of the remineralization revealed that in case of non-fluoridated dentifrice group, the prismatic holes showed deposition of granular, variable sized particles with uneven distribution, while in fluoridated dentifrice group, deposits were found to have partially but more densely filled up the prism cores. In case of mineral enriched mouthrinse group these deposits were found to be in the form of amorphous globular precipitate.

Calcium hydroxide as a root canal filling material in primary teeth--a pilot study.

A pilot study was carried out in five mandibular primary molars using calcium hydroxide (Ca(OH)2) Paste as root canal filling material to find out an alternative to the routinely used zinc oxide eugenol (ZnOE), which is non-resorbable and causes deflection of succedaneous teeth. The six month clinical and radiographic follow-up carried out at 2 months interval, revealed that the treated teeth with Ca(OH)2 as root canal filling material were successful, showing no pain and tenderness to percussion. A tendency for decrease in size of radiolucency was seen. Two teeth showed complete healing of the periradicular radiolucency. Depletion of Ca(OH)2 paste was seen from the root canals even prior to physiological resorption of roots in 2 out of 5 treated teeth.

Scientific rationale and cost effectiveness of routine use of rubber dam in clinical practice.

The rubber dam was first developed and put to use in the 19th century by S.C. Barnum. Since then, the use of the rubber dam in dentistry has become mandatory especially during root canal treatment. Various irrigation solutions which are used during root canal treatment have toxic effects on the soft tissues around the teeth. This can be prevented or minimized when rubber dam is put to use. Similarly for esthetic dentistry, optimum results are obtained if the working area is protected from contamination by saliva.

Placental transfer of fluoride in pregnant women consuming optimum fluoride in drinking water.

The study was conducted on 25 healthy women residing in optimum fluoride areas, who were to deliver normally through vaginal route, to correlate the maternal and cord plasma fluoride levels and evaluate the placental transfer of fluoride. A wide variation was found in the maternal and cord plasma fluoride levels. In only 8 percent of the cases the fluoride levels in cord plasma were higher than maternal plasma. It was deduced that the placenta allows passive diffusion of fluoride from mother to foetus and does not act as a barrier.

Role of trace elements Se and Li in drinking water on dental caries experience.

An epidemiological survey of dental caries using modified Moller's index (1966) carried out in 483 children (aged 7-17 years) of rural areas--Talwandi Kalan, Dhanansu and Bhatian (District Ludhiana) of Punjab with almost similar F levels in their drinking water supply, similar socio-economic status, environmental factors/demographic parameters and dietary habits revealed wide variations in the prevalence and severity of dental caries. Further investigation extended to evaluate the concentrations of various trace elements Se, Li, Zn, Cu, Fe and Mn in drinking water to find out the disparity of dental caries status, revealed that the higher figures of prevalence and severity of dental caries observed in Dhanansu and Bhatian as compared to Talwandi Kalan could be attributed to the presence of Se in drinking water supply of these areas which was not detectable in the water supply of Talwandi Kalan. On the contrary, the concentration of Li in water supply of Talwandi Kalan with low caries was found to be higher compared to that of Dhanansu and Bhatian with higher dental caries in children population.

Management of natal/neonatal/early infancy teeth.

The natal, neonatal and early infancy teeth predominantly being of the normal series of primary dentition, the management should aim at preservation of these teeth for esthetics and maintenance of space for eruption of permanent successor. The treatment method should take into consideration (a) trauma to child's oral tissue or mother's breast (b) mobility and (c) danger of inhalation. Trauma was noted in 10 percent, mobility and danger of inhalation in 94 percent. Extraction carried out in 97 percent of 50 children with natal/neonatal/early infancy teeth showed that the neighbouring primary teeth tended to move into the extraction space. Eruption of the permanent successors to natal/neonatal teeth was not delayed, rather in some instances the eruption was found to be enhanced as compared to contralateral incisor as noted in unilaterally occurring natal/neonatal teeth. The mandibular anterior arch collapse was not permanent as the successors erupted uncrowded. The paper discusses the method and timing of extraction. From the immunological and hematological point of view the best time for extraction was calculated to be 7-25 days of birth.