Comparison of Efficacy and Safety of Midazolam versus Nitrous Oxide as Sedative Agents during Paediatric Dental Treatment: A Systematic Review / Comparison of Efficacy and Safety of Midazolam versus Nitrous Oxide as Sedative Agents during Paediatric Dental Treatment: A Systematic Review

ABSTRACT Objective: To identify and study the existing literature on the efficacy and safety of midazolam compared to inhalation of nitrous oxide in children undergoing dental treatment. Material and Methods: Electronic resources such as PubMed Central, Cochrane Database of Systematic Reviews, Lilacs, Science Direct, and SIGLE were thoroughly searched. The title scan was used to find randomised controlled trials reviewed for inclusion by reading the abstract. Studies comparing the sedative, behavioural, and anxiolytic effects and safety in children undergoing dental treatment under midazolam and nitrous oxide inhalation were included. The Cochrane Reviews system software, Revman 5.4.1, was used to assess the quality of the included studies. Results: 11328 articles were identified by screening the electronic databases, of which 10906 were eliminated after titles were read and duplicates were removed. Ten full-text articles were examined, of which three were excluded as they did not match the eligibility criteria. Hence, a total of 7 studies were included. Midazolam and nitrous oxide inhalation were not statistically different in terms of the success of treatment and behaviour modification. However, midazolam showed a deeper level of sedation and resulted in amnesia in more children when compared to nitrous oxide sedation. All of the included studies were found to have a high risk of bias. Conclusion: Though all the studies included showed an increased risk of bias, midazolam and nitrous oxide inhalation seem equally effective sedative agents for controlling behaviour in children undergoing dental treatment. Midazolam shows a deeper sedation level when given orally and produces a higher rate of anterograde amnesia.

Short- and long-term dental arch spatial changes following premature loss of primary molars A systematic review

Aim: The aim of this study was to evaluate the dental arch spatial changes in maxillary and mandibular arches after premature loss of primary molars. Introduction: Primary teeth must be maintained during the change from primary to mixed and then permanent dentition, to preserve and maintain the dental arch. When this normal process is disturbed, usually due to severe decay requiring extraction before normal exfoliation, it can result in migration of adjacent teeth toward the missing space resulting in decreased arch length and malocclusion in the permanent dentition. Materials and Methods: A comprehensive search was conducted using electronic databases such as PubMed Central, Cochrane Database of Systematic Reviews, Google Scholar, LILACS, and ScienceDirect. The title and abstract were screened to find relevant articles, which were then reviewed in full to see if they were worthy of inclusion. All longitudinal and observational studies that looked at space changes after the loss of primary first or second molars were included. Quality assessment of the studies was done based on the Newcastle-Ottawa scale as all the included studies were non-randomized studies. Results: Four thousand five hundred and seventy-eight articles were identified by screening electronic database and assessed for eligibility, 12 full-text articles were assessed, and 4 full-text articles were excluded as they did not match the inclusion criteria. Thus, eight articles were included in this systematic review. Short term and long term space changes and loss of maxillary and mandibular molars were studied individually. In the short term changes, the distal migration of the primary cuspid towards the missing space within 1 month was attributable to early space changes after premature loss of the mandibular first molar, and the greatest space loss was recorded in the first 3 months after premature loss. After the premature loss of the maxillary first molar, immediate space loss of 1mm was documented due to distal migration of the primary canine. Studies found that space loss was caused by the distal migration of primary canines in the case of mandibular primary first molar loss, and that space loss was larger in the mandibular arch after premature loss of second primary molars. Conclusion: The greatest repercussions occurred during the first 3 months after the deciduous molars were extracted, and a space maintainer was recommended in the majority of cases, mainly when there is premature loss of mandibular second primary molar as it leads to mesial displacement of the first permanent molar.

Oral health status for primary dentition – A pilot study

Introduction: Formulating an oral health status which will include oral hygiene index (OHI) exclusively for children, deft index, and the incidence of white spot lesions (WSL) will make it easier for the examiner to assess the current oral health status of a child and help in planning preventive strategies. This index will provide a comprehensive yet quick way to assess the oral health status of children as it includes past caries experience, present oral hygiene status, and future prediction of caries. Materials and Methods: Two hundred children (100 male, 100 female) aged 3–5 years (primary dentition) were included in this study. OHI, recorded index tooth wise and segment wise, deft index, and the WSLs classification were recorded in all the children. Receiver operating characteristics (ROC) curve was used to evaluate the accuracy of recording OHI in children index tooth wise and segment wise. Results: All the three indices were recorded for the 200 subjects, and based on the area under the curve of receiver operating characteristics, it was found that the OHI for primary dentition can be recorded tooth wise or segment wise. Index teeth chosen for primary dentition were labial surfaces of 54, 61, and 64, lingual surfaces of 82, 75, and 85. Conclusion: It includes the past caries experience, present hygiene status, and the future prediction of caries, making it a wholesome index. This cumulative index can be widely used in studies of epidemiology and ensure quicker evaluation during dental health programs in public school systems.

Estimation of salivary ferritin in children with childhood caries ­ a cross sectional study / Estimativa da ferritina salivar em crianças com cárie na infância - um estudo transversal

Objective: Early childhood caries is the presence of dental caries in a child upto seventy one months of age. Saliva plays a major role in maintaining good oral health. The composition of saliva acts as a marker for oral health and the salivary proteins help in modulating the oral microflora in the oral cavity. Some salivary biomarkers help in detecting caries risk and can also predict their prognosis. Ferritin is one of the major biomarkers present in the saliva which acts as an iron binding protein and also as a monitoring tool in children suffering from iron deficiency. The ferritin levels are in increased in serum as well as in saliva to balance the deficiency of iron in the body. Material and methods: Sixty children were selected for the study aged between three to six years. The saliva sample was collected using standard spit method in a sterile container and Ferritin was tested in the samples by Chemiluminescence microparticle immunoassay(CMIA). Results: Salivary ferritin was found to be higher in the saliva of children with early childhood caries(mean value= 5.867) than in children without early childhood caries(mean value= 3.412). Conclusion: A direct association is present between salivary ferritin levels and dental caries. Increased level of ferritin is observed in children with Early childhood caries. Clinical relevance: The level of salivary ferritin is found to be raised in the present study in children with Early childhood caries. The exact mechanism is although not known it can be assumed that the children with early childhood caries might have deficiency of iron which has led to the increased amount of salivary ferritin in the saliva. (AU)

Objetivo: A cárie precoce é definida como a presença de cárie dentária em uma criança de até setenta e um meses de idade. A saliva desempenha um papel importante na manutenção de uma boa saúde bucal. A composição da saliva atua como um marcador para a saúde bucal e as proteínas salivares auxiliam na modulação da microflora oral na cavidade oral. Alguns biomarcadores salivares ajudam a detectar o risco de cárie e também podem prever seu prognóstico. A ferritina é um dos principais biomarcadores presentes na saliva, que atua como uma proteína ligadora de ferro e também como uma ferramenta de monitoramento em crianças com deficiência de ferro. Os níveis de ferritina aumentam tanto no soro quanto na saliva para equilibrar a deficiência de ferro no corpo. Material e Métodos: foram selecionadas para o estudo 60 crianças com idades entre três e seis anos. A amostra de saliva foi coletada pelo método padrão de cuspir em um recipiente estéril e a ferritina foi testada nas amostras através de um imunoensaio de micropartículas por quimioluminescência (CMIA). Resultados: A ferritina salivar foi maior na saliva de crianças com cárie na primeira infância (valor médio = 5,867) do que em crianças sem cárie na primeira infância (valor médio = 3,412). Conclusão: Existe uma associação direta entre os níveis de ferritina salivar e a cárie dentária. Nível elevado de ferritina é observado em crianças com cárie na primeira infância. Relevância clínica: O nível de ferritina salivar está elevado no presente estudo em crianças com cárie na primeira infância. Embora o mecanismo exato seja desconhecido, pode-se presumir que crianças com cárie na primeira infância podem ter deficiência de ferro, o que levou a um aumento na quantidade de ferritina salivar na saliva. (AU)

Comparison of two systems of tooth numbering among undergraduate dental students.

Background: Dental charting is the basis of treatment in dentistry. It should be recorded to know the presence of healthy or diseased, for communication purpose with the colleagues and also used for reference purpose. The three commonly used systems are universal system, Federae Dentale Internationale numbering system (FDI) system, and Palmer/Zsigmondy system. Although these systems are in practice there are lot of confusions in referring a tooth which leads to mismanagement which eventually terminates the clinician‑patient relationship. Hence, a growing need of a new system to make dental charting simple, easy, and to avoid confusions is always present. Molar, incisor, canine, Akram, premolar (MICAP) a tooth numbering system that was introduced by Akram et al. in the year 2011. Aim: To assess the attitude of undergraduate students toward the MICAP system and their preference to use in identification of teeth. Materials and Methods: The undergraduate students who were involved in the study were briefed about the ICPM system through a lecture and demonstration. All the 155 undergraduate dental students were asked to number the teeth of given patients using both FDI and the ICAP system. The attitude of the students towards the new system was assessed using a validated questionnaire. Forty‑one percentage of students agreed for the uniqueness of the system, and thirty‑six percentage agreed that the system was easy to understand. Forty‑six percent of students were unsure about the easiness of usage of MICAP system and 42% of students about the clinical applicability of MICAP system. Conclusion: MICAP system of tooth identification can be followed by the students if the system is included in the curriculum and repeatedly used for routine teeth identification.

Local Anesthetic Used for Dental Treatment in Children- Systematic Review.

Aims: To analyse the existing literature on the effectiveness of various injectable amide local anaesthetic agents for children undergoing routine dental treatment. Design: A systematic search was carried out for the databases of PubMed, Central, LILACS, Science direct, Metapress and SIGLE to identify clinical trials published on the effectiveness of injectable amide local anaesthetic agents in dental journals from the inception of the databases up to July 2015. Results: The systematic search gave nine studies. Four of out seven studies found articaine to more effective. No significant difference in anaesthetic effectiveness of the agents were found in seven studies. One study reported significant difference in the anaesthetic effectiveness in favour to articaine. Two studies reported articaine to have longer duration of action. Conclusion: With the available evidence, this review may suggest that articaine is an effective amide anesthetic agent. Lignocaine is most effective at 2% concentration. Prilocaine and mepivacaine show comparable effectiveness. As eight of the studies have high risk of bias, there is a greater need for well-designed randomized controlled studies to be conducted to assess effectiveness of various injectable amide local anaesthetics to be used in children for routine dental treatment.

Alopecia areata of dental origin in a child.

Alopecia areata (AA) is a chronic inflammatory disease that involves the hair follicle. Current evidence indicates that hair follicle inflammation in AA is caused by a T-cell-mediated autoimmune mechanism occurring in genetically predisposed individuals. AA has a reported incidence of 0.1%-0.2%, with a lifetime risk of 1.7%. It has also been found that AA accounts for roughly 2% of new dermatology outpatient cases in the US and the UK, 3.8% of cases in China and 6.7% of cases in Kuwait. Pediatric AA constitutes approximately 20% of all AA cases. AA affects males and females equally. The most common site to be affected is the scalp (90%). The face, eyebrows, eyelashes, beard, underarm hair, and pubic hair may be affected and, sometimes, even the entire body. AA requires combined therapy, involving topical or intralesional corticosteroids, immune therapy with diphenylcyclopropenone, and even psychotherapy. In some cases, treatment consists of simply eliminating the dental infectious process. This case report describes AA of dental origin in a 9-year-old girl, which resolved after management of the dental problem.

Oral Manifestations of Achondroplasia : A Case Report.

Achondroplasia a common form of dwarfism, caused by a single recurrent point mutation in more than 97% of patients, is an autosomal dominant disorder with an incidence of approximately 1/7500. The name of this disease was called Chondrodystrophia foetalis before Parrot in 1878 reported the name of this disease as Achondroplasia, distinguished from other similar diseases. The present case report deals with a patient who was diagnosed with achondroplasia. The craniofacial features are discussed and the management done and planned for further management has been discussed.