Development and validation of a novel Middle childhood oral health impact scale (MCOHIS)

Purpose: The study was planned to develop and validate a novel middle childhood oral health impact scale (MCOHIS) for 6- to 9-year-old children in India. Methodology: A cross-sectional study design was employed to develop and validate MCOHIS in the sequential phases. A panel of ten pediatric dentists evaluated a pool of 36 items corresponding to the oral health-related quality of life (OHRQoL) of children. MCOHIS with 20 items under five domains was formulated and content validation was done. Cohen's kappa statistics was employed to measure the concordance between the child's self-report and the caregiver's proxy report. Concurrent validation was done among 130 participants from 13 districts of Tamil Nadu state, India. Discriminant validity was checked among another sample of 60 participants. Internal consistency and test-retest reliability of MCOHIS were assessed using Cronbach's alpha and Kappa statistics respectively. Results: MCOHIS had adequate content validation with Scale Level Content Validity Index / Average score of 0.94 for relevance. There was a statistically significant inter-rater reliability observed between the child's self-report and caregivers' proxy report in all items with a moderate to substantial agreement. Concurrent validation showed a statistically significant positive correlation with a Rho value of 0.712. There was a statistically significant difference noted in overall discriminant validity (P < 0.001). Acceptable internal consistency reliability was observed with Cronbach's alpha value of 0.75. Test-retest reliability showed a high stability coefficient of 0.98. Conclusions: MCOHIS was found to be a valid and reliable age-specific tool for assessing the OHRQoL of Indian children aged 6–9 years.

Ego defense mechanisms among pediatric dental postgraduate students in India A descriptive cross-sectional study

Background: Ego defense mechanisms (EDMs) act as a major factor for overcoming stressful situations in life. Aims: The study aimed to assess the various patterns and factors of EDMs employed by pediatric dental postgraduate students in India. Settings and Design: Cross-sectional design, web-based questionnaire survey. Methods: A cross-sectional questionnaire study on EDM was conducted among 246 pediatric dental postgraduates in India from July to October 2019. The modified form of the Defense Style Questionnaire-20 included 10 EDMs under three major patterns– Mature, Immature, and Neurotic. The questionnaire was sent to all pediatric dental postgraduates enrolled in the Indian Society of Pedodontics and Preventive Dentistry and reminders were sent every week for 6 weeks. Results: Among the 1041 pediatric dental postgraduates who received the E-mail, two hundred and forty-six students responded to the same. The respondents included 89 males and 157 females. The mature pattern was found to be the most commonly employed EDM (males-47.20%; females-51.60%). Sublimation (72.76%), a mature type of defense was found to be the most common EDM factor employed by the majority of the students. The immature pattern was higher among males when compared to females (males-14.60%; females-5.70%). Conclusion: Most pediatric dental postgraduates exhibited a mature pattern, followed by a neurotic and immature pattern of EDM. The mature pattern of EDM was displayed more by the female students than the male students. Sublimation was found to be the maximum expressed factor followed by acting out.

Effectiveness of school dental health education on the oral health status and knowledge of children: A systematic review

Objective: To evaluate the effectiveness of school dental health education on the oral health status, oral health-related knowledge, and practice behavior of 6–12-year-old children. Methods: Hand search and electronic search based on the keywords on school dental health education in seven search engines till 2017 identified 7434 articles. Trials involving school-based dental health education with a minimum follow-up period of 6 months were screened. Risk of bias assessment was done independently by two authors. Results: Among the 18 articles which fulfilled the eligibility criteria, six were randomized controlled trials (RCTs) and 12 were non-RCTs. Quality assessment showed that 12 trials had a low risk of bias. Oral health-related knowledge improved in children. Oral health-related practice behaviors such as frequency and duration of brushing improved. Use of fluoridated toothpaste was increased. Plaque scores and gingival bleeding scores reduced. Conclusion: School dental health education had a positive impact on the oral health status, knowledge, and practice behavior of children. There is a definite need for high-quality RCTs analyzing the effectiveness of school dental health education on specific oral health outcomes.

Effect of nonfluoridated remineralizing agents on initial enamel carious lesions: A systematic review

Background: Although fluoride enables remineralization, presence of calcium and phosphate ions is necessary to promote the process. So, various nonfluoridated remineralizing agents have been emerging to treat the noncavitated carious lesions. Aim: The aim of this systematic review was to assess the clinical effectiveness of nonfluoridated remineralizing agents on initial enamel carious lesions. Methods: Seven electronic databases were searched using the key words. In total, 158 human clinical trials were retrieved in the search from January 1950 to October 2016. Seventy-one repeated articles were excluded. Among the 87 articles obtained, 53 articles were eliminated after reading the title and abstracts. After assessing the full text, 28 articles were excluded. Three more studies were included from the cross references of the articles chosen. Results: All the nine trials included assessed the clinical effectiveness of casein phosphopeptide amorphous calcium phosphate (CPP ACP). They showed a positive effect of CPP ACP on the remineralization of white spot lesions. Conclusion: The use of CPP ACP resulted in significant reduction of the white spot lesion size measured using visual examination methods. This systematic review indicated a lack of reliable evidence supporting the clinical effectiveness of other commercially available nonfluoridated remineralizing agents.

Objective and subjective parameters of oral health in South Indian children: A cross-sectional study

Oral health of schoolchildren is a strong predictor of their overall well-being. This study was planned to assess and compare the objective and subjective parameters of oral health of South Indian school children. Methodology: Three hundred and sixty school children participated in this cross-sectional study. Their oral hygiene status, dental caries status, and treatment needs were assessed. Two questionnaires were filled by these children, to assess their oral health-related quality of life (OHRQoL) and their knowledge on oral health. Their academic scores were collected from the schools. Statistical analysis was done using Kruskal–Wallis ANOVA test and Spearman correlation test appropriately. Results: Children with no caries had better OHRQoL (P = 0.02). There was a negative correlation between dental caries status and OHRQoL score (P = 0.003) and dental caries treatment needs and OHRQoL score (P = 0.01). There was a positive correlation between knowledge on oral health and OHRQoL score (P = 0.02). Conclusion: Children with no caries had a better OHRQoL when compared to children with caries. Children with caries had more treatment needs, poor oral hygiene, low quality of life, and performed lesser in academics. However, they had adequate knowledge on oral health. Hence, both objective and subjective parameters of oral health should be given importance while treating children.

Effect of dental treatments on salivary immunoglobulin A of children with and without dental caries: A comparative study.

Aim: To evaluate and compare the effect of dental treatment on the salivary immunoglobulin A (IgA) levels of children with and without dental caries. Materials and Methods: The study involved 30 children, among which 15 had caries and the other 15 were without caries. Salivary sample collection was done for all the children before dental treatment, and for the children with caries, the sampling was repeated 3-4 weeks after the dental treatment. The salivary IgA quantitation was done by enzyme-linked immunosorbent assay (ELISA), using Human IgA ELISA Quantitation kit, and the results were statistically analyzed by independent sample "t" test. Results:The salivary IgA level was significantly more in children with caries (13.07 ± 1.55 mg/100 ml) than in caries-free children (11.90 ± 1.58 mg/100 ml) in the pre-treatment phase. The salivary IgA level in children with caries was 13.52 ± 1.68 mg/100 ml in the post-treatment phase and it was not statistically different from the pre-treatment value. Conclusion: Mere quantitation of salivary IgA levels might have no reflection on the functional antibodies involved in caries process, and successful dental treatment alone does not alter the salivary IgA levels, suggesting a multifaceted approach to combat the cariogenic challenge.

Mechanism of oil-pulling therapy - In vitro study.

Background: Oil pulling has been used extensively as a traditional Indian folk remedy without scientific proof for many years for strengthening teeth, gums and jaws and to prevent decay, oral malodor, bleeding gums and dryness of throat and cracked lips. Aim: The aim of this study was to evaluate the antibacterial activity of sesame oil and lignans isolated from sesame oil on oral microorganisms and to check whether saponification or emulsification occurs during oil-pulling therapy. Materials and Methods: The in vitro study was carried out in three different phases: (1) Antibacterial activity of the lignans and sesame oil were tested by minimum inhibitory concentration assay by agar dilution method and agar well diffusion method, respectively. (2) Increase in free fatty acid level of oil and the quantity of sodium hydroxide (NaOH) used up in the titration are good indicators of saponification process. This was assessed using analytical tests for vegetable oils. (3) Swished oil was observed under light microscope to assess the status of the oil, presence of microorganisms, oral debris and foreign bodies. Results: Sesamin and sesamolin isolated from sesame oil did not have any antibacterial effect against oral microorganisms like Streptococcus mutans, Streptococcus mitis and Streptococcus viridans. Emulsification of sesame oil occurs during oil-pulling therapy. Increased consumption of NaOH in titration is a definite indication of a possible saponification process. Conclusion: The myth that the effect of oil-pulling therapy on oral health was just a placebo effect has been broken and there are clear indications of possible saponification and emulsification process, which enhances its mechanical cleaning action.

Effect of oil pulling on plaque induced gingivitis: a randomized, controlled, triple-blind study.

BACKGROUND: Oil pulling has been used extensively as a traditional Indian folk remedy for many years for strengthening teeth, gums, and the jaw and to prevent decay, oral malodor, bleeding gums, dryness of the throat, and cracked lips. AIMS: The aim of this study was to evaluate the effect of oil pulling with sesame oil on plaque-induced gingivitis and to compare its efficacy with chlorhexidine mouthwash. MATERIALS AND METHODS: A total of 20 age-matched adolescent boys with plaque-induced gingivitis were selected for this study. They were divided randomly into the study or oil pulling group (Group I) and the control or chlorhexidine group (Group II) with 10 subjects in each group. Plaque index and modified gingival index scores were recorded for the 20 subjects and baseline plaque samples were also collected. The plaque samples were used to identify the microorganisms and to measure the total colony count of the aerobic microorganisms present. The study group was subjected to oil pulling with sesame oil and the control group was given chlorhexidine mouthwash everyday in the morning before brushing. Reassessment of the index scores and collection of plaque for measuring the colony count of the aerobic microorganisms was done after 10 days. RESULTS: There was a statistically significant reduction of the pre- and post-values of the plaque and modified gingival index scores in both the study and control groups (P < 0.001 in both). There was a considerable reduction in the total colony count of aerobic microorganisms present in both the groups. CONCLUSION: The oil pulling therapy showed a reduction in the plaque index, modified gingival scores, and total colony count of aerobic microorganisms in the plaque of adolescents with plaque-induced gingivitis.

Oral findings of Down syndrome children in Chennai city, India.

PURPOSE: To assess the common oral findings and anomalies of Down syndrome (DS) children in Chennai city, India. MATERIALS AND METHODS: Among the 130 DS children examined, 102 children aged 15 years and below were included in the study. There were 57 male children and 45 female children in the total study sample. A specially prepared case record was used to record the following findings in each child: a brief family and personal history; anomalies of soft tissues, teeth, occlusion, and temporomandibular joint. Age wise and sex wise comparisons of the findings were done. RESULTS: About 97 children (95%) had the habit of regular tooth brushing. Everted lower lip (66%), retained primary teeth (31%), and midface deficiency (76%) were the most commonly seen soft tissue, dental, and occlusion anomalies, respectively. CONCLUSIONS: Midface deficiency was the most common orofacial anomaly seen in these children, followed by everted lower lip and retained primary teeth. Almost all the children had a regular tooth brushing habit. All the children examined were offered free dental treatment in our dental college.

Dental caries prevalence and treatment needs of Down syndrome children in Chennai, India.

PURPOSE: To assess the prevalence of caries and the treatment needs of Down syndrome children in the Indian city of Chennai. MATERIALS AND METHODS: Among the 130 Down syndrome children examined, only the children aged < or =15 years were included in the study ( n = 102). There were 57 male and 45 female children in the total study sample. A specially prepared case record was used to record the findings for each child. The dentition status and the treatment needs required were recorded. Comparisons of the findings were done based on age and gender distribution. RESULTS: Twenty-nine per cent of the total sample of Down syndrome children was found to be caries-free. Extraction (in 38 children) and one-surface filling (in 26 children) were the most needed specific treatments for primary and permanent teeth, respectively. Oral prophylaxis (99%) was the most required treatment in the overall treatment category. CONCLUSIONS: Contrary to the findings of earlier studies, the percentage of caries-free Down syndrome children was found to be lower in our study. However, their basic needs like oral prophylaxis, restorations and extractions remain the same and can be easily fulfilled by an efficient, community-based dental team.