Use of Fluoridated Dentifrices amoung Children:Are We in the Right Direction?

Introduction Use of topical fluorides in dentifrices has always been an important tool in prevention of dental caries in young children. Due to the easy availability of various low and high fluoride dentifrices, the parents have no clear understanding about their correct age-appropriate use in children. This study was undertaken to evaluate and understand the trend and current practices among the end user. Materials and Methods A total of 173 children aged 4 to 6 years were enrolled in the study from schools located in two different geographical areas of the Chandigarh city; group 1 (n = 90) from a peri-urban slum cluster: (Govt. Primary School, Indira Colony, Mani Majra, n = 51); Govt. Middle School, Mani Majra (n = 39); group 2 (n = 83) from an urban private city school (Ankur, Punjab University, Sector 14) using cluster sampling method. Two examiners using type IV examination examined all the children aged 4 to 6 years present using a preinstructed close-ended questionnaire. Data were analyzed using SPSS Software Version 25 (SPSS Inc., Chicago, IL, United States). Results The data regarding the knowledge of fluoride in pastes showed that 85% of the children were using high fluoride pastes, 10% were using nonfluoride pastes, and 5% were using low fluoride pastes. In group 1, none of the users were aware about the benefits/risk of using fluoride toothpastes and only 22% were aware in group 2. Only 27% of children in group 1 dispensed the correct amount of dentifrice for this age group i.e., a pea head size versus 67% in group 2; a half brush length was dispensed by 61.5% in group 1 and 28% in group 2, and just a smudge by 11.5% in group 1 and 5% in group 2. Forty one percent children in both the groups had a history of having intentionally consumed the toothpaste. The toothpaste was dispensed to the child by parent in 89% of cases in group 2 and only 50% in group 1 and 88% parents claimed to always supervise the child while tooth brushing versus only 53% in group 1. Majority of the respondents’, i.e., 97% in group 1 and 63% in group 2 had never been explained about the correct method of use of fluoride paste in children. Conclusion Knowledge about fluoridated toothpastes is low am

Comparative evaluation of three different recording criteria of dental fluorosis in a known endemic fluoride area of Haryana

Background & objectives: Various indices are available to record different grade of severity of dental fluorosis. These indices have chances of inter- and intra- examiner variability. Therefore, study was conducted to compare three different indices for recording dental fluorosis to find out the best and most practical index of recording dental fluorosis for field studies in children living in a fluoride endemic area. Methods: The severity grades were recorded in 300 schoolchildren aged 12-15 yr having dental fluorosis of low, medium and high fluoride areas using three different indices, viz. Dean's fluorosis index (1942), tooth surface index for fluorosis (TSIF, 1984) and ICMR index (2013). Dean's index was used as gold standard. Results: The occurrence of moderate and severe cases was higher as per the Dean's index and of mild and severe cases was higher as per the TSIF and the ICMR index. The mean time required for recording dental fluorosis as per Dean's index and TSIF was similar and almost double (1.25�05 min) of that required for ICMR index (0.68�20 min). The intra-examiner variability was found to be least in the ICMR index compared to Dean's index and TSIF. Interpretation & conclusions: The ICMR index is a simple index with objective scores and takes less time in recording the dental fluorosis as compared to Dean's index and TSIF in field studies.

Validation of ICMR index for identification of dental fluorosis in epidemiological studies.

Background & objectives: The Indian Council of Medical Research (ICMR) formulated a Task Force on dental fluorosis and recommended the subgroup to develop a simplified index for identification and grading of dental fluorosis to be used by the health workers. This study was conducted to pre-test the ‘ICMR Index for Dental Fluorosis’ in the field to check its reliability and reproducibility. Methods: A total of 600 photographs were taken, 150 in each grade of fluorosis by screening 14-17 yr school children from eight schools of Hisar (Haryana) and South west Delhi. Eighty photographs were finalized (20 in each grade) before calibration to be used for training of field workers. Calibration exercise was conducted involving the five member survey team on 100 diagnosed cases of dental fluorosis. The members again screened 74 children with dental fluorosis in the field to categorize in to different grades of fluorosis for assessment of inter-examiner reliability. Results: The ICMR criteria showed more difference in agreement in very mild and mild categories during calibration. The inter-examiner reliability (κ) ranged from 0.59-1. The criteria was further modified and inter- examiner reliability (κ) found to be 0.83-0.98 which was almost perfect agreement. Interpretation & conclusions: The tool developed by the ICMR to assess dental fluorosis can be used in a field set up by non-dental personnel reliably with high degree of reproducibility.

Nanotechnology: Role in dental biofilms.

Biofilms are surface- adherent populations of microorganisms consisting of cells, water and extracellular matrix material Nanotechnology is promising field of science which can guide our understanding of the role of interspecies interaction in the development of biofilm. Streptococcus mutans with other species of bacteria has been known to form dental biofilm. The correlation between genetically modified bacteria Streptococcus mutans and nanoscale morphology has been assessed using AFMi.e atomic force microscopy. Nanotechnology application includes 16 O/ 18 O reverse proteolytic labeling,use of quantum dots for labeling of bacterial cells, selective removal of cariogenic bacteria while preserving the normal oral flora and silver antimicrobial nanotechnology against pathogens associated with biofilms. The future comprises a mouthwash full of smart nanomachines which can allow the harmless flora of mouth to flourish in a healthy ecosystem

Dentigerous cyst in primary dentition: a case report.

Dentigerous cyst is a developmental odontogenic cyst, which apparently develops by accumulation of fluid between the reduced enamel epithelium and the tooth crown of an unerupted tooth. There is usually no pain or discomfort associated with the cyst unless there is acute inflammatory exacerbation. Management of dentigerous cyst in primary dentition needs special consideration regarding the preservation of the developing permanent tooth buds. Here, we report a case of dentigerous cyst in primary dentition in a 10-year-old male patient and its management.

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.

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%).

Jaw cyst-Basal cell nevus-Bifid rib syndrome: a case report.

Jaw cyst-Basal cell nevus-Bifid rib syndrome or Gorlin-Goltz syndrome involves multiple organ system. The most common findings include multiple odontogenic keratocysts in the jaws and basal cell nevus on the skin that have an early age onset. These multiple odontogenic keratocysts warrant aggressive treatment at the earliest because of the damage and possible complications associated with them. Recurrence in these lesions is the most characteristic feature that has to be taken in consideration while explaining the prognosis to the patient. A case report of a child affected with Gorlin-Goltz syndrome diagnosed, treated and followed at this hospital is presented here.

Efficacy and acceptabilty of oral-transmucosal midazolam as a conscious sedation agent in pre-school children.

The purpose of the present study was to test the efficacy of oral-transmucosal route of administration of midazolam in young potentially un-cooperative children. A sample of 40 children up to 4 years of age with ASA I status were randomly divided into experimental and control groups of 20 each. The children in experimental group received 0.5-mg/kg-body weight midazolam mixed in strawberry syrup via the oral-transmucosal route and those in control group were given the same syrup diluted with normal saline. A class II amalgam restoration was performed and routine behavior management techniques were employed in both groups. It was found that the number of procedures successfully completed and sedation produced 15 minutes after test solution administration was significantly greater in the experimental group compared to the control group. The total treatment time was also much lesser in the experimental group children. There was no significant difference in the acceptability of the test solutions in the children of the two groups.

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.

Bioavailability of fluoride in humans from commonly consumed diets in India.

There is a paucity of data on the amount of fluoride absorbed in humans from whole cooked food; especially a combination of different foods taken at regular meal times. The present study was thus aimed at estimating the amount of fluoride present and absorbed in humans from four regional representative meals viz. North Indian Vegetarian, North Indian Non-vegetarian, South Indian and East Indian. Twenty five healthy human volunteers aged 22-35 years participated in the study and each diet was tested on five volunteers. Each test diet was weighed into six equal parts, one part was kept for estimation of fluoride content and remaining five were given one each to the five test subjects in each of the four test diet groups. Eight hour plasma fluoride profiles were then studied after ingestion of weighed quantity of test diets and means calculated. The bioavailability of fluoride from these diets was evaluated in relation to that of sodium fluoride in solution form. The amount of fluoride estimated in different test diets varied between 1.53 - 10.0 mg. The bioavailability was found to be 1.6 per cent for north Indian vegetarian diet, 7.5 per cent for east Indian diet, 14.4 per cent for north Indian nonvegetarian diet and 31.7 per cent for south Indian diet, however, the amount of F(mg) absorbed in plasma from these diets was found to be low i.e. 0.06 mg, 0.75 mg, 0.72 mg and 0.48 mg respectively.

Evaluation of the change in the knowledge of community regarding infant dental care subsequent to intervention strategies through existing health manpower in rural areas of Haryana (India).

The knowledge about infant dental care (as a part of primary preventive programme) was delivered by the existing health team of CHC viz. medical doctors, multipurpose workers, health workers, Anganwadi workers (ICDS scheme), after due training from the dental experts, in the rural community of Raipur Rani (Haryana). The knowledge of community regarding infant dental care subsequent to intervention strategies when evaluated and compared to baseline values three years after intervention revealed that 72 percent of the community had the correct knowledge of prolonged breast/bottle feeding causing nursing bottle caries. 94 per cent had correct knowledge about harmful effects of thumb/finger sucking on teeth and jaw bones and 77 percent about harmful effects of mouth breathing. 98 percent of expecting mothers knew when to clean the gum pads and 62 percent how to clean the gum pads in an infant. 100 percent of the expecting mothers had the correct knowledge that pacifiers should not be used in small children.

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.