Comparison of two different caries risk assessment tools for infants and toddlers - A cross-sectional study.

CONTEXT: One of the essential components for successful caries management is caries risk assessment (CRA). Among CRA tools (CRATs) published in the literature: Caries management by risk assessment (CAMBRA) 123 and American Academy of Pediatric Dentistry (AAPD) CRATs are specifically designed for infants and toddlers. AIMS: The aim of this study is to compare readily available internationally accepted CRAT for infants and toddlers and check the usability of these tools in assigning caries risk among the Indian population. SETTINGS AND DESIGN: The study was conducted at Baby Oral Health Promotion Clinic, Department of Pediatrics, Tertiary Care Hospital using a cross-sectional study design. SUBJECTS AND METHODS: Data were collected using CAMBRA 123 and AAPD CRATs from 379 children aged 0-6 years. The caries risk of the children was recorded with each CRAT and a comparison was made between the two tools used. STATISTICAL ANALYSIS USED: The percentage of agreement and Cohen's kappa coefficient were used to know the agreement between the CAMBRA 123 and AAPD CRATs using the SPSS statistical tool. The significance level was set at 5% (α = 0.05). RESULTS: For children aged <2 years, the study showed slight agreement between the CAMBRA 123 and AAPD, whereas, for children more than 2 years, there was a fair agreement between the two methods which was statistically significant. This indicates that the agreement between the two methods is still not perfectly established, and AAPD CRA assigns a higher risk category than CAMBRA 123. CONCLUSIONS: CAMBRA 123 is a promising user-friendly quantitative method for CRA in clinical practice. Since there is ambiguity in assessing the caries risk in children <2 years, there is a need to establish a CRAT that can be used exclusively for children below 2 years.

Unmasking the Silent Threat: Periodontal Health's Impact on COPD Severity and Hospitalization.

OBJECTIVE: This study investigated the relationship between chronic obstructive pulmonary disease (COPD) and periodontitis, focusing on how periodontal health impacts COPD airflow limitation, exacerbations, and hospitalization. BACKGROUND: Periodontitis, a multifactorial inflammatory disease, is characterized by destruction of tooth-supporting structures, while COPD is a global pulmonary disorder with high mortality. METHODS: A total of 199 COPD patients aged over 40 years underwent lung function tests (spirometry), 6 min walk test, and St George's Respiratory Questionnaire-COPD (SGRQ-C) to assess lung health. Periodontal indices such as probing depth (PD), clinical attachment loss (CAL), and plaque index (PI) were assessed. RESULTS: We found a significant negative correlation between periodontal disease severity and lung function (lower FEV1, FVC, and FEV1/FVC ratio) after adjusting for smoking. Likewise, periodontal parameters (PPD, PI, and CAL) exhibited negative correlations with lung function. These periodontal indices were independently associated with airflow limitation severity, exacerbations frequency, and prior-year hospitalization. Linear regression indicated that each unit increase in PPD, PI, and CAL corresponded to estimated increases in GOLD airflow limitation grading (0.288, 0.718, and 0.193, respectively) and number of exacerbations (0.115, 0.041, and 0.109, respectively). In logistic regression, PPD, PI, and CAL adjusted odds ratios (ORs) were estimated to increase by 1.29 (95%CI: 1.03-1.62), 3.04 (95%CI: 1.28-7.2), and 1.26 (95%CI: 1.06-1.49), respectively, for hospitalization in previous year. CONCLUSION: Periodontitis is associated with COPD airflow limitation, exacerbation, and hospitalization, with PI being the most clinically relevant periodontal factor. Dentists and physicians should monitor and increase awareness among COPD patients to maintain oral hygiene for prevention of periodontal diseases and mitigate its effect on COPD progression.

Changes in Pulp and Roots of Deciduous Teeth during Different Stages of Physiologic Resorption: A Histologic Study.

Background: Resorption of primary teeth and eruption of permanent teeth involves a complex series of changes. The cellular and histological changes occurring during the process of resorption vary stagewise. The knowledge of the changes occurring in the pulp of deciduous teeth would provide information about the resorptive process. Aim: To evaluate the histologic changes of the pulp of deciduous teeth related to different stages of physiologic root resorption. Study setting and design: To establish the cause and effect relationship, a contrived histologic study design was planned. Materials and methods: A total of 60 extracted deciduous incisors, canines, and molars were included in the study. The remaining root length (RRL) was determined based on the standardized photographs. The teeth were then grouped into three based on the percentage of RRL. The teeth were subjected to decalcification with 5% nitric acid, following which histological processing was performed. Statistical analysis: The present study being a qualitative study design, descriptively explains the histologic findings, and no statistical tests have been applied. Results: During the initial stages of resorption, there were no histological alterations noted in the pulp, particularly in the cervical 3rd, with the cellular structure relatively maintained. As the resorption progresses, reversal lines were evident, indicating a process of repair occurring simultaneously during the process of resorption. With further advancement, the repair is overtaken by the resorption indicated by the presence of resorptive cells. Neovascularization and an increase in immune cells are also evident in advanced stages. Conclusion: The pulp exhibits progressive changes as the resorption continues from stage I to stage III. The changes vary from a smaller number of immune cells and odontoclasts in stage I to increasing number of the same as resorption progresses. How to cite this article: Murthy P, Bhojraj N, Hegde U. Changes in Pulp and Roots of Deciduous Teeth during Different Stages of Physiologic Resorption: A Histologic Study. Int J Clin Pediatr Dent 2023;16(3):437-443.

Combined remineralizing effect of arginine and fluoride on artificially demineralized human primary dentin evaluated using quantitative light induced fluorescence.

Introduction: One the most common chronic dental diseases affecting children is dental caries. Dentin caries is a condition in which caries has progressed to the dentin and caused a significant depth of lesion. Clinical studies have revealed that an increased caries risk is associated with a decreased alkali-producing capacity of the microbial populations colonizing the oral cavity of adults, which arginine somewhat compensates for. Aims: To evaluate the remineralizing efficacy of fluoridated toothpaste, with fluoride-arginine containing toothpaste on demineralized dentin of primary teeth using quantitative light-induced fluorescence™. Materials and Methods: Forty-five primary molars were decoronated and sectioned to prepare dentin specimens and mounted in an acrylic block in a uniform manner using a customized acrylic jig. Samples were randomized into three groups, were subjected to demineralization to create artificial dentin caries lesion. Following this, all the 45 samples were subjected to multispecies bacterial pH cycling for 21 days. All the specimens were evaluated for postdemineralization, pH cycling day 7, 14, and 21 on QLF™. Results: On day 21, maximum fluorescence gain was observed by the positive control group followed by the arginine and negative control group. The variation observed between positive control and arginine group was found to be statistically significant. Conclusions: An in vitro development of artificial caries such as demineralized lesion on primary dentin sample using plaque biofilm was observed successfully under QLF after 72 h. Arginine in combination with fluoride showed almost similar remineralization of demineralized primary dentin compared to fluoride alone after 21 days of multispecies bacterial pH cycling.

Quantification of tongue coating using quantitative light-induced fluorescence-digital image analysis and its correlation with visual evaluation.

BACKGROUND: The tongue coating is a grayish-white deposit that quickly reflects the state of health or disease of the human body. Quantitative light-induced fluorescence (QLF) is a novel digital imaging system that objectively quantifies tongue coating. AIMS: The present study aims to evaluate the correlation between the visual assessment of tongue coating and tongue coating by analysis of QLF-digital (QLF-D) images. SETTINGS AND DESIGN: This was an in vivo explorative study. MATERIALS AND METHODS: Fifty children aged 11-13 years with clinically visible tongue coating were selected for the study. Tongue coating was assessed clinically by the Tongue Coating Index (Shimizu et al., 2007) and digitally by QLF-D Biluminator™ 2, C3 software. STATISTICAL ANALYSIS: Data obtained were subjected to statistical analysis using SPSS 23.0 software. Spearman's rho correlation test was done, and P < 0.05 was considered statistically significant. RESULTS: A statistically significant correlation was found between the visual assessment scoring and the QLF image analysis for the evaluation of tongue coating. CONCLUSION: The Digital QLF tongue imaging system was found to be reliable due to its correlation with the clinical score and objective nature.

Comparative assessment of the efficacy of low concentration bleaching agents using quantitative light induced fluorescence in removing stains: An In vitro study.

Background: Tooth discoloration has become a common esthetic problem in recent years. Removal of stains by bleaching is well-documented. Low concentration home bleaching products are available in market in different forms and concentrations. Aim: The aim of this study is to evaluate and compare the efficacy of low concentration commercially available home bleaching products (whitening strip, gel, and mouthwash) in removing stains and whitening the tooth using clinical and digital methods. Materials and Methods: Sixty permanent enamel samples mounted in an acrylic block were artificially stained and randomly divided into four groups. Negative control, 15 % Carbamide peroxide gel group, 2% Hydrogen 16 peroxide mouthwash group and 6% Hydrogen peroxide strip group respectively. The samples were bleached with respective agents according to the manufacturer's instructions. The efficacy on 7th and 14th day was evaluated clinically (SGU change), photographically (ΔE), and using quantitative light-induced fluorescence (ΔF). The data were analyzed using paired t-test and analysis of variance. Results: Postbleaching, 6% hydrogen peroxide strips and 15% carbamide peroxide gel showed maximum improvement (ΔΔF - 15.73 and 11.89, ΔE - 19.8 and 18.9, respectively) when compared to 2% hydrogen peroxide mouthwash and negative control group (ΔΔF - 9.68 and 6.59, ΔE - 15.04 and 9.44, respectively). The difference was statistically significant (P = 0.001). Conclusion: 6% hydrogen peroxide strips and 15% carbamide peroxide gel showed maximum improvement in stain removal and tooth whitening however, the strips showed better efficacy than the gel. Strips have the added advantage of lesser contact period, less salivary dilution, and no gingival contact. Therefore, strips can be a better alternative for gels and mouthwashes.

Early Maxillary Dentoalveolar Changes in Children with Unilateral Cleft Lip and Palate After Palatal Repair: A Pilot Study.

OBJECTIVE: To assess early maxillary dentoalveolar changes in children with unilateral cleft lip and palate (UCLP) up to 6 months after palatoplasty. DESIGN: Pilot study. PATIENTS AND PARTICIPANTS: Eight children with UCLP at the age of 18 to 30 months, who were awaiting palatal repair, were included. INTERVENTIONS: All participants with repaired lip were scheduled for palatal repair between 18 and 24 months by Bardach's technique. MAIN OUTCOME MEASURE(S): Arch widths, arch depths, and arch perimeter was measured on 32 dental casts of 8 participants at 4 time points: just prior to palatal repair (T1), 1 month (T2), 3 months (T3), and 6 months (T4) after palatal repair. Manual method using digital vernier caliper (Zhart, India) was used for model analysis. Intraexaminer reliability was also assessed. RESULTS: Only one examiner assessed all the dental casts after blinding. There was a significant decrease in the intercanine width (29.75 ± 1.98 mm at T1 to 26.42 ± 1.67 mm at T4; P < .001) and anterior arch depth (9.86 ± 1.07 mm at T1 to 8.29 ± 1.51 mm at T4; P < .001). Growth occurred in intertuberosity width (38.18 ± 1.40 mm at T1 to 39.76 ± 1.09 mm at T4; P < .001) and total arch depth (24.36 ± 1.21 mm at T1 to 26.79 ± 1.04 mm; P < .001) over 6 months post-surgery. CONCLUSIONS: There was growth restriction in the anterior part of the palate, whereas the posterior region continued to grow after palatal repair. These changes were observable even in the early months after palatoplasty.

Evaluation of mineral loss in primary and permanent human enamel samples subjected to chemical demineralization by international caries detection and assessment system II and quantitative light-induced fluorescence™: An in vitro study.

PURPOSE: The purpose of the study was to understand the mineral loss in primary and permanent enamel samples and an attempt is made to standardize the process of chemical demineralization to generate more meaningful results in research studies involving the remineralization of demineralized samples. MATERIALS AND METHODS: Due to variability among enamel samples theoretically, it is impossible to standardize demineralization by running time-based chemical demineralization cycle without frequent monitoring. Instead of carrying out demineralization cycles for a fixed duration of time, we quantified the mineral loss 24 hourly using the International Caries Detection and Assessment System (ICDAS) and Quantitative Light-induced Fluorescence System (QLF™). Twenty primary and permanent enamel samples were subjected to demineralization, and ICDAS and QLF™ evaluation were done at 0, 24, 48, 72, 96, 120, 144, and 168 h of demineralization. RESULTS: The first visual change in permanent enamel is appreciated at 24 h (ICDAS II code1, QLF™ code1 -16.353 - ΔF) of demineralization, at 48 h (ICDAS II code2, QLF™ code2, -24.515 - ΔF), there was localized white spot lesion in permanent enamel and remained until 96 h (ICDAS II code 2, QLF™ code 2, -25.739 - ΔF) of demineralization. In primary samples, distinct visual change was seen at 24 h (ICDAS II code2, QLF™ code2, -19.431 - ΔF), and at 48 h clinically, there was a distinct visual change, but optically mild enamel breakdown was appreciated (ICADSII code 2 QLF™ code3, -27.201 - ΔF), which remained constant till 120 h of demineralization (ICDAS II code2 QLF™ code3 -37.645 - ΔF). CONCLUSION: Different samples demineralize at different rates. The demineralization in primary samples was 1.25 times higher than permanent samples. Recommendation: due to inherent variability in the samples continuous monitoring of the demineralization process on a 24 hourly basis is required to standardize the process.

A cross-sectional study on eruption timing of primary teeth in children of Mysore, Karnataka.

CONTEXT: Eruption of first primary teeth is the most anxiously awaited developmental milestone in a child. However, primary teeth have shown wide variations in their eruption time among different population, ethnic, and racial groups. AIMS: The present study was conducted with the aim to evaluate the time and sequence of eruption of primary teeth of children of Mysore. SETTINGS AND DESIGN: A cross-sectional study design included 1392 participants aged 3 months to 36 months recruited by simple random sampling method. The variables such as age, gender, and number of erupted primary teeth were recorded. SUBJECTS AND METHODS: Clinical examination was done under natural illumination. A tooth was considered erupted when any part of its crown had penetrated the gingiva and was visible in the oral cavity. STATISTICAL ANALYSIS USED: Probit regression analysis was performed to obtain the mean and median age of eruption of teeth. The significance of difference in the mean age of eruption across gender and arch was determined using paired t-test. RESULTS AND CONCLUSION: The first primary tooth to erupt was mandibular central incisor at 10.24 ± 2.47 months followed by maxillary central incisor at 11.06 ± 2.65 months. The duration of primary teeth eruption was 17.89 and 18.32 months in males, 18.54 months and 18.32 months in females for maxilla and mandible, respectively. Eruption of primary tooth is delayed among children of Mysore as compared to standard eruption chart. The results will provide information to health professional about contemporary tooth eruption time derived from an Indian population.

Polymorphism in the Eruption Sequence of Primary Dentition: A Cross-sectional Study.

INTRODUCTION: Primary teeth have shown wide variations in their eruption time among different population. Population specific eruption ages are provided as mean with standard deviations or median ages with its percentile range. This alone will be insufficient for prediction of tooth eruption sequence because they provide no information on the frequency of sequence variation within the pairs of teeth. Norms of polymorphic variation in the eruption sequence can be more useful. AIM: This study aims at providing norms for the sequence polymorphism in primary teeth among the children of Mysore population. MATERIALS AND METHODS: A cross-sectional study was designed with 1392 children, recruited from December 2015 to June 2016 by simple random sampling method. Tooth was recorded as present or absent. Across the entire possible intra quadrant tooth pair, cases of present-present, absent-absent, present-absent and absent-present and were counted and computed as percentages. RESULTS: Sequence polymorphisms were more common in 82-84 pairs of teeth. Significant polymorphic reverse sequence was observed in 52-54 (9%), 82-84 (35%) in males and 82-84 (18%) in females. There was no polymorphism in maxillary arch in females. CONCLUSION: The present study provides the baseline data values for sequence variation in primary teeth eruption. To the best of investigators knowledge, there are no previous studies describing the sequence polymorphism in primary teeth in Indian population. The results of this study helps in assessment of eruption sequence problems in paediatric dentistry and in evaluation and prediction of tooth eruption sequence in individual child.

Modified distal shoe appliance for the loss of a primary second molar: a case report.

Preservation of primary teeth until their normal exfoliation plays a crucial role in preventive and interceptive dentistry. Premature loss of the primary second molar prior to the eruption of the permanent first molar in the absence of the primary second molar can lead to mesial movement and migration of the permanent molar before and during its eruption. In such cases, an intra-alveolar type of space maintainer to guide the eruption of the permanent first molar is indicated. In certain cases, however, the conventional design is not practical. This paper describes a new design for distal shoe appliances in cases of primary second molar loss prior to the eruption of the permanent mandibular first molar.

Successful prevention of oral self-mutilation using a lip guard: a case report.

Self-injurious behavior (SIB) is causing deliberate harm to the body without suicidal intent; this problem occurs in a number of psychiatric, behavioral, and developmental disorders. This report describes the case of a girl, aged 19 months, whose lower lip injuries due to SIB were successfully treated through the use a combination of extraoral and intraoral prostheses. A custom-made lip guard with a custom-made adjustable head strap was effective in the management of the lip trauma. SIB was prevented and there was no recurrence even at the 17-month follow-up appointment.