A Clinical Evaluation of Gingival Overgrowth in Children on Antiepileptic Drug Therapy.

INTRODUCTION: Gingival overgrowth, a well-known side effect of chronic phenytoin therapy has also been known to be caused by other anti epileptic drugs (AED's). Various factors like plaque, gingival inflammation, and periodontal health have been postulated to effect gingival overgrowth. AIM: To identify the AED having an effect on gingival overgrowth and to study the factors affecting it. MATERIALS AND METHODS: Three groups of 30 children each on monotherapy of phenytoin, sodium valproate, and carbamazepine were longitudinally followed for six months. Their oral and epileptic health status was assessed and were monitored for change in plaque levels, gingival inflammation, probing depth and the status of gingival overgrowth at baseline, at the end of 3 months and finally at the end of 6 months. The data was recorded and statistically analysed. RESULTS: Phenytoin caused gingival overgrowth in a significant number of children (53.6%) within 3 months. Sodium valproate also led to gingival overgrowth, but not upto statistically significant levels. Patients on carbamazepine did not show any signs of gingival overgrowth. Gingival overgrowth is seen more on buccal side, in the anterior segment and in the lower arch. No correlation could be found between, either plaque level, or gingival inflammation with gingival overgrowth. Probing depth could be positively correlated with gingival overgrowth. CONCLUSION: Phenytoin is the drug, which can be chiefly implicated for causing gingival overgrowth. Sodium valproate carries the potential for gingival overgrowth, although only up to clinically insignificant levels in 6 months. Carbamazepine can be considered a safe drug in children in relation to gingival overgrowth.

A Comparative Evaluation of Microleakage of Glass Ionomer Cement and Chitosan-modified Glass Ionomer Cement: An in vitro Study.

OBJECTIVE: To do a comparative study of microleakage of glass ionomer cement (GIC) and chitosan modified glass ionomer cement and evaluate which exhibited lesser microleakage. MATERIALS AND METHODS: Sixty freshly extracted sound primary molar teeth were obtained. Two groups of samples were created for the study which comprised of group I (glass ionomer cement-GIC) and group II (Chitosan modified glass ionomer cement). Class V cavities were prepared on the buccal surfaces. All the tooth surfaces except the restoration and a 1 mm zone adjacent to its margins were covered with two coats of varnish. The specimens were then immersed in 2% basic fuschin dye solution for 24 hours. The teeth were sectioned into two halves buccolingually in an occlusoapical direction. Sections were viewed under stereomicroscope and the degree of microleakage was evaluated using specific scoring criteria. For comparative evaluation of microleakage scores between glass ionomer cement and chitosan modified cement, a nonparametric Mann-Whitney statistical analysis was done. RESULTS: Statistical analysis showed no significant differences between groups I and II with the p-value at >0.05. CONCLUSION: Chitosan modified GIC holds great promise for general dentistry as a future restorative material with microleakage properties similar to or better than GIC. How to cite this article: Abraham D, Thomas AM, Chopra S, Koshy S. A Comparative Evaluation of Microleakage of Glass Ionomer Cement and Chitosan-modified Glass Ionomer Cement: An in vitro Study. Int J Clin Pediatr Dent 2014;7(1):6-10.

A Comparative Evaluation of the Effect of Bonding Agent on the Tensile Bond Strength of Two Pit and Fissure Sealants Using Invasive and Non-invasive Techniques: An in-vitro Study.

BACKGROUND: Newer technologies and the development of pit and fissure sealants have shifted the treatment philosophy from 'drill and fill' to that of 'seal and heal'. AIMS: The purpose of this in-vitro study was to evaluate the effects of bonding agents on the tensile bond strengths of two pit and fissure sealants by using invasive and non-invasive techniques. STUDY DESIGN AND METHODS: One hundred and twenty bicuspids were collected and teeth were divided into two groups: Group-I (Clinpro) and Group-II (Conseal f) with 60 teeth in each group. For evaluating tensile bond strengths, occlusal surfaces of all the teeth were flattened by reducing buccal and lingual cusps without disturbing fissures. Standardised polyvinyl tube was bonded to occlusal surfaces with respective materials. Sealants were applied, with or without bonding agents, in increments and they were light cured. Tensile bond strengths were determined by using Universal Testing Machine. STATISTICAL ANALYSIS: Data were then statistically analysed by using Student t-test for comparison. RESULTS: A statistically significant difference was found in tensile bond strength in invasive with bonding agent group than in non-invasive with bonding agent group. CONCLUSION: This study revealed that invasive techniques increase the tensile bond strengths of sealants as compared to non- invasive techniques and that the use of a bonding agent as an intermediate layer between the tooth and fissure sealant is beneficial for increasing the bond strength.

Displacement, location, and angulation of unerupted permanent maxillary canines and absence of canine bulge in children.

INTRODUCTION: In this study, we examined displacement (labiopalatal and mesiodistal) and angulation of unerupted permanent maxillary canines on either side in children (n = 49) aged between 10 and 12 years with unilateral absence of the canine bulge on palpation. METHODS: The side without the canine bulge was considered the experimental (n = 49) and the contralateral side (where the bulge was palpable) the control (n = 49) in each subject. Orthopantomographs were taken to assess mesiodistal displacement and angulation of the canines on both sides. The horizontal tube shift method was used to assess the labiopalatal displacement of the canines on the experimental sides. RESULTS: There was a significantly high possibility of finding mesially overlapping canines (with respect to the lateral incisor on the orthopantomograph) on the sides without the bulge (chi-square, 60.05; P <0.001), all of which were found to be palatally displaced. However, 22.45% of the canines on the side without the bulge showed no abnormal displacement. The mean angulation was lower for palatally displaced canines than those that were not (t = 9.89; P <0.001). CONCLUSIONS: There is a significantly high possibility of finding palatally displaced canines in children aged 10 to 12 years on sides with the canine bulge absent on palpation; rarely, the canine is transposed with the first premolar. Palatally displaced unerupted canines have a significantly high possibility of being more mesially angled (to the horizontal) on the orthopantomograph compared with undisplaced canines.

Surgical Repositioning of a Dilacerated Impacted Incisor.

Dilaceration is one of the most common complications of trauma to deciduous dentition. The possible causes of dilaceration are trauma and developmental disturbances, while some authors suggest an association with some developmental syndromes. Dilaceration can be seen in both the permanent and deciduous dentition. The present case report describes surgical repositioning of a dilacerated impacted maxillary central incisor in a 9-year-old boy.

Applicability of the Moyers mixed dentition probability tables and new prediction aids for a contemporary population in India.

INTRODUCTION: The Moyers mixed dentition space analysis method is among the most commonly used in clinical practice for detecting tooth size-arch length discrepancies. In view of reported secular trends, racial, and sex differences in tooth sizes, the purposes of this study were to evaluate the applicability of Moyers probability tables in a contemporary orthodontic population of India and to formulate more accurate mixed dentition prediction aids. METHODS: Odontometric data were collected from 300 male and 300 female subjects of Indian descent, who had fully erupted mandibular permanent incisors and maxillary and mandibular canines and premolars. We measured the mesiodistal crown widths with vernier scale dial calipers. The odontometric values obtained were then subjected to statistical and linear regression analysis. RESULTS: All tooth groups showed significant differences (P <0.001) between mesiodistal widths of male and female subjects. Regression equations for the maxillary arch (males, Y = 7.15 + 0.67X; females, Y = 7.44 + 0.65X) and the mandibular arch (males, Y = 5.55 + 0.71X; females, Y = 6.15 + 0.67X) were used to develop new probability tables on the Moyers pattern. Significant differences (P <0.05) were found between our predicted widths and the Moyers tables at almost all percentile levels, including the recommended 75% and 50% levels. CONCLUSIONS: We believe that these new prediction aids could be considered for a more precise mixed dentition space analysis in Indian children.

Comparison between the dimensions of lateral incisor crowns adjacent to unerupted palatally displaced and nondisplaced canine.

AIM: To compare the dimensions of lateral incisor crowns adjacent to unerupted palatally displaced and nondisplaced permanent maxillary canines. METHODS: The sample consisted of 36 children between 10 and 12 years of age with unerupted maxillary canines. Each presented with a unilaterally palatally displaced (with respect to the lateral incisor) canine. The lateral incisor next to the palatally displaced canine was considered the experimental tooth; the tooth on the contralateral side was considered the control tooth. Measurements were crown width (mesiodistal), thickness (labiopalatal), taper (convergence of the crown toward the incisal edge), taper type, and crown length. RESULTS: No association was found between the experimental and control lateral incisors for crown width and thickness. However, a significant correlation was found for crown taper (P=.048) and length (P=.01). The experimental lateral incisors had a higher mean crown taper (0.54 mm) than the controls (0.24 mm). The mean crown length was smaller for the experimental lateral incisors (6.74 mm) than the control ones (7.55 mm). CONCLUSION: There is a significantly greater possibility of finding lateral incisors with greater crown taper and shorter length next to palatally displaced canines. However, there is no significant difference in crown width or thickness.

Efficacy of 10% Povidone Iodine in children affected with early childhood caries: an in vivo study.

UNLABELLED: For prevention of dental caries, S. mutans numbers must be reduced and prevented from returning to the original level. An antibacterial agent that is effective and also acceptable to young children can help to establish a favorable oral environment and halt the caries process. PURPOSE: This study was conducted to evaluate the efficacy of topical antimicrobial (10% Povidone- Iodine) on S. mutans counts in children with Early Childhood Caries after full mouth rehabilitation. Also its effects on the clinical outcomes in terms of incidence of new caries and secondary caries were evaluated. METHOD: Full mouth rehabilitation was done in 30 children (mean age 4.2 years) suffering from Severe Early Childhood Caries (SECC). Stimulated saliva samples were collected to determine the post operative baseline S. mutans counts. Thereafter the subjects were randomly divided into two groups. The experimental group received 10% Povidone Iodine at 3 months interval for a period of 12 months while the control group received placebo (deionized water) at similar intervals. Change in the S.mutans count at 6 and 12 month intervals were compared to the baseline post-operative mutans score. Results revealed that application of 10% Povidone Iodine caused a significant reduction in the rise of Streptococcus mutans levels from the baseline postoperative score after 12 months of treatment thus decreasing the oral load of the organisms. Reduction in counts; in turn decreased the relapse of caries in these children. CONCLUSION: Thus oral rehabilitation coupled with regular application of 10% Povidone Iodine application can be a good alternative to control dental caries in children affected with Early Childhood Caries (ECC).

Arch length deficiency on sides containing palatally erupting canines.

AIM: To measure the arch length of sides containing palatally displaced canines and to compare them with those of contralateral sides with normally positioned canines. METHODS: The study sample consisted of 36 children 10 to 12 years of age with unerupted permanent maxillary canines who presented with palatally displaced canines, unilaterally, with respect to the maxillary lateral incisors. The palatal displacement was evaluated using the horizontal tube shift method with periapical radiographs, after the canine cusp tips were found to overlap their adjacent lateral incisors on panoramic radiographs. Arch length was measured on either side from a uniform point on the mesiolingual surface of the permanent first molar to a point on the dental arch that coincided with an anterior extension of the midpalatal raphae. The side that contained the palatally displaced canine was considered experimental, while the contralateral side was the control. The mean, standard deviation, range, and 95% confidence interval values were calculated, and the Student t test was carried out to obtain the P values for the arch lengths. RESULTS: The mean arch length value from the experimental sides was 31.38 ± 1.98 mm (95% CI 29.30 to 33.45). The mean value from the control sides was 32.86 ± 2.28 mm (95% CI 30.48 to 35.24). CONCLUSION: There is a significantly high possibility of finding palatally displaced canines with respect to maxillary lateral incisors on sides with lesser arch lengths compared to the contralateral sides.

Reliability of the magnification method for localisation of ectopic upper canines.

OBJECTIVE: To evaluate the reliability of the magnification method for localisation of palatally placed canines. METHODS: Panoramic radiographs were taken of subjects, aged 10 to 12 years, with unerupted upper permanent canines. Two periapical radiographs (horizontal parallax method) were then used to identify 36 sublects with one palatally placed canine. Differences in the sizes of crowns of the canines on the panoramic radiographs were used to identify which tooth was palatally placed. The observer was blinded to the side with the palatally placed canine. The parallax and magnification results were tabulated, and the sensitivity and specificity of the magnification method calculated. RESULTS: The magnification method was found to have a sensitivity of 75 per cent; specificity of 100 per cent; positive predictive value of 100 per cent; negative predictive value of 80 per cent; and an accuracy of 87.5 per cent, in localising palatally placed canines. CONCLUSION: The magnification method, which uses the side-to-side difference in the magnification of the crowns of ectopic canines on panoramic radiographs, is adequate for initial assessment of canine position. The magnification method did, however, accurately identify canines that were not palatally placed. Additional radiographs may be required to accurately localise an ectopic canine.