Complete versus incomplete caries removal procedures and their effects on dental pulp in primary teeth - An in vivo study.

INTRODUCTION: Dental caries results from an ecologic shift within the dental biofilm from a balanced population of microorganisms to an acidogenic, aciduric, and cariogenic microbiological population developed and maintained by frequent consumption of fermentable dietary carbohydrates. Total caries removal (TCR) of deep lesion may result in pulpal exposure requiring more invasive treatment. Hence, current pediatric dentistry has shifted to minimally invasive treatment that avoids more complex, time-consuming procedure, and the child's discomfort. AIM: The aim of this study is to evaluate and compare clinical performance and radiographic changes after complete and incomplete caries removal procedures. MATERIALS AND METHODS: The study was conducted on 60 primary molars in children aged 6-9 years. Selected 60 primary molars were randomly divided into two groups. Group 1 (PCR): infected dentin was removed, while the affected dentin was maintained on the pulpal wall. Group 2 (TCR): both infected and affected dentin were removed through low-speed carbide bur and hand excavator. Teeth were evaluated at 4 and 6 months clinically and radiographically. RESULTS: The proportion was compared using Fisher's exact test. The Statistical Package for the Social Sciences version 21 was used for analysis. The level of significance was kept at 5%. CONCLUSION: The clinical and radiographic success rates of ICR and CCR in primary teeth with deep carious lesions were high and did not differ significantly, indicating that the retention of carious dentin does not interfere with pulp vitality. Thus, ICR is a reliable minimally invasive approach that might replace the CCR in primary teeth when correctly indicated.

The Impact of Rubber Dam Association With Physiological Stress Parameters on Children of 7-10 Years Undergoing Pit and Fissure Sealant Treatment: An In-Vivo Study.

Introduction Anxiety is an emotion representing apprehension towards an unknown stimulus or situation. Rubber dam application during dental procedures in children makes the treatment more comfortable and acceptable as it gives them a psychological feeling that treatment is being carried out outside the oral cavity. The prime objective of this study was to evaluate and compare physiological parameters, which include pulse rate, arterial oxygen saturation level, blood pressure, and respiratory rate before and after rubber dam isolation. Material and methods The study consisted of 30 children patients of 7-10 years, comprised of 14 females and 16 males with a mean age of 8.15 ± 0.93 years. The study was a 'split mouth' clinical design study, where 60 sites in 30 patients (two sites in each patient) were used. The selected sites were divided into two groups by a convenience sampling method and were categorized as Group-I (control group - 30 sites were treated with pit and fissure sealants under cotton roll and saliva ejectors on mandibular right permanent first molar) and Group-II (study group - 30 sites were treated with pit and fissure sealants underrubber dam isolation on mandibular left permanent first molar). Results Rubber dam application reduced different physiological parameters of stress such as pulse rate, systolic and diastolic blood pressure, and respiratory rate at different intervals from the baseline values. Rubber dam and cotton roll applications have no significant effects on oxygen saturation levels at different intervals in healthy individuals. From statistical analysis, it was evident that a statistically significant difference was evident between the control and experimental groups (P value < 0.005). Conclusion It is confirmed in this study that rubber dam reduces different physiologic parameters of stress. After the application of the rubber dam, children's pulse rate, systolic and diastolic blood pressure, and respiratory rate were reduced. Clinical significance The study highlights the imperative role of rubber dam isolation in improving dental and medical effectiveness. In addendum to this, our research promotes the clinical use of rubber dams in pediatric dentistry.

Salivary Total Protein and Alkaline Phosphatase Activity as Biomarkers for Skeletal Maturity and Growth Prediction in Healthy Children: An In Vivo Study.

Introduction: Skeletal maturity assessment involves radiographic analysis and visual inspection of developing bone and their initial appearance or sequential ossification and related changes in size and shape along with the expression of various biomarkers in body fluids. Aim: To investigate the correlation of biomarkers such as salivary alkaline phosphatase (S-ALP) and salivary total protein (STP) with skeletal maturity assessment and growth prediction in growing children. Materials and methods: A total of 8-15-year-old 150 healthy children were divided into five groups depending upon radiographic stage maturity of the middle phalanx of the left hand's third finger according to the Hagg and Taranger method. Radiographs were taken using intraoral periapical (IOPA) radiographic films. Results: Salivary alkaline phosphatase (S-ALP) activity in the MP3 G group was significantly higher than MP3 F group and MP3 I group. Total protein levels in MP3 F were significantly lower than in MP3 G. The mean value of S-ALP (33541.45 IU/L) and that of STP (2.77 mg/mL) was observed to be highest in the MP3 G group (G3) group. Conclusion: Salivary total protein (STP) and S-ALP may be used as an additional diagnostic tool to assess skeletal maturation and optimize growth prediction during myofunctional orthodontic treatment. Clinical significance: Skeletal maturity assessment plays a significant role in orthodontic diagnosis, treatment planning, and stability of orthodontic treatment. Radiographic parameters involve radiographic exposure; hence in this study noninvasive biomarkers such as S-ALP and STP have been evaluated for skeletal maturity assessment and growth prediction. How to cite this article: Abhangi KK, Choudhari SR, Butala PB, et al. Salivary Total Protein and Alkaline Phosphatase Activity as Biomarkers for Skeletal Maturity and Growth Prediction in Healthy Children: An In Vivo Study. Int J Clin Pediatr Dent 2023;16(4):603-607.

The Evaluation of the Antibacterial and Antifungal Efficacy of Novel Kids Mineral Trioxide Aggregate (e-MTA) With ProRoot MTA and Glass Ionomer Cement.

Background Most pulpal and periapical problems could be treated nonsurgically. However, in cases of infections, certain operations must be performed that require using materials with good antibacterial and antifungal efficacy. ProRoot mineral trioxide aggregate (MTA) was marketed as gray- and white-colored preparations, composed of 75% Portland cement, 20% bismuth oxide, and 5% gypsum by weight. MTA, composed of powder and liquid as distilled water, formed a colloidal gel that further solidified and formed a hard cement within approximately four hours. The new endodontic material Kids e-MTA (Kids-e-dental, Mumbai, India) was introduced recently. It was also available as powder and liquid. It was a bioactive cement consisting of very fine hydrophilic particles of several mineral oxides. Aim This study compares the antimicrobial and antifungal efficacy of e-MTA (mineral trioxide aggregate) (Kids-e-dental, Mumbai, India), ProRoot MTA (Dentsply Sirona, Tulsa Dental, OK, USA), and glass ionomer cement (GIC) (GC Asia Dental Pte Ltd, Singapore). Materials and methods The agar diffusion method was used to test the materials. e-MTA, ProRoot MTA, and GIC were tested for their antibacterial efficacy against Enterococcus faecalis and antifungal efficacy against Candida albicans. The zone of inhibition was calculated and measured using a precision ruler. The collected data was put through Student's unpaired t-test. Results and conclusions On conducting the tests and comparing the results, it was found that e-MTA had a slightly better antibacterial efficacy and almost similar antifungal efficacy compared to ProRoot MTA but significantly superior properties compared to GIC.

A comprehensive oral and dental management of an epileptic and intellectually deteriorated adolescent.

Epilepsy along with intellectual deterioration and other neurological disorders can have social, physical, and psychological consequences, especially, when they begin in childhood. Moreover, the seizure episode along with mental deterioration may compromise the oral and dental care resulting in numerous decayed teeth. This report presents the case history of an adolescent with poor oral hygiene and numerous decayed teeth. This report also presents the comprehensive endodontic, surgical, and prosthodontic management of epileptic mentally challenged patient in the dental office. Epilepsy along with intellectual deterioration and other neurological disorders can have social, physical, and psychological consequences, especially, when they begin in childhood. Moreover, the seizure episode along with mental deterioration may compromise the oral and dental care resulting in numerous decayed teeth. This report presents the case history of an adolescent with poor oral hygiene and numerous decayed teeth. This report also presents the comprehensive endodontic, surgical, and prosthodontic management of epileptic mentally challenged patient in the dental office.

Sturge-Weber syndrome with pyogenic granuloma.

Vascular lesions represent one of the rare disorders affecting overall quality of life of a child. A wide variety of these conditions are known, ranging from a simple nevus to life-threatening hemangiomas. These conditions make the treatment options more complex due to the fear of uncontrollable bleeding. The present case is one of the rare combinations of Sturge-Weber syndrome and pyogenic granuloma. Conditions of importance and treatment options keeping hemangioma in mind are discussed.

Dens invaginatus: a case report.

Dens invaginatus, also known as dens in dente, is a rare anomaly affecting human dentition. The condition results in invagination of an amelodental structure within the pulp. This case report discusses the current management protocol of dens invaginatus as demonstrated in an adolescent female and describes treatment options. As with most conditions, early diagnosis and preventive measures help minimize complications in dens invaginatus cases.

Comparative evaluation of remineralizing potential of three agents on artificially demineralized human enamel: An in vitro study.

INTRODUCTION: Remineralization as a treatment procedure has received much attention from clinicians. The objective of this in vitro study was to find out the efficacy of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF), and tricalcium phosphate fluoride (TCP-F) in remineralizing enamel surface on which artificial caries lesion had been created. The changes were analyzed using DIAGNOdent(®) (KaVo) and scanning electron microscope (SEM). MATERIALS AND METHODS: A total of 52 premolars and 24 molars were selected and classified into four groups of 13 premolars and 6 molars in each: I (CPP-ACP), II (CPP-ACPF), III (TCP-F), and IV (artificial saliva). All the samples were assessed using DIAGNOdent at the baseline and after demineralization and remineralization. Ten samples were randomly selected from each group baseline after demineralization and after remineralization for surface evaluation using SEM. RESULTS: Statistical analysis showed that all the experimental groups had a significantly higher amount of remineralization except for group IV. CONCLUSION: All the three experimental groups showed a statistically significant amount of remineralization. However, because of the added benefit of fluoride (NaF 0.2%), CPP-ACPF (Tooth Mousse-Plus(®)) and TCP-F showed marginally more amount of remineralization than did CPP-ACP (Tooth Mousse(®)). Remineralization efficacy was TCP-F > CPP-ACPF > CPP-ACP.

Mucocele of the glands of blandin-nuhn in children: a clinical, histopathologic, and retrospective study.

BACKGROUND: The anterior lingual salivary glands (glands of Blandin-Nuhn) are mixed mucous and serous glands that are embedded within the musculature of anterior tongue ventrum. AIM: The present study was designed to describe the clinical and histopathological features. MATERIAL AND METHODS: We investigated the clinical and histopathologic features of 30 cases of mucocele of glands of Blandin-Nuhn. All the cases were seen in the department of pedodontics. RESULTS: All the lesions were located on the ventral surface of the tongue. Lesions were situated at the midline in 24 patients and laterally in 6 patients. All the lesions were surgically treated. There was female predominance, and most patients were younger than 15 years. CONCLUSION: Histopathological examination showed extravasation type of mucocele, suggesting that trauma may be a frequent initiating factor. All the patients were younger than 15 years.

Effect of immediate and delayed postpreparation on the integrity of the apical seal: an in vitro study.

AIM: The aim of this in vitro study was to evaluate if there is any significant difference in apical leakage when gutta-percha is removed immediately after obturation for postspace preparation or after a week. MATERIALS AND METHODS: Two commonly used sealers AH26 and tubliseal were used in four groups each consisting of 20 teeth each. The tooth was sectioned at the amelocemental junction to leave a root portion of 12 to 14 mm. Canals were checked for patency and prepared to No-55 K file size. Two people, using a stereomicroscope, independently evaluated each tooth-half for the extent of apical leakage. RESULTS: The leakage results were analyzed using a one-way ANOVA according to present study, immediate postpreparation is preferable than delayed postpreparation. The relationship of in vitro leakage measurements to the in vivo situation has not been established. CLINICAL IMPLICATION: Hence, immediate postpreparation is preferable than delayed postpreparation.

Unilateral pathology associated with bilateral etiologies.

Hormonal fluctutaions affect not only a woman's reproductive system but surprisingly they have a strong influence on the oral cavity also. These changes are not necessarily the result of direct hormonal action on the tissue, but are perhaps best explained as the effects of the local factors (e.g. plaque on tissues exacerbated by hormonal activity). One such case of pubertal induced gingival enlargement associated with chronic generalized periodontitis caused by the combined influence of hormones and the habit of unilateral mastication is presented here. A 14-year-old girl reported with a complaint of swollen gums in the right maxillary and mandibular arches of the mouth since 2 years. The patient also had the habit of unilateral mastication (left side) since childhood which was revealed upon history. Amelioration of the gingival inflammation and the periodontal attachment loss was obtained through conventional periodontal therapy, including plaque control, scaling, root planing, and surgical removal of the soft tissue using Modified Widman Flap and bone grafting. Postoperative follow-up did not show any signs of recurrence. Pubertal induced gingival enlargement with unilateral masticatory habit needs early removal of enlargement to prevent further bone loss.

Caries prevention effect of intensive application of sodium fluoride varnish in molars in children between age 6 and 7 years.

BACKGROUND: The aim of this study was to evaluate the efficacy of intensive application of sodium fluoride varnish in prevention of caries in molars in children between 6 and 7 years and to evaluate the caries status in molars before and after application of fluoride varnish (Cavity Shield). MATERIALS AND METHODS: Two hundred fifty children (6-7 years) randomized into varnish and control groups. Children in varnish group received fluoride varnish (Cavity Shield) three times during one week (once every 2 days). Clinical and radiographical examinations of all children were performed prior to the first application of varnish and 1 year later. For evaluation and comparison, all the collected data were subjected to statistical analysis. RESULTS: At the end of 1 year period, varnish group had 27.7% caries reversal in deciduous dentition which was statistically significant. Though there was a decrease in the caries increment in the permanent dentition, it was not statistically significant. CONCLUSION: Application of fluoride varnish Cavity Shield three times once a week, once a year either in permanent or in deciduous dentition, is associated with substantial reduction in caries increment. CLINICAL SIGNIFICANCE: Fluoride varnish can prove to be an effective tool in prevention of dental caries in both primary and permanent dentitions.