Clinical Evaluation of Overall Efficacy and Pain Perception of Ultrasonic Oscillating Tips and Conventional High-speed Burs for Removal of Dental Caries in Children in Age-group of 6-8 Years.

Aim: To clinically evaluate the overall efficacy and pain perception of ultrasonic oscillating tips and conventional high-speed burs to remove enamel and dentinal caries in children of ages 6-8 years. Materials and methods: Bilateral deciduous canines with caries involving enamel or enamel and dentin were excavated by using a high-speed airrotor on one tooth and ultrasonic oscillating tips on another tooth in the same appointment. The overall response of the patient, both ultrasonic oscillating tips and airrotor along was recorded by Wong-Baker's Facial Pain Rating Scale (WBFPS) along with time taken to make each cavity and noise level generated by high-speed and ultrasonic system. Results: Evaluation of WBFPS after every method of caries excavation showed that 84% of subjects in the ultrasonic group reported score of 0 as compared to only 24% of subjects in the airrotor group. Score 2 was reported by 16% of the subjects in the ultrasonic group and 32% of the subjects in the airrotor group. Score 4 was reported by 44% of the subjects in the airrotor group. Ultrasonic groups reported more time to remove caries as compared to the airrotor group. The ultrasonic group reported less noise as compared to the airrotor group and the difference between the two was significant. Conclusion: Patients preferred the ultrasonic method for caries excavation because of less pain and noise. The use of ultrasonic oscillating tips is as effective in caries excavation, less painful, and more time-consuming than the conventional airrotor. Significance: Ultrasonic oscillating tips can be successfully used in pediatric dentistry to aid patient cooperation and reduce pain during caries excavation. How to cite this article: Kenjale MA, Shah P, Desai S, et al. Clinical Evaluation of Overall Efficacy and Pain Perception of Ultrasonic Oscillating Tips and Conventional High-speed Burs for Removal of Dental Caries in Children in Age-group of 6-8 Years. Int J Clin Pediatr Dent 2023;16(2):251-258.

Plaque contact and unimpaired Trem2 is required for the microglial response to amyloid pathology.

Using spatial cell-type-enriched transcriptomics, we compare plaque-induced gene (PIG) expression in microglia-touching plaques, neighboring plaques, and far from plaques in an aged Alzheimer's mouse model with late plaque development. In 18-month-old APPNL-F/NL-F knockin mice, with and without the Alzheimer's disease risk mutation Trem2R47H/R47H, we report that expression of 38/55 PIGs have plaque-induced microglial upregulation, with a subset only upregulating in microglia directly contacting plaques. For seven PIGs, including Trem2, this upregulation is prevented in APPNL-F/NL-FTrem2R47H/R47H mice. These TREM2-dependent genes are all involved in phagocytic and degradative processes that we show correspond to a decrease in phagocytic markers and an increase in the density of small plaques in Trem2-mutated mice. Furthermore, despite the R47H mutation preventing increased Trem2 gene expression, TREM2 protein levels and microglial density are still marginally increased on plaques. Hence, both microglial contact with plaques and functioning TREM2 are necessary for microglia to respond appropriately to amyloid pathology.

Radicular Cyst Involving Deciduous Maxillary Incisor along with Bilateral Supernumerary Teeth: A Case Report.

Radicular cyst involving the deciduous dentition is rare. Most of the cases reported it with primary molar teeth with apical infection. But very rare literature is available regarding radicular cysts associated with primary incisors. Case report: A case of 9-year-old boy, who had bilaterally impacted supernumerary teeth, had developed a radicular cyst associated with a previously traumatized and intruded right upper primary lateral incisor is reported. Supernumerary teeth and intruded primary lateral incisor were removed along with enucleation of a radicular cyst. Conclusion: The importance of correct diagnosis and management of radicular cyst in pediatric patients is important as most of the radicular cysts of primary teeth go undiagnosed, which can affect the developing succedaneous tooth bud. How to cite this article: Bhosale AN, Desai S, Patil S, et al. Radicular Cyst Involving Deciduous Maxillary Incisor along with Bilateral Supernumerary Teeth: A Case Report. Int J Clin Pediatr Dent 2022;15(2):218-221.

An in vitro comparative evaluation of casein phosphopeptide-amorphous calcium phosphate fluoride, tricalcium phosphate and grape seed extract on remineralization of artificial caries lesion in primary enamel.

OBJECTIVES: To evaluate and compare the remineralization potential of casein phosphopeptide-amorphous calcium phosphate fluoride, tricalcium phosphate and grape seed extract on artificial caries lesions in primary enamel. STUDY DESIGN: A sample of 40 non-carious, primary molar teeth was collected and cut in longitudinal sections into three equal halves. Those 120 samples were divided into four equal groups. Group A: Sections treated with casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF), Group B: Sections treated with tricalcium phosphate, Group C: Sections treated with grape seed extract Group D: Sections treated with deionized water (control group). Samples were evaluated for change in surface characteristics, mineral content using Scanning electron microscopy-energy dispersive X-ray analysis (SEM-EDX) and microhardness using Vicker's microhardness tester. Cavitated lesions were evaluated for Cone beam computer tomography to obtain baseline data post remineralization. RESULTS: The remineralization potential of grape seed extract was found to be greater compared to tricalcium phosphate followed by CPP-ACPF. CONCLUSION: All the three groups viz. CPP-ACPF, tricalcium phosphate and grape seed extract showed remineralization under the in vitro pH cycling model, while grape seed extract group showed significantly greater remineralization compared to the CPP-ACPF and tricalcium phosphate groups.

Identification of Suicidal Ideation in the Canadian Community Health Survey-Mental Health Component Using Deep Learning.

Introduction: Suicidal ideation (SI) is prevalent in the general population, and is a risk factor for suicide. Predicting which patients are likely to have SI remains challenging. Deep Learning (DL) may be a useful tool in this context, as it can be used to find patterns in complex, heterogeneous, and incomplete datasets. An automated screening system for SI could help prompt clinicians to be more attentive to patients at risk for suicide. Methods: Using the Canadian Community Health Survey-Mental Health Component, we trained a DL model based on 23,859 survey responses to classify patients with and without SI. Models were created to classify both lifetime SI and SI over the last 12 months. From 582 possible parameters we produced 96- and 21-feature versions of the models. Models were trained using an undersampling procedure that balanced the training set between SI and non-SI; validation was done on held-out data. Results: For lifetime SI, the 96 feature model had an Area under the receiver operating curve (AUC) of 0.79 and the 21 feature model had an AUC of 0.77. For SI in the last 12 months the 96 feature model had an AUC of 0.71 and the 21 feature model had an AUC of 0.68. In addition, sensitivity analyses demonstrated feature relationships in line with existing literature. Discussion: Although further study is required to ensure clinical relevance and sample generalizability, this study is an initial proof of concept for the use of DL to improve identification of SI. Sensitivity analyses can help improve the interpretability of DL models. This kind of model would help start conversations with patients which could lead to improved care and a reduction in suicidal behavior.

Comparison of Tensile Bond Strength of Addition Silicone with Different Custom Tray Materials Using Different Retentive Methods.

AIM: To compare the bond strength of addition silicone with different commonly used custom tray materials by means of different retentive methods (mechanical, chemical, and a combination of chemical and mechanical methods). MATERIALS AND METHODS: Fabrications of 90 samples of different tray resin materials were done using an aluminum mold. They were divided into three main groups. Perforations, adhesive application, and a combination of both were done according to the grouping of samples. Polyvinyl siloxane material (medium body) was loaded over the samples. A universal testing machine with a crosshead speed of 5 mm/minute was used to determine the tensile bond strength of tray resin samples to medium body impression material. Based on these values, Student's-test, group statistics, and ANOVA test were used for statistical analysis. RESULTS: Visible light cure (VLC) resin showed the highest bond strength in chemicomechanical methods. This was followed by repair resin material. Tray resin material showed poor bond strength in all three retentive methods. The mechanical method was the least retentive in all three resin materials. CLINICAL SIGNIFICANCE: VLC tray resin material can be used with chemical and mechanical retention in clinical situations to make predictably accurate elastomeric impressions. CONCLUSION: It was concluded that VLC tray resin shows good bond strength with polyvinyl siloxane impression material when both mechanical perforations and adhesive applications were done.

Recent advances, novel targets and treatments for cholelithiasis; a narrative review.

Cholelithiasis is a common and frequent condition all over the world with a high prevalence rate in western countries. Individuals with cholesterol gallstone disease experience intense gastrointestinal symptoms and have a high risk of developing comorbidities like cholecystitis, Gall bladder (GB) cancer and pancreatitis. Multiple risk factors associated with cholesterol gallstones include but not limited to genetics, dietary habits, lifestyle changes, comorbid conditions and various drugs. These factors may lead to alteration in bile, cholesterol & phospholipids homeostasis in the GB, intestine and hepatocytes culminating in cholesterol gallstones formation. Surgical (cholecystectomy) and non-surgical (oral dissolution therapy) treatments are available for the disease, albeit with certain complications and high treatment cost. Thus, there is a need for interventions, complementary or alternative therapies for the treatment and prevention of cholesterol gallstones. Currently available drug therapies used for cholesterol gallstones include statins and ezetimibe. Many patients consider traditional herbal practitioners due to their promise of non-invasive and pain free management of gall stones. This present a positive shift towards generally acceptable safety and cost effectiveness of herbal treatment warranting extensive research for alternative or complementary choice such as herbal plants as an emerging area for their potential therapeutic effects. This review discusses current strategies, latest trends available in the disease pathogenesis, drug development for novel targets, risk management, newer anti-lithogenic drugs and herbal plants that target the different aspects of the disease.

The Spectrum of Clinical, Immunological, and Molecular Findings in Familial Hemophagocytic Lymphohistiocytosis: Experience From India.

Hemophagocytic lymphohistiocytosis (HLH) is a syndrome of immune dysregulation characterized by hyperactivation of the immune system, excessive cytokine secretion and severe systemic inflammation. HLH is classified as familial (FHL) when associated with mutations in PRF1, UNC13D, STX11, and STXBP2 genes. There is limited information available about the clinical and mutational spectrum of FHL patients in Indian population. This study is a retrospective analysis of 101 molecularly characterized FHL patients over the last 10 years from 20 different referral centers in India. FHL2 and FHL3 together accounted for 84% of cases of FHL in our cohort. Patients belonging to different FHL subtypes were indistinguishable based on clinical and biochemical parameters. However, flow cytometry-based assays viz. perforin expression and degranulation assay were found to be specific and sensitive in diagnosis and classification of FHL patients. Molecular characterization of respective genes revealed 76 different disease-causing mutations including 39 (51%) novel mutations in PRF1, UNC13D, STX11, and STXBP2 genes. Overall, survival was poor (28%) irrespective of the age of onset or the type of mutation in our cohort. Altogether, this article sheds light on the current scenario of FHL in India. Our data reveal a wide genetic heterogeneity of FHL in the Indian population and confirms the poor prognosis of FHL. This study also emphasizes that though mutational analysis is important for diagnostic confirmation of FHL, flow cytometry based assays help significantly in rapid diagnosis and functional validation of novel variants identified.

N-formyl-l-aspartate: A novel sperm chemoattractant identified in ovulatory phase oviductal fluid using a microfluidic chip.

BACKGROUND: Chemotaxis, as a mechanism for sperm guidance although known, has been difficult to demonstrate in vitro. Consequently, very few chemoattractants have been identified till date. OBJECTIVES: To investigate sperm motility behavior in response to ovulatory (OV) and preovulatory (preOV) oviductal fluid (OF) and identify potential chemotactic metabolites. MATERIALS AND METHODS: Intracellular calcium ([Ca2+ ]I ) influx in capacitating sperm was determined by spectrofluorimetry. The chemotactic response of rat caudal sperm to OF from the preOV- and OV- phases of normally cycling female rats was assessed in a microfluidic device developed by us. Hydrophilic metabolites extracted from the OF of both the phases were resolved and identified by LC-MS/MS, followed by data analysis using XCMS and MetaboAnalyst software, and chemotactic potential of the most promising compound was validated using the microfluidic device. RESULTS: Spectrofluorimetric analysis depicts a significant increase in sperm [Ca2+ ]I in response to OV-OF. With the microfluidic chemotaxis assay, sperm population shows a significantly increased directionality and velocity to an ascending gradient of 0.06 µg/µl OV-OF compared to preOV-OF. LC-MS/MS of the OFs demonstrates five and four metabolites to be exclusive to the OV-OF and preOV-OF, respectively, and 25 metabolites common to both, of which 14 metabolites, including N-formyl-l-aspartate (NFA), are increased in OV-OF; NFA was tested for its ability to influence sperm movement, and shows chemotaxis potential. DISCUSSION AND CONCLUSION(S): This is the first study that has systematically demonstrated sperm chemotaxis with OV phase rat OF, identified NFA present in this fluid as a novel chemoattractant to sperm, and proven the utility of the device to test putative chemoattractants. It remains to be seen whether NFA is present in the follicular fluid (FF) of infertile women, and whether it may likely be a reason for the failure of natural conception in idiopathic infertile women.

Clinical and Genetic Profile of X-Linked Agammaglobulinemia: A Multicenter Experience From India.

Background: There is paucity of literature on XLA from developing countries. Herein we report the clinical and molecular profile and outcome in a multicenter cohort of patients with XLA from India. Methods: Data on XLA from all regional centers supported by the Foundation for Primary Immunodeficiency Diseases (FPID), USA and other institutions providing care to patients with PIDs were collated. Diagnosis of XLA was based on European Society for Immunodeficiencies (ESID) criteria. Results: We received clinical details of 195 patients with a provisional diagnosis of XLA from 12 centers. At final analysis, 145 patients were included (137 'definite XLA' and eight 'probable/possible XLA'). Median age at onset of symptoms was 12.0 (6.0, 36.0) months and median age at diagnosis was 60.0 (31.5, 108) months. Pneumonia was the commonest clinical manifestation (82.6%) followed by otitis media (50%) and diarrhea (42%). Arthritis was seen in 26% patients while 23% patients developed meningitis. Bronchiectasis was seen in 10% and encephalitis (likely viral) in 4.8% patients. Pseudomonas aeruginosa was the commonest bacterial pathogen identified followed by Streptococcus pneumoniae, Staphylococcus aureus and Klebsiella pneumoniae. Molecular analysis revealed 86 variants in 105 unrelated cases. Missense variants in BTK gene were the most common (36%) followed by frameshift (22%) and nonsense variants (21%). Most pathogenic gene variants (53%) were clustered in the distal part of gene encompassing exons 14-19 encoding for the tyrosine kinase domain. Follow-up details were available for 108 patients. Of these, 12% had died till the time of this analysis. The 5-year and 10-year survival was 89.9% and 86.9% respectively. Median duration of follow-up was 61 months and total duration of follow-up was 6083.2 patient-months. All patients received intravenous immunoglobulin (IVIg) replacement therapy. However, in many patients IVIg could not be given at recommended doses or intervals due to difficulties in accessing this therapy because of financial reasons and lack of universal health insurance in India. Hematopoietic stem cell transplant was carried out in four (2.8%) patients. Conclusion: There was a significant delay in the diagnosis and facilities for molecular diagnosis were not available at many centers. Optimal immunoglobulin replacement is still a challenge.

Clinical and Genetic Spectrum of a Large Cohort of Patients With Leukocyte Adhesion Deficiency Type 1 and 3: A Multicentric Study From India.

Leukocyte adhesion deficiency (LAD) syndrome is a group of inborn errors of immunity characterized by a defect in the cascade of the activation and adhesion leading to the failure of leukocyte to migrate to the site of tissue injury. Three different types of LAD have been described. The most common subtype is LAD type 1 (LAD1) caused due to defects in the ITGß2 gene. LAD type 2 (LAD2) is caused by mutations in the SLC35C1 gene leading to a generalized loss of expression of fucosylated glycans on the cell surface and LAD type 3 (LAD3) is caused by mutations in the FERMT3 gene resulting in platelet function defects along with immunodeficiency. There is a paucity of data available from India on LAD syndromes. The present study is a retrospective analysis of patients with LAD collated from 28 different centers across India. For LAD1, the diagnosis was based on clinical features and flow cytometric expression of CD18 on peripheral blood leukocytes and molecular confirmation by Sanger sequencing. For patients with LAD3 diagnosis was largely based on clinical manifestations and identification of the pathogenic mutation in the FERMT3 gene by next-generation Sequencing. Of the total 132 cases diagnosed with LAD, 127 were LAD1 and 5 were LAD3. The majority of our patients (83%) had CD18 expression less than 2% on neutrophils (LAD1°) and presented within the first three months of life with omphalitis, skin and soft tissue infections, delayed umbilical cord detachment, otitis media, and sepsis. The patients with CD18 expression of more than 30% (LAD1+) presented later in life with skin ulcers being the commonest manifestation. Bleeding manifestations were common in patients with LAD3. Persistent neutrophilic leukocytosis was the characteristic finding in all patients. 35 novel mutations were detected in the ITGß2 gene, and 4 novel mutations were detected in the FERMT3 gene. The study thus presents one of the largest cohorts of patients from India with LAD, focusing on clinical features, immunological characteristics, and molecular spectrum.

Assessment of parental attitude toward different behavior management techniques used in pediatric dentistry.

BACKGROUND: The goal of any good dental treatment is to provide a quality dental care to the patient. This may not be possible if the patient is unwilling to cooperate or unable to do so due to their age or related factors. In such children, behavior management techniques are very helpful. With changing times, there have been changes in the law and the outlook of parents and society toward dental treatment. This influences the various behavior management methods used by pediatric dentists. OBJECTIVES: This study was conducted to assess the attitudes of parents of children of different pediatric age groups towards: Behavior management techniques used by pediatric dentists The effect of maternal anxiety on the child's behavior in clinic Pharmacological behavior management techniques The effect of parental presence in the operatory on the child's behavior. MATERIALS AND METHODS: Three hundred parents were evaluated and divided into three groups comprising 100 each on the basis of their children's age, Group A: 2-5 years, Group B: 6-9 years, and Group C: 10-13 years, which were further divided into two subgroups, on the basis of the child's gender, with each subgroup having parents of 50 male and 50 female children each. For example, Group A1: 50 parents of 2-5-year-old boys, Group A2: 50 parents of 2-5-year-old girls. RESULTS: ANOVA test showed different hierarchies of acceptance for the techniques in all the groups. In all the three groups, tell show do, positive reinforcement, and live modeling were the most accepted techniques. However, statistically significant difference between the groups was not observed for the three techniques. The least accepted techniques for all the groups were hand over mouth technique and voice control technique. CONCLUSION: Parents were more receptive of those techniques which were visually more acceptable involving a communicative management, such as tell show do, positive reinforcement, and live modeling.

Oral cancer screening: serum Raman spectroscopic approach.

Serum Raman spectroscopy (RS) has previously shown potential in oral cancer diagnosis and recurrence prediction. To evaluate the potential of serum RS in oral cancer screening, premalignant and cancer-specific detection was explored in the present study using 328 subjects belonging to healthy controls, premalignant, disease controls, and oral cancer groups. Spectra were acquired using a Raman microprobe. Spectral findings suggest changes in amino acids, lipids, protein, DNA, and ß-carotene across the groups. A patient-wise approach was employed for data analysis using principal component linear discriminant analysis. In the first step, the classification among premalignant, disease control (nonoral cancer), oral cancer, and normal samples was evaluated in binary classification models. Thereafter, two screening-friendly classification approaches were explored to further evaluate the clinical utility of serum RS: a single four-group model and normal versus abnormal followed by determining the type of abnormality model. Results demonstrate the feasibility of premalignant and specific cancer detection. The normal versus abnormal model yields better sensitivity and specificity rates of 64 and 80%; these rates are comparable to standard screening approaches. Prospectively, as the current screening procedure of visual inspection is useful mainly for high-risk populations, serum RS may serve as a useful adjunct for early and specific detection of oral precancers and cancer.

A randomized clinical trial investigating the relationship between aprotinin and hypercoagulability in off-pump coronary surgery.

BACKGROUND: Off-pump coronary artery bypass (OPCAB) surgery is associated with a hypercoagulable state in which the platelet thrombin receptor, protease-activated receptor-1 (PAR-1), helps propagate a thrombin burst within saphenous vein grafts. Aprotinin, used in cardiothoracic surgery mainly for its antifibrinolytic properties, also spares platelet PAR-1 activation due to thrombin. We hypothesized that this PAR-1 antagonistic property provides an antithrombotic benefit during OPCAB surgery. METHODS: Patients were randomly assigned to receive saline (n = 38) or a modified full-dose regimen of aprotinin (n = 37) IV during OPCAB surgery. Blood sampled perioperatively from the coronary sinus, skin wounds, and systemic circulation was analyzed to test coagulation and platelet function. Major adverse cardiovascular events were monitored by obtaining troponin I at 24 h (myocardial infarction), predischarge computed tomography angiography (vein graft thrombosis), and by clinical examination for stroke. RESULTS: Coronary sinus blood obtained immediately after OPCAB surgery showed significantly less activation in the aprotinin group, as judged by reduced formation of platelet-leukocyte conjugates (P < 0.02) and platelet-derived microparticles (P < 0.05). The aprotinin group showed inhibition of platelet aggregation induced by thrombin (P = 0.007) but not adenosine diphosphate. Thrombin generation, defined by F1.2 levels, was significantly reduced by aprotinin in the coronary sinus but not in skin wound incisions. Major adverse cardiovascular events were significantly reduced in aprotinin-treated patients (5.4% vs 29.7%, P < 0.05). Aprotinin also demonstrated antifibrinolytic properties through diminished red blood cell transfusion (P < 0.04) and reduced blood loss postoperatively (603 +/- 330 vs 810 +/- 415 mL, P < 0.004). CONCLUSION: This study demonstrates that aprotinin protects patients undergoing OPCAB surgery from a hypercoagulable state by diminishing thrombin-induced platelet activation and thrombin generation within saphenous vein grafts, while maintaining systemic hemostatic and antifibrinolytic benefits. These results support further investigation of aprotinin and other PAR-1 antagonists in OPCAB surgery.

Possible explanations for children's literal interpretations of homonyms.

This study was designed to examine factors associated with literal interpretations of homonyms. Participants were 212 second graders, ages 7;0-8;11, who listened to a story containing 16 key words. The key words were homonymous words ('pseudo-homonyms'), nonsense words, or familiar words used accurately. While listening to the story, children selected an illustration of each key word. Later, they were asked to recall the key words and to justify their picture selections. There was no association between interpretation and recall accuracy for nonsense words or familiar words used accurately; however, children who accurately recalled a homonymous key word were more likely to interpret the homonym 'literally,' relative to children who failed to recall the key word. Yet most of the children who correctly interpreted the pseudohomonyms also correctly interpreted these key words. Most children correctly recalled the story context regardless of key word type, but whereas correct recall of context predicted accurate interpretation of nonsense words and familiar words used accurately, it did not do so for homonyms. Children made equivalent numbers of literal and accurate interpretations of homonyms, even when correctly recalling context. Children's justifications for their word interpretations implicated the role of metacognitive skills, particularly in terms of selective attention, as a factor influencing homonym interpretation.