Assessment of pain in paediatric dental patients during administration of local anesthesia with and without the use of audiovisual distraction.

Background: Infants and children who experience pain in early life, show long-term changes in terms of pain perception and related behaviors. Local anesthesia is integral to the practice of painless dentistry but the pain of injection itself is deterrent to successful administration of local anesthesia and can be a most anxiety-provoking procedure. Distraction as a behavior management technique is successfully known to reduce pain and manage children's dental behavior by diverting their attention away from painful stimuli during invasive dental procedure. This study aimed to compare the pain associated with local anesthetic injection delivered with and without the use of distraction as a behavior management technique in 6-8-year-old children. Materials and Methods: In this randomized, clinical, in vivo study with a split-mouth design we compared the pain of 30 children (6-8-year-old), requiring dental treatment necessitating the use of local anesthesia bilaterally in either of their maxillary and mandibular arches. Treatment was done in two visits, 1 week apart. Children were randomly assigned to receive the distraction (iPad) at one visit while no distraction in other visits. Two different pain assessment scales were used: Wong-Baker faces pain scale (FPS) and FPS-Revised. The Chi-square test was used for statistical analysis. P ≤ 0.05 was considered to be statistical significance. Results: Children who received local anesthesia with audiovisual distraction had lower pain rating scores than those who received local anesthesia with no distraction. Conclusion: Audiovisual distraction significantly reduces pain associated with injection of local anesthesia.

Morphology and prevalence of middle canals in the mandibular molars: A systematic review.

OBJECTIVES: The purpose of this paper is to systematically review the various studies and case reports on the morphology and prevalence of middle canals in the mandibular molars. METHODOLOGY: Electronic databases such as MEDLINE, PubMed, EBSCOhost, ScienceDirect and various journals were screened to identify published literature till March 2017 and earlier for articles related to middle canals in the human permanent mandibular molars. Obtained articles were categorized as original researches, case reports and review articles. Well-defined review questions were developed using the patient population, intervention, comparison and outcome framework to summarize the objectives: "Does middle canal vary in morphology and anatomic location? What is the prevalence of middle canals in mandibular molars? Does ethnicity affect the prevalence of middle canals in mandibular molars?" Morphology was studied and prevalence rates were determined from the evaluation of data extracted from the articles. RESULTS: The search strategy resulted in 87 articles, of which 36 were original research papers and 51 were case reports. The prevalence of middle canals in the various populations ranged from 0.26% to 53.8%. Middle canals were reported in Europeans, Asians, Africans and South and North American populations. The prevalence of middle mesial canal and middle distal canal in various races was reported as up to 53.8% and 10%, respectively. The orifice of middle canal exists below a dentinal projection in the groove between the two main canals. They were observed in fin, confluent and independent configuration. Out of these, confluent configuration was more prevalent. CONCLUSION: Middle canal varies in morphology and anatomic location. Ethnicity affects the prevalence of middle canals in the mandibular molars.

A comparison of the validity of the Demirjian, Willems, Nolla and Häävikko methods in determination of chronological age of 5-15 year-old Indian children.

BACKGROUND: Demirjian's method has been the most popular and extensively tested radiographic method of age estimation. More recently, Willems' method has been reported to be a better predictor of age. Nolla's and Häävikko's methods have been used to a lesser extent. Very few studies have compared all four methods in non-Indian and Indian populations. Most Indian research is limited by inadequate sample sizes, age structures and grouping and different approaches to statistical analysis. AIM: The present study aimed to evaluate and compare the validity of the Demirjian, Willems, Nolla and Häävikko methods in determination of chronological age of 5 to 15 year-old Indian children. DESIGN: In this cross-sectional observational study, four methods were compared for validity in estimating the age of 1200 Indian children aged 5-15 years. RESULTS: Demirjian's method overestimated age by +0.24 ± 0.80, +0.11 ± 0.81 and +0.19 ± 0.80 years in boys, girls and the total sample, respectively. With Willems' method, overestimations of +0.09 ± 0.80, +0.08 ± 0.80 and +0.09 ± 0.80 years were obtained in boys, girls and the total sample, respectively. Nolla's method underestimated age by -0.13 ± 0.80, -0.30 ± 0.82 and -0.20 ± 0.81 years in boys, girls and the total sample, respectively. Häävikko's method underestimated age by -0.17 ± 0.80, -0.29 ± 0.83 and -0.22 ± 0.82 years in boys, girls and the total sample, respectively. Statistically significant differences were observed between dental and chronological ages with all methods (p < 0.001). Significant gender-based differences were observed with all methods except Willems' (p < 0.05). Gender-specific regression formulae were derived for all methods. CONCLUSION: Willems' method most accurately estimated age, followed by Demirjian's, Nolla's and Häävikko's methods. All four methods could be applicable for estimating age in the present population, mean prediction errors being lower than 0.30 years (3.6 months).

An In vitro Evaluation of Microleakage Associated with Three Different Compomer Placement Techniques in Primary Molars.

BACKGROUND: Microleakage is one of the most frequently encountered problems in posterior tooth-colored restorations. Efforts to decrease this problem with resin restorations include techniques for reducing the ratio of bonded to unbonded restoration surfaces and following strategic incremental placement techniques to reduce residual stress at tooth-restoration interface which reduces the C-factor, hence microleakage. AIM: The present study aimed to evaluate microleakage associated with three placement techniques for compomer restorations in primary molars. DESIGN AND METHODOLOGY: This in vitro experimental study assessed the microleakage associated with bulk-fill, horizontal-incremental, and oblique-incremental compomer placement techniques in primary molars. Ninety specimens were divided into three groups of thirty for each of the placement techniques. RESULTS: Nearly 86.6% of the specimens presented with microleakage involving the entire axial wall and pulpal floor in the bulk-fill group, whereas 56.6% and 46.6% of the specimens in the horizontal-incremental and oblique-incremental groups showed microleakage up to two-third and one-third of the axial walls, respectively. A significant difference in scores was observed between groups (P < 0.001). CONCLUSION: Microleakage was observed with all the three techniques but was comparatively lower with the incremental placement techniques. The oblique-incremental technique offered the least microleakage.

Management of Ranula in a Child by Modified Micro-Marsupialization Technique: A Case Report.

Ranulas pose a challenging situation, both clinically and surgically, because of their location on the floor of the mouth, an area that exhibits tightly-netted vital structures. Several treatments have been proposed, including excision with or without removal of the sublingual gland, marsupialization with or without cauterization of the roof of the lesion, drainage of the lesion, and micro-marsupialization. It has been suggested that a modified micro-marsupialization technique can establish drainage of saliva and formation of new permanent epithelized tracts along the path of sutures, thereby reducing the recurrence. This paper presents a report of a ranula in a 12 year-old child that was successfully managed using a modified micro-marsupialization procedure.

Role of Colors in Pediatric Dental Practices.

OBJECTIVE: This study evaluated the association between colors and emotions in a pediatric dental population. STUDY DESIGN: In this randomized cross-sectional study, 100 children aged 6-12 years were categorized as non-anxious and anxious using Corah's Dental Anxiety Scale-Revised. They were then instructed to color two cartoon faces, one depicting happiness emotion and the other, sadness, with any of six colors provided. Data obtained were statistically analyzed. RESULTS: The mean Corah's Dental Anxiety scores were 11.7 and 4.97 for the anxious and non-anxious children, respectively. Both groups expressed the highest preference for the color yellow for happiness emotion. No significant differences were observed between color choices in either group (p>0.05), except for black which was not chosen by any child for happiness (p<0.005). Children in both groups significantly preferred red for sadness emotion. No significant differences were observed between color choices in the anxious group (p>0.05). In the non-anxious group, yellow assumed significant preference over green (p<0.05). CONCLUSIONS: Yellow was the most-preferred color and black, the least-preferred, for happiness emotion, whereas, for sadness emotion, red and green were the most- and least-preferred colors, respectively. Color preference was not affected by the presence of dental anxiety.

Staging of third molar development in relation to chronological age of 5-16 year old Indian children.

BACKGROUND: The usefulness of the developmental status of the third molar has been studied in assessment of the chronological age of adolescents in whom the development of the other permanent teeth is nearly complete. However, little is known about the timing and pattern of third-molar development in the Indian population. AIM: This study aimed to stage the third molar development in relation to chronological age of 5-16year old Indian children. DESIGN: In this cross-sectional observational study, the status of third molar development in relation to chronological age of 1139 Indian children aged 5-16 years was evaluated radiographically, using Orhan's modification of Demirjian's method. RESULTS: The frequency of occurrence of the third molars varied from 47% to 70%. Crypt formation, crown completion and root completion occurred as early as 5.4, 8.7 and 15.0 years, respectively. No significant differences based on gender or side were observed in third-molar development (p>0.05). For most stages, maxillary third molars were slightly more advanced than their mandibular counterparts (p>0.05). CONCLUSION: Considering the high degree of variability observed in third molar genesis and development, the usefulness of this tooth in age determination studies may be very limited in the age group studied.

Willems I VS Willems II: A comparative study of accuracy in 5-15 year old Indian children.

BACKGROUND: Studies testing the Willems method of age estimation with gender-specific scores on different population groups have reported consistently more accurate results over other methods. Not enough is known about the validity of Willems non-gender specific scores. AIM: The present study aimed to compare the accuracy of the Willems I (gender-specific scores) and Willems II methods (non-gender-specific scores) in the age estimation of 5-15 year-old Indian children. DESIGN: In this cross-sectional observational study, the Willems I and II methods were tested and compared for accuracy in estimating the age of 1200 Indian children aged 5-15 years. RESULTS: The mean differences between dental age calculated by the Willems I method and chronological age were +0.09±0.80 years, +0.08±0.80 years and +0.09±0.80 years for boys, girls and the total sample, respectively. With the Willems II method, the values were -0.06±0.80 years, +0.11±0.79 years and +0.01±0.80 years for boys, girls and the total sample, respectively. Both methods did not show any statistically significant differences between dental and chronological ages for either gender or the total sample (p>0.05). CONCLUSION: The Willems I method was more accurate in predicting age of boys, while the Willems II method was more accurate in girls in the present study, but not significantly so. Both methods are appropriate for use in this population.

Clinical Efficiency of Three Caries Removal Systems: Rotary Excavation, Carisolv, and Papacarie.

PURPOSE: The removal of dentinal caries using the rotary method of excavation is most often associated with pain and anxiety in children. Chemo-mechanical caries removal may eliminate some of the drawbacks of the rotary technique and improve patient comfort. The purpose of this study was to compare the efficiency of the rotary, Carisolv, and Papacarie methods for caries removal in primary teeth, length of time needed, influence on child behavior, pain perception, and treatment preference of the child. METHODS: This controlled, split-mouth study with a cross-over design compared three caries removal methods in the primary molars of 50 five- to 12-year-old children. RESULTS: The rotary method was the most efficient and least time-consuming (P<0.001). Pain perception, however, was highest with this method (P<0.05). Papacarie exhibited a higher efficiency and required fewer applications than Carisolv (P<0.01). The Papacarie method was the most preferred, and the rotary method the least-preferred (P<0.05). CONCLUSIONS: Chemo-mechanical caries removal may be a promising alternative treatment procedure, particularly for anxious young patients.

Oral Myiasis: A Concealed Threat to Disabled Children of Developing Countries.

Disabled children with special health care needs are at high risk for oral disease. Myiasis is a rare condition that is associated with inadequate public and personal hygiene and is common in medically, mentally, and physically compromised individuals living in developing tropical countries. The purpose of this paper is to describe a case of oral myiasis in a 13-year-old Indian girl with spastic cerebral palsy.

Malocclusion in individuals with mental subnormality--a review.

The occurrence of malocclusion in individuals with mental disability poses an additional obstacle to social acceptance; not only from an esthetic point of view, but also in that it compromises all aspects of oral function. This review examines the reported prevalence of malocclusion in individuals with mental subnormality including Down syndrome, from 1981 to 2013, assessed according to Angle's classification, the Dental Aesthetic Index (DAI), the Index of Orthodontic Treatment Need (IOTN) and certain malocclusions. Although widely reported in many studies, it is still quite difficult to compare the exact proportion of occlusal anomalies and orthodontic treatment need among mentally challenged individuals. This is due partly to the multiplicity of measurement methods and the difficulty in standardizing criteria. Several studies have reported higher prevalence of malocclusion including anterior open bite, anterior cross bite, severe malocclusions in mentally challenged individuals, especially those with Down syndrome. The findings have been varied and attributed to musculoskeletal abnormalities, altered cranial-base relationships, premature tooth loss or eruption, lip incompetence, etc. Future research needs to be devoted to determining exactly why malocclusion is higher among individuals with mental subnormalities. It will be a challenge to identify the preventable factors among multiple complex etiologies to reduce these disparities.

Molar-incisor hypomineralization: prevalence, severity and clinical characteristics in 8- to 13-year-old children of Udaipur, India.

BACKGROUND: The last couple of decades has seen an increasing interest in molar-incisor hypomineralization (MIH). Although the reported prevalence of MIH ranges from 2.4% to 40.2% worldwide, very little data is available from India. OBJECTIVE: To assess the prevalence, clinical characteristics, distribution, severity and association with caries of MIH defects in children aged 8-13 years of Udaipur, Rajasthan. STUDY DESIGN: This cross-sectional descriptive study consisted of 1173 children aged 8-13 years selected by random sampling procedure. The European Academy of Pediatric Dentistry criteria were followed for MIH diagnosis. The presence of dental caries and treatment need for MIH-affected teeth were recorded as per the WHO criteria. RESULTS: The prevalence of MIH in the children examined was 9.46%. Severity of the defects increased with the age of the children. Involvement of incisors increased when more First permanent molars (FPMs) were affected. An average of 3.65 teeth was involved per MIH-affected individual. Significantly larger numbers of mandibular FPMs and maxillary central incisors were diagnosed with MIH. The association of dental caries was significantly higher with MIH-affected FPMs. Primary molars and permanent canines and premolars were also showed MIH like lesions in some of the MIH-affected children. CONCLUSION: MIH was observed in about 10% of the children examined. MIH-affected FPMs appear to be more vulnerable to early caries and subsequent pulp involvement with need for extensive dental treatment.

Malignant fibrous histiocytoma clinically mimicking dental abscess in a child: report of an unusual case.

Swellings of the orofacial tissues arising from infections of dental origin are relatively common. Occasionally a similar presentation may be due to a malignant tumor, and oral clinicians must always bear this possibility in mind with facial swellings that do not respond to conventional therapy Malignant fibrous histiocytoma is a high-grade aggressive sarcoma, which is relatively rare in children and uncommon in both the head-and-neck and mandibular regions. This article describes an unusual case of malignant fibrous histiocytoma involving the mandible of an 11-year-old child. The purpose of this article is to emphasize the importance of diagnosing such lesions in the early stage to improve prognosis and limit complications.

Indigenous tooth powders = covert lead poisoning?

AIM: The present study aimed to measure the concentration of lead in various indigenous preparations of tooth powders available and used locally in and around Udaipur, Rajasthan, India. MATERIALS AND METHODS: Seven different brands of tooth powders manufactured and/or marketed locally were obtained from stores all over Udaipur city. Some home-made powders commonly used for cleaning teeth were also collected. The tooth powders were analyzed for lead content by atomic absorption spectrophotometry. RESULTS: All tooth powders tested were found to contain high levels of lead ranging from 21 ppm to 82 ppm, above the maximum permissible level of 20 ppm prescribed by the Bureau of Indian Standards. CONCLUSION: Indigenous tooth powders contain high levels of lead and thus may be a source of lead poisoning that is often overlooked.

Characteristics of occlusion in primary dentition of preschool children of Udaipur, India.

OBJECTIVE: The present study aimed to study the occlusion characteristics of the primary dentition in a group of 3-5 year-old Indian children and the differences with age in the same group. METHODS: The study was a cross-sectional survey based on examination of the primary dentition of 200 preschool children aged 3-5 years who were selected from nursery schools in Udaipur, India, using a stratified random sampling technique. The study group was assessed for the several occlusal parameters, which included primary molar and canine relationship, degree of overjet and overbite, anterior and posterior crossbite, and the presence or absence of physiologic spaces and crowding. RESULTS: Flush terminal plane was more common at 3-4 years of age, mesial step at 4-5 years, and class I canine relationship in both age groups. The prevalence of overjet less than 1 mm and overjet exceeding 1 mm was almost comparable in both groups. Overbite with less than 30% overlap was most frequently observed in both age groups, with 30-60% overlap following closely behind. Physiologic and primate spacing were observed in less than half of the children examined, while a small percentage displayed the presence of either single-segment or two-segment crowding. CONCLUSION: The present study provided insight into the state of dentition, occlusal pattern, spacing, and crowding in the primary dentition of Indian children of Udaipur.

An in vitro evaluation of antimicrobial efficacy of primary root canal filling materials.

OBJECTIVE: The present study aimed to evaluate and compare six different materials commonly used for filling the root canals of primary teeth for antimicrobial efficacy against some of the microorganisms commonly found in infected root canals. STUDY DESIGN: In this experimental in vitro study six root canal filling materials were tested for antimicrobial efficacy against eight microbial strains using the agar diffusion method. RESULTS: Zinc oxide eugenol paste exhibited the strongest antimicrobial potential followed by Endoflas, zinc oxide-calcium hydroxide-sodium fluoride mixture, zinc oxide-calcium hydroxide mixture and calcium hydroxide paste (Apexcal). The addition of sodium fluoride to the zinc oxide-calcium hydroxide mixture enhanced the antimicrobial efficacy. Metapex demonstrated minimal inhibition and Vaseline was non-inhibitory. CONCLUSIONS: All the test filling materials demonstrated varying antimicrobial activity against the microorganisms tested. Zinc oxide eugenol paste and materials containing zinc oxide were found to be more effective against the microorganisms compared to materials without zinc oxide.

Complications of untreated molar-incisor hypomineralization in a 12-year-old boy.

Complications arising because of untreated molar-incisor hypomineralization (MIH) have received little mention in the dental literature. However, this can be an area of concern, with severe consequences in rare cases. Hence, early recognition and prompt management of MIH is essential for long-term oral health of affected individuals. This paper describes an untreated case of severe MIH that resulted in infection of facial spaces.

Relapsing acute myeloid leukemia presenting as hypopyon uveitis.

Anterior segment infiltration in acute myeloid leukemia (AML) presenting as hypopyon uveitis is very rare. We report this case as an uncommon presentation in a patient on remission after bone marrow transplant for AML. In addition to the hypopyon, the patient presented with "red eye" caused by ocular surface disease due to concurrent graft-versus-host disease and glaucoma. The classical manifestations of masquerade syndrome due to AML were altered by concurrent pathologies. Media opacities further confounded the differential diagnosis. We highlight the investigations used to arrive at a definitive diagnosis. In uveitis, there is a need to maintain a high index of clinical suspicion, as early diagnosis in ocular malignancy can save sight and life.

Relating tooth- and blood-lead levels in children residing near a zinc-lead smelter in India.

BACKGROUND: Lead toxicity particularly affects children because of their increased capacity for absorption and retention. Blood-lead (BPb) levels reflect recent exposure and are of limited value in predicting neurotoxicity, whereas in teeth, lead accumulates over a long period of time and provides an integrated record of lead exposure from intrauterine life until the teeth are shed. AIM: The present study aimed to relate tooth-lead (TPb) and BPb levels in children residing near a zinc-lead smelter in India, and to evaluate the effectiveness of primary teeth as bioindicators of life-long lead exposure. DESIGN: The lead levels in primary teeth and blood of 100 children aged between 5 and 13 years, living in the proximity of a zinc-lead smelter were measured by atomic absorption spectrophotometry. The mean levels were tabulated based on village, age, sex and tooth type, and analysed statistically. RESULTS: The mean BPb level was significantly influenced by proximity to the lead source, but not by age or sex. There was no consistent pattern of correlation between BPb and TPb levels. CONCLUSION: Primary teeth showed significantly high lead levels compared to blood; they reflect cumulative exposure to lead and prove to be better indicators of body lead burden.

A talon cusp on fused teeth associated with hypodontia: report of a unique case.

Fusion and talon cusps are rare developmental dental anomalies affecting both primary and permanent dentitions. Talon cusps normally occur on the palatal surface of permanent maxillary incisors, while fused teeth are more common in the primary anterior dentition. An understanding of these dental anomalies and their associated problems are important to provide prophylactic measures, thereby preventing or minimizing possible complications. This paper presents a unique case of fused mandibular permanent incisors with a lingual talon cusp associated with hypodontia of an adjacent tooth.