Lobular Capillary Hemangioma in a Young Child: Diagnostic Dilemma and Management.

Pyogenic granuloma (lobular capillary hemangioma) is a common reactive tumour-like lesion of the oral cavity arising in response to various stimuli such as chronic local irritation, drug intake, and hormonal changes. The clinical features are similar to other reactive oral lesions such as peripheral giant cell granuloma (PGCG) and therefore the definitive diagnosis depends on histopathologic evaluation. We report a case of a three-year-old Indian boy presenting with a three-month history of a 3.3×1.4×0.8 cm large sessile, lobular, soft-tissue mass of the left mandibular posterior gingival region which was referred to us. An excisional biopsy of the lesion revealed multinucleated giant cells lying in an inflammatory cell infiltrate-rich stroma consisting of plump endothelial cells on histopathologic examination suggestive of lobular capillary hemangioma. The patient was asymptomatic with no new growth on regular follow-up. This is the first reported case of a large pyogenic granuloma in a very young child, which is an uncommon presentation.

The Optimal Hemostasis Duration After Tooth Extraction: A Randomized Controlled Trial.

Background There is a lack of evidence-based practice regarding the duration of pressure pack placement following tooth extraction. This study aimed to compare the incidence of post-extraction bleeding following 60 minutes versus 10 minutes of pressure pack placement. Methodology A randomized controlled trial was conducted at a tertiary care hospital and included patients requiring intra-alveolar tooth extractions. Patients were randomly allocated into the experimental group or control group by a permuted block randomization method. A blinded observer noted the incidence of post-extraction bleeding. Categorical variables were summarized as frequency and percentage. The chi-square test was used for intergroup statistical analysis. P-values <0.05 were considered statistically significant. Results There were 528 participants, 264 of whom were allocated to each group. The incidence of post-extraction bleeding was 8% and 6.8% in the experimental and control groups, respectively. On bivariate analysis, there was no statistically significant difference between the two groups (p = 0.618; relative risk with 95% confidence interval = 1.0). Conclusions In the majority of cases, hemostasis was achieved in 10 minutes. Therefore, removing the pressure pack after 10 minutes may be advised to ensure hemostasis and, ultimately, save chairside time.

Assessment of Understandability and Actionability of YouTube Videos on Hemolytic Disease of the Newborn.

Introduction With revolutions in Information Technology, information and misinformation are easier to be found online. YouTube is the largest and most commonly searched video content website in the world. It is assumed that, due to the coronavirus pandemic, most patients try to know about diseases through the internet and reduce the number of hospital exposures unless otherwise. In order to assess the understandability and actionability of such YouTube videos available freely online about the disease, Hemolytic disease of the newborn (HDN), this study was planned. Methods This is a cross-sectional study conducted with the first 160 videos available on May 14, 2021, with the search keyword "HDN" with a relevance filter and a duration of 4 to 20 minutes. The videos were further screened regarding the information content and language. These videos were assessed by three independent assessors using the patient educational materials assessment tool for audio-visual content. Results Out of the first 160 videos selected for screening, 58 videos were excluded due to a lack of content about the searched disease "HDN". Another 63 videos were excluded due to the language of instruction not being in English. Finally, 39 videos were assessed by three assessors. The understandability and actionability responses were checked for reliability and a Cronbach's alpha of 93.6% was found, indicating good data reliability. To reduce subjectivity, average scores of understandability and actionability were taken based on the scores of these three assessors. There were eight and 34 videos with average understandability and actionability scores of <70% respectively. The median average understandability and actionability scores were 84.4% and 50% respectively. There was a statistically significant difference between understandability and actionability scores with considerably lower actionability scores of YouTube videos on the disease, HDN (p<0.001). Conclusion There is a great need to include actionable information by content developers in videos. Most information available has adequate understandable content making it easier for the general public to know about the diseases. YouTube and similar social sites thus possibly are helping in the dissemination of information promoting awareness among the public in general and patients in particular.

Inflammatory Dentigerous Cyst in a 10-year-old Child Treated by Marsupialization: A Case Report.

Aim: To describe the successful eruption of an unerupted premolar associated with a dentigerous cyst without the use of any appliances. Background: Inflammatory dentigerous cyst is a variant of dentigerous cyst occurring in the mixed dentition due to stimulation of the reduced enamel epithelium of a developing permanent tooth by periapical inflammation from its carious, nonvital deciduous precursor. Marsupialization is the preferred treatment to preserve the permanent tooth. Case description: A 10-year-old patient presented to us with a well-defined, tender swelling involving the left mandibular body with buccal cortical expansion. Following imaging, marsupialization was performed involving wide excision of the alveolar mucosa overlying the region along with the cystic lining. At follow-up, spontaneous eruption of permanent teeth into occlusion was noted. Conclusion: This suggests that marsupialization along the crest may allow for successful eruption of the associated permanent teeth with the resolution of the cyst. Clinical significance: Marsupialization along the crest provides a conservative option that allows spontaneous, unassisted eruption of permanent teeth in cases of inflammatory dentigerous cysts. Careful preoperative assessments must be used to make treatment decisions. The successful eruption of permanent teeth and the total resolution of the disease both depend on adequate follow-up. How to cite this article: Jayam C, Yerragudi N, Kumar N, et al. Inflammatory Dentigerous Cyst in a 10-year-old Child Treated by Marsupialization: A Case Report. Int J Clin Pediatr Dent 2023;16(6):871-874.

Understandability and Actionability of Available Video Information on YouTube Regarding Hemophilia: A Cross-Sectional Study.

Introduction With the advent of revolutionary information technology, most general medical information can be accessed by the community at large. However, the factual nature of information, its understandability, and actionability of diseases like Hemophilia are unknown to the general population. Hence the present study has been envisaged to assess the understandability and actionability of available video information on YouTube about Hemophilia. Methods A cross-sectional study was performed using the Patient Education Materials Assessment Tool for Audiovisual materials (PEMAT-AV) to assess the understandability and actionability of 50 videos shown by order of relevance utilizing three independent assessors. An online google survey was prepared using the PEMAT questionnaire as a basis and results were recorded and saved as a Microsoft Excel sheet for analysis. Data was analyzed using either Microsoft Excel or an online calculator as the case may be. Results A total of 50 short videos on Hemophilia were assessed by three independent assessors using PEMAT. The data so obtained was rechecked by an independent reviewer before data analysis. Three videos were excluded due to non-English language while only two videos out of 50 showed 100% average understandability and actionability. Average understandability and actionability scores range between 34 to 100 percent and 11.1 to 100 percent, respectively. Most videos have higher average understandability than actionability (P value=0.003). Conclusion Our study shows there are only a few high-quality short videos available as audio-visual patient education materials on YouTube about Hemophilia. There is a great need to develop content that is beneficial to patients as patient educational material.

Oral manifestations associated with COVID-19 disease: An observational cross sectional study.

Objectives: The aim of present study was to investigate oral manifestations associated with COVID-19 disease. Materials and methods: This cross-sectional study comprised 367 suspects with mild/moderate COVID-19 symptoms who reported to a tertiary care hospital's screening OPD. An in-depth case history was taken, and an oral cavity examination was performed to detect any oral findings. All participants were tested for SARS-CoV-2 using a naso-pharyngeal swab and reverse transcription polymerase chain reaction.Oral manifestations and the results of RT-PCR testing were correlated. Statistical analyses were performed using Epi Info and R software. To estimate the prevalence of oral symptoms, the Pearson chi-square test was used. Results: Oral manifestations were found in 58% of the study population. The difference in the prevalence of oral manifestations between RT-PCR positive COVID-19 patients versus RT-PCR negative suspects was statistically significant (p = 0.007) with xerostomia and dysgeusia being significantly higher in positive patients (p = 0.036 and p = 0.044 respectively) while the prevalence of stomatopyrosis and other intraoral signs was insignificant. Conclusion: Xerostomia and dysgeusia are the common oral manifestations of COVID-19.

Assessment of Sagittal Condylar Guidance with Protrusive Inter-occlusal Method, Panoramic Radiographs, and Lateral Cephalogram: A Comparative Study.

BACKGROUND: Condylar guidance can be determined using the clinical and radiographic methods. The present study was conducted to determine condylar guidance using the protrusive interocclusal wax method, panoramic radiographs, and lateral cephalogram. AIMS: The aim of the study was to compare the correlation between sagittal condylar guidance with protrusive interocclusal method, panoramic radiographs, and lateral cephalogram. MATERIALS AND METHODS: The present study was conducted on 82 dentulous subjects (males 41, females 41). In all subjects, interocclusal registration values and condylar guidance values were measured using panoramic radiographs and lateral cephalograms. RESULTS: The mean ± SD protrusive interocclusal registration value on the left side was 34.01 ± 1.2 mm and 34.08 ± 1.4 mm on the right side. The panoramic radiographs showed 35.12 ± 1.6 mm on the left side and 35.16 ± 1.7 mm on the right side. The mean ± SD protrusive interocclusal registration values on the left side was 34.01 ± 1.2 mm on the left side and 34.08 ± 1.4 mm on the right side. Lateral cephalogram showed 34.35 ± 1.3 mm on the left side and 34.67 ± 1.6 mm on the right side. There was a significant difference between the methods (p < 0.05). CONCLUSION: Sagittal condylar guidance can be evaluated using protrusive interocclusal method. Along with it, other methods such as panoramic radiographs and lateral cephalogram may also be used for recording condylar guidance. CLINICAL SIGNIFICANCE: Lateral cephalogram and panoramic radiographs may be reliable in determining condylar guidance, which can be used in orthodontic treatment planning.

Assessment of C-reactive Protein Level and Efficacy of Diclofenac Sodium and Mefenamic Acid in Relieving Pain in Mandibular Impacted Third Molar Surgery.

AIM: To compare the efficacy of diclofenac sodium and mefenamic acid in relieving pain in mandibular impacted third molar surgery and to assess the level of the C-reactive protein (CRP) level. MATERIALS AND METHODS: This study was conducted on 90 patients of impacted mandibular third molars. All patients were administered with 2% lignocaine with 1:80,000 adrenaline, and surgical removal of impacted third molar was done following the standardized surgical procedure by a single oral surgeon. Patients were divided into two groups of 45 each. In group I, patients were prescribed 50 mg diclofenac sodium and in group II patients were prescribed 500 mg mefenamic acid for three times a day for 3 days. The CRP level was again evaluated after 3 days of analgesics. Pain was assessed using the visual analog scale (VAS). RESULTS: The mean VAS was 2.58 in group I and 3.46 in group II, which was statistically considerable (p < 0.05). The mean CRP level postoperatively in group I was 15.7 and after 3 days was 27.2 in group I, whereas it was 25.1 postoperatively and 31.5 after 3 days in group II. CONCLUSION: Authors found that diclofenac sodium as useful as mefenamic acid. The CRP level was raised significantly following surgery, thus reflecting that it is an indicator of inflammation. CLINICAL SIGNIFICANCE: Diclofenac sodium can be used to relieve pain. The CRP level evaluation can be helpful to assess inflammation following surgery.

Assessment of the Role of Vitamin D in the Treatment of Oral Lichen Planus.

AIM: Lichen planus is an autoimmune disease that can affect the skin and mucous membranes, including the oral mucosa. Vitamin D plays a very important role in the bone health along with boosting immunity. This study was carried out to assess the role of vitamin D in the treatment of oral lichen planus. MATERIALS AND METHODS: A sample size of 450 was taken which included patients showing clinical presentation of oral lichen planus. The patients were equally divided into three different groups based on their vitamin D levels. The data were analyzed using SPSS version 26.0. RESULTS: The patients who were given the vitamin D supplementation showed the maximum improvement. The comparison of the data were found to be statistically significant. CONCLUSION: It was concluded that vitamin D played an important role in the treatment of oral lichen planus. CLINICAL SIGNIFICANCE: The role of vitamin D in lichen planus needs to be explored. This study may be useful in conducting further study to assess the role in vitamin D supplementation in the treatment of oral lichen planus.

A Comparative Assessment of the Management of Mandibular Angle Fractures Using 3D Plates and 2D Miniplates.

AIMS: The aim of this study was to compare 2D plates with 3D miniplate system in the management of mandibular angle fractures. MATERIALS AND METHODS: The study was conducted on 146 patients with mandibular angle fracture, who were equally divided into two groups of 73. Patients in group I were treated with 3D plating and in group II with 2D plating. In all cases, 2.0 mm titanium miniplates were used. The etiology of fracture, amount of mouth opening, and pain and sensory deficit were recorded. Clinical and radiographic assessment was done at 1, 3, and 6 months. RESULTS: The etiology of mandibular angle fracture is roadside accident (RSA) seen in 110 (75.3%) cases, fall in 24 (16.4%), and assault in 12 (2.6%) cases. There was significant (p < 0.05) mouth opening in group I at 1 month postoperatively (32.4 mm) as compared to group II (27.5 mm), at 3 months in group I (33.6 mm) as compared to group II (30.2 mm), and at 6 months in group I (36.4 mm) as compared to group II (31.6 mm). After 1 month, sensory deficit was present in six patients in group I and 10 patients in group II. After 3 months, group I had no patients and three patients in group II. Right angle fracture was found in 71 patients (group I-36, group II-35). Mandibular right angle fracture in 58 patients (group I-28, group II-30). CONCLUSION: The authors found that the 3D miniplate system is more useful in the management of cases of mandibular angle fracture as compared to 2D miniplates. CLINICAL SIGNIFICANCE: There has been increase in mandibular fractures in the last few years. Appropriate management with 3D miniplates may be useful in providing better treatment outcomes.

In vivo Comparative Evaluation of Esthetics after Microabrasion and Microabrasion followed by Casein Phosphopeptide-Amorphous Calcium Fluoride Phosphate on Molar Incisor Hypomineralization-Affected Incisors.

BACKGROUND: Molar incisor hypomineralization (MIH) is an esthetic setback for the patient as well as for the dentist, treatment options for MIH includes minimally invasive techniques like microabrasion which has a limited literature of its effect. Furthermore, the effect of remineralizing such as casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) agent on MIH-affected teeth is minimally studied. AIM: Comparative evaluation of the esthetic after microabrasion and microabrasion followed by Tooth Mousse Plus on hypomineralized incisors of MIH-affected patients. SETTINGS AND DESIGN: The study was a randomized clinical trial. MATERIALS AND METHODS: The study comprised Grade I MIH patients in the age strata of 7-16 years having lesions on incisors. As per inclusion criteria, 46 lesions were divided into two groups of microabrasion and microabrasion followed by CPP-amorphous calcium fluoride phosphate (ACFP). Photographs were obtained before treatment, just after treatment, and 6 months after treatment. The photographic evaluation was done using the CIE L*a*b* scoring method. STATISTICAL ANALYSIS USED: ANOVA and posthoc Tukey's test were applied to compare the difference in lightness ΔL and total color change ΔE of these two groups. RESULTS: In microabrasion group, the overall change in ΔL of white tooth discoloration came -0.9 standard deviation (SD) 7.3. In microabrasion followed by CPP-ACFP group, statistically significant difference was found between both these groups with P value of P ≤ 0.001. CONCLUSIONS: Microabrasion followed by the remineralizing agent can improve the esthetics of white tooth discoloration with time.

Animal Bite in a 6-month-old Child and Facial Injury with Associated Unusual Nasal Injury: Management of Injuries along with 1-year Follow-up.

In children, accidental injuries (AI) are the most common cause of major trauma. Although rare, nonaccidental injuries (NAI) can also cause major trauma. Among NAI, animal bites form a significant fraction. Animal bites form a significant fraction of NAI in children. Amongst animal bites, dog and cat bites are the most common. In adults, the likelihood of bites is on leg/thigh but in children due to their low stature, bites are more common on scalp, head, neck, or chest region. As children have lower tissue mass/size, what appears a small wound in adults comparatively appears as a larger wound in children, causing severe disfigurement. The present paper discusses cat bite injury to maxillofacial region, distinguishing from other differential diagnoses. Potential complications, initial management, and total rehabilitation of facial injuries especially nasal injury caused by a cat in a 6-month-old child are also discussed. HOW TO CITE THIS ARTICLE: Sikka N, Jayam C, Choudhary RS, et al. Animal Bite in a 6-month-old Child and Facial Injury with Associated Unusual Nasal Injury: Management of Injuries along with 1-year Follow-up. Int J Clin Pediatr Dent 2019;12(6):560-565.

Parental awareness, knowledge, and attitude toward conscious sedation in North Indian children population: A questionnaire-based study.

AIM: The purpose of this study is to find the opinion, attitude, beliefs, and the existing knowledge of parents of Himachal Pradesh suburban city about conscious sedation. OBJECTIVE: To know the effect of education of parent and prior sedation experience of the child on opinion, attitude, and knowledge of parent about conscious sedation. METHODOLOGY: A questionnaire in Hindi/English was provided to parents who accompanied their child for the treatment in the Paedodontics Department of HPGDC College Shimla. Information regarding demography, existing knowledge gained through television, the internet, opinion about the safety of the procedure, knowledge of nothing by mouth guidelines, restraints usage, and knowing their preferences of staying with the child during treatment was explored. Questions were straight yes or no type and multiple choice type. Some questions were statements and wanted the respondents to strongly agree, agree, disagree, or strongly disagree. RESULTS AND CONCLUSION: A total of 350 questionnaires were collected. Parents feel sedation is safe in the dental office as an adjunct to dental treatment. Education played a role in existing knowledge about sedation and perception about the safety of conscious sedation.

A Comparison of Oral Midazolam-ketamine, Dexmedetomidine-fentanyl, and Dexmedetomidine-ketamine Combinations as Sedative Agents in Pediatric Dentistry: A Triple-Blinded Randomized Controlled Trial.

INTRODUCTION: It is common to encounter a patient who is anxious to the magnitude that precludes the possibility of provision of dental treatment. This study aims to evaluate and compare the sedative effect of oral combinations of midazolam-ketamine (MK), dexmedetomidine-fentanyl (DF), and dexmedetomidine-ketamine (DK) in a group of uncooperative children requiring dental treatment. METHODOLOGY: This was a prospective, randomized, triple-blind study where 36 children who were 3-9 year old with American Society of Anesthesiologists -I status and presenting early childhood caries were randomly assigned to: Group A - 0.3 mg/kg of M and 5 mg/kg K, Group B - 2 ug/kg of D with 3 ug/kg of F, and Group C - 2ug/kg of D with 5 mg/kg of K in 1 mL honey. Patients' blood pressure, heart rate, and oxygen saturation were recorded from the start of the procedure till discharge. Patients' behavior, sedation status, and wake-up behavior were evaluated with Modified Observer Assessment of Alertness and Sedation Scale and ease of treatment completion by Houpt scale. RESULTS: Hemodynamic changes were statistically insignificant in all three groups. 72.8% of patients in Group A and 58.3% of patients in Group B were successfully sedated during treatment. Behavior improvement was seen in all three groups during treatment with statistically insignificant difference in behavior scores produced by Group C. Ease of treatment completion was moderately better with Group A. CONCLUSION: Oral DK has a comparable sedative property with oral MK combination. Oral DF promises to be a potential sedative agent for children due to its successful anxiolysis.

Concealment effect of resin infiltration on incisor of Grade I molar incisor hypomineralization patients: An in vivo study.

CONTEXT: Molar incisor hypomineralization (MIH) is a commonly occurring esthetic setback among patients. Depending on the graveness of the lesion, esthetics of MIH can be improved by treatments such as enamel microabrasion, bleaching, composite resin bonding, and the combination of some or all of these techniques. AIM: The aim of this study is to evaluate the esthetic results of resin infiltration treatment on incisors with Grade I molar incisor MIH. MATERIALS AND METHODS: A total of 22incisor lesions with MIH were infiltrated with resin. Photographs were captured before infiltration, just after infiltration, and 6 months after infiltration. The photographic evaluation was done by the CIE L*a*b* scoring method. The means of each parameter such as ΔL and ΔE were calculated. STATISTICAL ANALYSIS: ANOVA in conjunction with Turkey's post hoc test was used to evaluate the means. RESULTS: The total color change observed was equal just after treatment and 6 months after treatment, with no statistically significant difference (P = 0.87) between these two time points. The mean of difference in total color change (ΔE3) of white tooth discoloration was 13.2 SD 6.8, showing an overall color change. CONCLUSION: Infiltration can conceal the white opaque appearance of Grade I MIH lesions, and also reduction in lesion whiteness is seen with time.

Comparative Evaluation of Caries Status in Primary and Permanent Molars in 7-8-year-old Schoolchildren of Shimla Using Caries Assessment Spectrum and Treatment Index.

BACKGROUND: A new epidemiological index is introduced for full assessment of dental caries which is known as caries assessment spectrum and treatment (CAST). "Spectrum" is considered backbone of this index as it covers from no lesion to advanced stage progression of caries. We aimed to evaluate and compare the status of caries in primary and permanent molars of 7-8-year-old schoolchildren of Shimla using CAST index and to find if any correlation exists between the status of caries in evaluated teeth. METHODS: Three hundred and one schoolchildren with age group of 7-8 years were selected from schools in Shimla. CAST codes were determined for primary molars and first permanent molars. The distribution of CAST codes in the examined molars is correlated with the help of Spearman's rank correlation coefficient. The level of statistical significance was established at P < 0.05. The intraexaminer reliability was determined by the unweighted kappa coefficient. RESULTS: Caries was assessed in 6.3%-12.3% of the permanent molars in contrast to primary molars, in which caries was near about 50%. The correlation was stronger for first and second deciduous molars for the right side of the mouth than the left side (r = 0.293 and 0.257 in the maxilla and 0.503 and 0.319 in the mandible [P < 0.001], respectively, while correlation for teeth in opposite jaws was moderate [r = 0.20-0.47]). The intraexaminer reliability was examined (k = 0.90 for the primary and 0.85 for permanent molars). CONCLUSION: The correlation between primary and permanent molars regarding the caries status in primary molars is weak while strongest correlation was present on the right side of the mouth for first and second deciduous molars. The study also showed the applicability of the CAST index in epidemiological surveys.

Primary tuberculous osteomyelitis of the mandible in a 3-year-old child.

A 3-year-old girl child presented with swelling in her right lower jaw that had started 5 days previously. History revealed the child being non-immunised. Initial-evaluation revealed proptosis and bony hard swelling over the right body of the mandible. Radiological evaluation including a CT scan indicated expansile osteolytic lesion involving the body-ramus with onion-peel periosteal reaction suggesting osteomyelitis/malignancy. Blood investigations showed raised erythrocyte sedimentation rate and eosinophilia. Family screening for tuberculosis (TB) revealed that the patient, her father and siblings were PPD positive though chest screening and sputum examinations were negative in all of them. Lesion biopsy showed acute/chronic osteomyelitis with eosinophilia, tilting diagnosis towards eosinophilic granuloma/Hand-Schuller-Christian disease. Further investigations for diabetes insipidus, histiocytosis-X, skull-pelvic-femur radiographs, abdominal ultrasonography, ophthalmic consultation and PCR-TB test were negative. Histology, radiography, purified protein derivative (PPD)-positive result and history led to the diagnosis of primary TB of the mandible. Complete resolution occurred following antitubercular therapy. The case report emphasises that diagnosis of TB can sometimes be based on circumstantial evidence and positive response to antitubercular therapy even in view of a negative PCR result.

Molar Incisor Hypomineralization.

Molar incisor hypomineralization (MIH) is a developmental defect affecting teeth. High prevalence rates of MIH and its clinical implications are significant for both the patients and clinicians. A wide variation in defect prevalence (2.4-40.2%) is reported. It seems to differ with regions and various birth cohorts. Some of the recent prevalence studies are tabulated. Patient implications include hypersensitive teeth, rapid progression of caries, mastication impairment due to rapid attrition, and esthetic repercussions. Implications for clinicians include complexity in treatment planning and treatment implementation, poor prognosis of the restorations, difficulty in achieving pain control during treatment, and behavior management problems. Intention of this paper is to review the etio-pathogenesis, prevalence, clinical features, diagnostic features, and eventually present a sequential treatment approach, i.e., in accordance with current clinical practice guidelines.

Comparative evaluation of dexmedetomidine and midazolam-ketamine combination as sedative agents in pediatric dentistry: A double-blinded randomized controlled trial.

BACKGROUND: Pharmacological methods have been used as an adjunct to enhance child cooperativeness and facilitate dental treatment. OBJECTIVE: Purpose of this study was to evaluate and compare the effect of sedation by intranasal dexmedetomidine and oral combination drug midazolam-ketamine in a group of children with uncooperative behavior requiring dental treatment. MATERIALS AND METHODS: This was a prospective, randomized, double-blind study that included patients 3-9 years old with American Society of Anesthesiologists-I status. About 36 children presenting early childhood caries were randomly assigned to one of three groups studied: Group MK received intranasal saline and oral midazolam (0.5 mg/kg) with ketamine (5 mg/kg) mixed in mango juice; Group DX received intranasal dexmedetomidine (1 µg/kg) and oral mango juice; and Group C received intranasal saline and oral mango juice. Patients' heart rate, blood pressure, and oxygen saturation were recorded before, during, and at the end of the procedure. Patients' behavior, sedation status, and wake up behavior were evaluated with modified observer assessment of alertness and sedation scale. Ease of treatment completion was evaluated according to Houpt scale. RESULTS: Hemodynamic changes were statistically insignificant in Group MK and Group DX. About 75% patients in Group MK were successfully sedated as compared to 53.9% Group DX and none of the patients in Group C. Ease of treatment completion was better with Group MK as compared to Group DX and least with Group C. Around 50% patients in Group MK had postoperative complications. CONCLUSION: Oral midazolam-ketamine combination and intranasal dexmedetomidine evaluated in the present study can be used safely and effectively in uncooperative pediatric dental patients for producing conscious sedation.