Effectiveness of Animal-Assisted Activity on Pain Perception and Anxiety of Children Undergoing Intraoral Local Anesthetic Administration.

Purpose: To investigate the impact of animal-assisted activity (AAA) involving a dog (play therapy) on reducing the pain experienced by children during the administration of local anesthetic (LA). Methods: Children between the ages of eight and 12 years who required LA administration were randomized into an AAA group and a control group. Baseline data for the simplified Modified Child Dental Anxiety Scale-Faces version (MCDAS[f]) was recorded, followed by the implementation of either AAA with standard care or standard care alone. The conventional protocol was followed for the administration of LA. Procedural pain was evaluated using both the Faces Pain Scale-Revised (FPS-R) and the Faces, Legs, Activity, Cry, and Consolability Scale (FLACC). All variations in pulse were also recorded. After the procedure, a simplified MCDAS(f) was recorded once again. The data were tabulated and statistically analyzed. Results: The children in the AAA group reported lower pain scores, as measured by FPS-R, compared to the control group (P =0.009). Pain, as observed in the FLACC scores, was also low in the experimental group (P <0.001). A notable reduction in anxiety scores (P <0.001) was observed among children assigned to the AAA group. Conclusion: AAA involving a dog led to a reduction in the pain experienced by children undergoing LA administration, subsequently decreasing anxiety.

Is dynamic computer-assisted surgery more accurate than the static method for dental implant placement? A systematic review and meta-analysis.

STATEMENT OF PROBLEM: Dynamic computer-assisted surgery for dental implant placement has become popular, but systematic comparisons of the accuracy of computer-assisted surgery with static surgery are lacking. PURPOSE: The purpose of this systematic review and meta-analysis was to determine evidence on the difference in the accuracy of dynamic computer-assisted surgery compared with the static method for dental implant placement. MATERIAL AND METHODS: A systematic search was conducted in 3 electronic databases: PubMed, Ovid, and Cochrane. Studies conducted on dental implants that compared the accuracy of positioning implants with a dynamic system with that of a static system were included. Randomized clinical trials, prospective and retrospective cohort studies, and in vitro studies were included in the review. Review articles, case reports, letters, opinion articles, commentaries, and nonpeer-reviewed literature were excluded. RESULTS: Of the 26 full-text articles, 14 fulfilled the inclusion criteria. Of these, 2 were randomized clinical trials, 2 were prospective studies, and 1 was a retrospective cohort study. The remaining 9 were in vitro studies. A total of 1633 implants were placed with the static and 902 with the dynamic method. A significant mean difference (-0.51 degrees [95% CI: -0.90, -0.13]) between dynamic and static systems was only observed in the angular deviation of in vitro studies (P=.009). Meta-analysis was performed using Review Manager statistical software and forest plots were generated. CONCLUSIONS: A difference was found in the angular deviation of implants placed with the dynamic approach compared with the static system. The dynamic system was better, but this difference was not demonstrable in clinical studies. No significant difference was found in the apical and coronal deviations of the dynamic and static systems.

Comparative evaluation of "Tell-Tell-Tell," "Ask-Tell-Ask," and "Teach back" communication techniques on oral health education among 12-13-year-old children - An educational intervention trial.

Background: Effective communication with children can improve their understanding and aid in complying with oral hygiene instructions. Aim: The aim is to compare the retentiveness of oral hygiene instructions in children educated using three communication techniques. Methodology: One hundred and twenty children in the age range of 12-13 years were included in the study. Baseline awareness of oral hygiene maintenance was assessed using a questionnaire. Twenty children were randomly assigned to each group: Tell-Tell-Tell, Ask-Tell-Ask, Teach-back, and information provided. Knowledge was reassessed after a week; data were tabulated and assessed statistically. Results: There were no statistically significant differences in the baseline data among the groups (P > 0.05). Regardless of the group, there was an improvement in knowledge regarding the frequency and timing of brushing as well as the cause of dental caries after the intervention. However, children in Ask-Tell-Ask and Teach back showed significant improvement over Tell-Tell-Tell (P ≤ 0.01). Conclusion: Communication strategies, such as Ask-Tell-Ask and Teach back, which have a strategy to involve children, have been shown to be superior over Tell-Tell-Tell.

Effectiveness of low-level laser therapy in reducing pain perception of children during dental local anesthetic administration using laser acupuncture pen on the LI4 point: a randomized clinical trial.

PURPOSE: Laser acupuncture, a non-invasive variant of acupuncture, has been proven effective in the medical and dental fields. Hence, the present study aims to determine the effect of low-level laser therapy on the LI4 point, using a laser acupuncture pen, in reducing children's pain during local anesthetic (LA) administration. METHODS: Children in the age range of 8-12 years, in need of LA administration, were randomly assigned to two groups: Group I: laser acupuncture, Group II: control. For all the children, baseline simplified Modified Child Dental Anxiety Scale-Faces version (MCDAS(f)) was recorded, followed by laser acupuncture or standard care. Following the conventional protocol, LA was administered. The procedural pain was assessed using the Faces, Legs, Activity, Cry and Consolability scale (FLACC) and Faces Pain Scale-Revised (FPS-R). All the variations in pulse rate were recorded from baseline to the completion of LA administration. After the procedure, simplified MCDAS(f) was recorded one more time. The data were tabulated and analyzed statistically. RESULTS: A significant reduction in anxiety after LA administration, as observed in MCDAS(f) score, was noticed only in the laser acupuncture group. The pain scores, as reported in FPS-R, were low in children randomized to the laser group compared to the control. The FLACC pain scores also showed low values in the experimental group. CONCLUSION: Based on the study findings, within the limitations, low-level laser therapy using a laser acupuncture pen can reduce the pain perception of children undergoing LA administration and alleviate dental anxiety.

Effect of Aromatherapy on Dental Anxiety and Pain in Children Undergoing Local Anesthetic Administrations: A Randomized Clinical Trial.

Introduction: In dentistry, local anesthetic (LA) administration in children is often associated with behavioral problems. Hence, the present study evaluated the efficacy of aromatherapy in reducing the dental anxiety and pain during LA procedure. Methods: This clinical trial was conducted upon 150 children in the age range of 8-12 years. Subjects were randomly divided into five groups; Group 1: Lavender essential oil using nebulizer; Group 2: Lavender essential oil using inhaler; Group 3: Orange essential oil using nebulizer; Group 4: Orange essential oil using inhaler; Group 5: Control (without aromatherapy). For all the children, baseline anxiety was recorded followed by aromatherapy (except for children in the control group). Following the standard protocol, LA was administered. The procedural pain was assessed using Faces, Legs, Activity, Cry and Consolability scale (FLACC) and Faces Pain Scale-Revised (FPS-R). Finally, anxiety was again recorded. Data were analyzed using SPSS version 17.0. Results: A significant difference in ANOVA test was observed among anxiety scores after LA in aromatherapy groups 1, 3, and 4 compared to control. When the FLACC scores were analyzed using Kruskal-Wallis, there were significantly lower values in aromatherapy groups compared to the control group. The pain scores, as reported in FPS-R, were also lower in aroma groups 1, 3, and 4. Conclusion: Aromatherapy with lavender or sweet orange, using either nebulizer or inhaler, decreased the dental anxiety of children, whereas, only sweet orange could reduce the pain as self-reported by children.

Estimation of occlusal vertical dimension using cephalometric angular reconstruction.

AIM: To propose a new technique, based on cephalometrics for determining the vertical dimension of occlusion (VDO). METHODS AND MATERIAL: Thirty-five participants in the age range of 20. ­: 22 years who met the inclusion criteria were recruited. Lateral cephalograms were obtained and tracing done. Five reference landmarks, Nasion (N), Anterior Nasal Spine (ANS), Porion (P), Gonion (G) and Gnathion (Gn) were marked and joined to form four angles, N-ANS-Gn, N-ANS-G, P-G-Gn and P-G-ANS; distance between ANS and Gn was considered as VDO in cephalogram (VDO-Ceph). The angles N-ANS-Gn and N-ANS-G; P-G-Gn, and P-G-ANS were correlated; two simple linear regression models were developed to predict N-ANS-Gn and P-G-Gn, using N-ANS-G and P-G-ANS, as independent variables. Using the formulae, the predicted angles, N-ANS-Gn and P-G-Gn were drawn and intersection marked as 'reconstructed point Gn'. The predicted VDO-Ceph values (distance between ANS and reconstructed Gn) were measured and correlated with actual values. RESULTS: The angles N-ANS-Gn and P-G-Gn had a statistically significant positive correlation with N-ANS-G (r = 0.77, P < 0.001) and P-G-ANS (r = 0.83, P < 0.001), respectively. Using simple linear regression analysis, the following formulae were obtained: N-ANS-Gn (in degrees) = 1.271 N-ANS-G (in degrees) + 24.83 and P-G-Gn (in degrees) = 0.987 P-G-ANS (in degrees) + 35.93. The predicted and actual VDO-Ceph values showed no statistical significance difference (P = 0.92). CONCLUSION: By tracing four cephalometric landmarks, N, ANS, P, G; and using the angular reconstruction, it is possible to predict the location of Gn. Hence, during prosthetic replacement of lost teeth, this can be employed for the estimation of lost dimensions.

Comparative evaluation of a modified endodontic approach using Curcuma longa L. and conventional pulpectomy in primary molars: A randomized clinical trial.

Background: Turmeric (Curcuma longa) is known for its anti-inflammatory and anti-septic properties. Aim: The aim is to compare a modified endodontic approach using turmeric and conventional Metapex® pulpectomy in primary molars. Materials and methods: Thirty children, in the age range of 4-9 years, with at least one primary mandibular molar indicated for pulpectomy, were included. Teeth were randomly assigned to turmeric and Metapex® groups. For those that were assigned to turmeric, after coronal and radicular pulp extirpation, a freshly prepared paste of turmeric powder and methyl cellulose (2:1) with saline was packed in the coronal pulp chamber. In the Metapex® group, a conventional pulpectomy was performed. Clinical and radiographic success was recorded at 3-, 6-, and 12-month follow-up visits. The data was statistically analyzed using the Chi-square test. Results: There were no clinical and radiographic failures at 3- and 6-month visits in both groups. The 12-month evaluation revealed clinical success rates of 92% (12 out of 13) and 100% (14 out of 14) for turmeric and Metapex®, respectively, whereas, the radiographic success rates were 85% (12 out of 13) for turmeric and 93% (13 out of 14) for Metapex®. No statistically significant differences were found between the groups at different follow-ups (P > 0.05). Conclusions: A modified endodontic approach using turmeric and conventional Metapex® pulpectomy did not differ significantly in total success after 12 months.

Effect of proton pump inhibitors on dental implants: A systematic review and meta-analysis.

AIM: The present systematic review aims to determine the evidence on the impact of proton pump inhibitors (PPIs) on dental implants. SETTINGS AND DESIGN: This secondary qualitative and quantitative research was done using a pre-specified question and inclusion criteria. MATERIALS AND METHODS: A systematic search was conducted in electronic databases such as PubMed, Ovid, and Cochrane. All the studies that assessed the effect of PPIs on dental implants were included, irrespective of the design. Literature review, letter to editors, short commentaries, and opinion articles were excluded. RESULTS AND STATISTICAL ANALYSIS USED: A total of three publications fulfilled the inclusion criteria. All these included articles were retrospective cohort studies; the methodological quality was assessed using Newcastle-Ottawa scale. A total of 452 implants were placed in 149 PPI users, whereas 6798 were positioned in 2241 nonusers. Of these, 43 and 212 implants failed in users and nonusers, respectively (odds ratio: 2.91, 95% confidence interval: 2.06-4.11). The meta-analysis was performed using the statistical software Review Manager, and a fixed-effect model was used to obtain the odds ratio. The success rate of implants based on age, gender, smoking, and bone augmentation could be combined only from two studies, which revealed a considerable effect of these factors. CONCLUSION: As far as the available evidence is considered, it seems as if the usage of PPI has a detrimental effect on the success of dental implants. This influence needs justification as none of the included studies segregated the data based on confounding factors. Hence, there is a need to conduct well-designed, prospective, randomized clinical trials with balanced confounding factors to derive a proper conclusion.

Comparison of stress induced in mandible around an implant-supported overdenture with locator attachment and telescopic crowns - a finite element analysis.

INTRODUCTION: One of the principle factors for the success of implant supported/retained overdentures (IOs) is the manner in which the stresses are transferred to the surrounding bone. Hence, the aim of the present study is to compare the stress induced in the mandible around IOs, using two different attachment systems, locator and telescopic. METHODS: 3D finite element models were prepared using Pro/ENGINEER or PTC Creo to simulate 4 clinical situations: IOs using two different attachment systems, locator and telescopic, with and without splinting. A vertical compressive load of 35N was directed toward the central fossa in the molar region of each overdenture. Non-linear static contact analysis was carried out to determine the stress distribution in various components of IOs. Then, the models were analyzed by a finite element program ABAQUS, and displayed using Von Mises stress patterns. RESULTS: The contact stress values developed on the implant and attachment components were lower with locator attachment, in both splinted and non-splinted models. On the other hand, the stress distribution to the cortical bone was more with non-splinted/splinted locator attachments (3.73/4.12 Mega Pascals) when compared to the non-splinted/splinted telescopic attachments (2.66/3.7 Mega Pascals). The stresses in all the components of overdenture were greater with the splinted model compared to non-splinted, in both the attachment systems. CONCLUSION: The locator attachment might demonstrate superior clinical performance, as the stresses on implant and attachment components were less compared to telescopic. Non-splinted model showed better results in both the attachment types.

Comparative evaluation of virtual reality distraction and counter-stimulation on dental anxiety and pain perception in children.

BACKGROUND: This study evaluated the efficacy of virtual reality (VR) distraction and counter-stimulation (CS) on dental anxiety and pain perception to local anesthesia in children. METHODS: A prospective, randomized, single-blinded interventional clinical trial with a parallel design was used. Seventy children 7-11 years old who required local anesthesia (LA) for pulp therapy or tooth extraction were recruited and allocated to two groups with equal distribution based on the intervention. Group CS (n = 35) received CS and Group VR (n = 35) received VR distraction with ANTVR glasses. Anxiety levels (using pulse rate) were evaluated before, during, and after administration of local anesthesia, while pain perception was assessed immediately after the injection. Wong-Baker faces pain-rating scale (WBFPS), visual analog scale (VAS), and Venham's clinical anxiety rating scale (VCARS) were used for pain evaluation. Student's t-test was used to test the mean difference between groups, and repeated measures ANOVA was used to test the mean difference of pulse rates. RESULTS: Significant differences in mean pulse rates were observed in both groups, while children in the VR group had a higher reduction (P < 0.05), and the mean VCARS scores were significant in the VR group (P < 0.05). Mean WBFPS scores showed less pain perception to LA needle prick in the CS group while the same change was observed in the VR group with VAS scores. CONCLUSIONS: VR distraction is better than CS for reducing anxiety to injection in children undergoing extraction and pulpectomy.

Impact of tooth brushing rhyme on the oral hygiene status of 6-7 year old children - an educational intervention study.

AIM: To determine the impact of a newly composed tooth brushing rhyme on oral hygiene status of 6 to 7-year-old children. METHODS: A total of 60 children in the age range of 6 to 7 years were randomly assigned to either group 1 (experimental) or group 2 (control). Group 1 children were given brushing instructions and made to memorize a newly composed tooth brushing rhyme; the control group received only routine brushing instructions. Baseline oral hygiene status of all the children was assessed using the oral hygiene index simplified (OHI-S) and its modification for primary dentition. Oral prophylaxis was performed, and OHI was further recorded at intervals of seven, 14 and 28 days for all the children. The data was tabulated, compared, and analyzed statistically. RESULTS: There was no significant difference in the baseline OHI-S scores between the two groups (P≥0.05). However, there was a significant difference in OHI-S scores in all the considered time intervals after the intervention. Based on the two components of OHI-S, a statistically significant difference was noted only in debris scores (7 days: P=0.04, 14 days: P≤0.001, 28 days: P≤0.001). CONCLUSION: The newly composed tooth brushing rhyme had a significant impact on the oral hygiene scores of children, and can be recommended in the routine educational curriculum of pre-primary children.

Impact of educational (sign language/video modeling) and therapeutic (Glycyrrhiza glabra--liquorice mouth wash) interventions on oral health pertaining to children with hearing impairment: A randomized clinical trial.

PURPOSE: To compare the effect of educational (sign language and video modeling) and therapeutic intervention (liquorice) on oral hygiene status of children with hearing impairment (CHI). METHODS: Ninety-three CHI, in the age range of 5-15 years, were recruited in to the study. Children were assigned to two educational intervention groups: sign language and video modeling. Each group was again randomly divided into two: with one subgroup receiving therapeutic intervention using liquorice as a mouth wash and the other group receiving no intervention. For all children, baseline oral hygiene, gingival, and plaque index scores were recorded and oral prophylaxis was performed. Based on the subgroup to which the child was assigned, oral hygiene instructions were given on a weekly basis, whereas therapeutic intervention was performed twice daily for 28 days. Reassessment was done after the completion of interventions and after 3 months, followed by statistical analysis. RESULTS: There was a significant mean reduction in oral hygiene, gingival, and plaque scores in all the children. The educational intervention could not influence the scores recorded, but the therapeutic intervention with liquorice led to a reduction in all the oral health parameters during the follow-up periods. CONCLUSION: Therapeutic intervention using liquorice as mouth wash along with educational intervention can be suggested in CHI.

Safety profile of phentolamine mesylate as reversal agent of pulpal and soft tissue dental anesthesia: a systematic review and meta-analysis.

OBJECTIVE: To systematically review the safety of phentolamine mesylate as a reversal agent for pulpal and soft tissue dental anesthesia. DATA SOURCES: Comprehensive search, up to August 2018, was performed in three major electronic databases. The methodologic quality of all the included studies was assessed using Cochrane Collaboration for randomized clinical trials. RESULTS: A total of nine studies were included for qualitative and quantitative assessment. The number of events was 269 in 2,057 participants in the phentolamine mesylate group, and 179 in 1,338 participants of the control group (odds ratio 1.19; 95% confidence interval 1.03 to 1.39). In the data segregated based on age, four studies conducted on children and adolescents revealed an odds ratio of 0.68, whereas two studies on adults revealed an odds ratio of 1.58. CONCLUSION: There were no severe complications reported in any of the included studies, but the occurrence of adverse events (mild and moderate) was greater in the phentolamine mesylate group compared to the control group. Age has a significant effect on the possibility of adverse events with phentolamine mesylate.

Adverse Effects of Implants in Children and Adolescents: A Systematic Review.

OBJECTIVE: To determine the evidence on the adverse effects of placing dental implants in healthy growing children. STUDY DESIGN: A systematic search was conducted in five electronic databases: PubMed, Ovid, Cochrane, EBSCO host, ProQuest. Studies on implants placed in children below the age of 19 years, with loss of tooth either due to trauma or caries were included, whereas, studies on mini implants and implants placed due to congenital absence of teeth were excluded. The articles that fulfilled the inclusion criteria were analyzed based on the predetermined criteria of success. RESULTS: A total of 8 publications fulfilled the inclusion criteria. All the included articles were case reports/series, involving a total of 16 implants (15 maxillary, one mandibular) in 11 adolescents (7 boys and 4 girls). The age of implant placement ranged between ten to 17 years with a mean age of 13.4 years and the follow up period, 4.5 months to 13 years. Pain, paresthesia, mobility or peri-implant radiolucency was not reported in any case report, indicating good integration. Radiographic crestal bone loss, probing depth and implant esthetics were not mentioned. The infraocclusion was not reported in 5 cases (age: 11-17 years, follow up: 4.5 months-two years), however, it was an adverse effect in 6 cases (age: ten-17 years, follow up: three-13 years). CONCLUSION: There is insufficient evidence to contradict the placement of dental implants in healthy growing children; the only reported adverse event is infraocclusion, the management of which too is discussed. However, as all the data is from case reports, the result should be interpreted with caution. Therefore, well-designed randomized controlled trials are needed to address this gap in the literature.

Effectiveness of Acupressure on Dental Anxiety in Children.

PURPOSE: Acupressure is a non-invasive variant of acupuncture and is known to reduce general anxiety. The purpose of this study was to test acupressure's effect on children's dental anxiety. METHODS: Eight- to 12-year-old children undergoing scaling and/or restorative procedures were randomly assigned to one of the following groups: acupressure (Group 1); sham (Group 2); or control (Group 3). Anxiety was recorded for all the children using the Modified Child Dental Anxiety scale (MCDAS). Acupressure beads with a piece of adhesive strip were employed over the selected acupoints for groups one and two. Anxiety was further recorded for all the children prior to and after completion of the treatment using MCDAS. The Frankl scale was used as the objective measure to assess the behavior of all the children. A physiologic parameter (pulse rate) was also recorded. The scores obtained from all the three groups were tabulated, compared, and analyzed statistically. RESULTS: A significant difference was found in MCDAS, pulse rate, and the Frankl behavior ratings among the three groups of children, with acupressure group displaying a lower level of anxiety. CONCLUSION: Acupressure can be a viable alternative to reduce dental anxiety in children undergoing scaling and restorative procedures.

Comparison of a New Auto-controlled Injection System with Traditional Syringe for Mandibular Infiltrations in Children: A Randomized Clinical Trial.

BACKGROUND: Pain in the dental operatory can have a profound effect on the behavior of children. AIM: The aim of this study is to evaluate the pain perception while administering local infiltration, in children undergoing dental extractions, using a new auto-controlled injection system. MATERIALS AND METHODS: Children in the age range of 6-10 years with teeth indicated for extraction were recruited and allocated to either Group I, computer-controlled injection system (auto system with special cartridge and compatible disposable 30-gauge, 10 mm needles), or Group II, traditional system (30-gauge, 10 mm needle and disposable traditional syringe). Local infiltration was administered and extraction performed after 3 min. The time of administration (TOA) of infiltrate was noted whereas anxiety and pain in both groups were assessed using the Modified Child Dental Anxiety Faces Scale simplified (MCDAS(f)), pulse rate, Faces Pain Scale-Revised (FPS-R), and Face, Legs, Activity, Cry, Consolability (FLACC) Scale. RESULTS: The TOA was high in computer group, compared to the traditional system (P < 0.001***); however, anxiety and pain were significantly less in computer group as reported in MCDAS(f), pulse rate, FPS-R, and FLACC (P < 0.001***). CONCLUSIONS: Computer system created a positive and comfortable experience for the child, as well as the practitioner. The possibility of using buccal infiltration instead of inferior alveolar nerve block in children below 10 years was also demonstrated.

Diagnostic accuracy of direct digital radiography and conventional radiography for proximal caries detection in primary teeth: A systematic review.

OBJECTIVE: The present study was conducted to uncover the diagnostic accuracy of digital versus conventional radiographic methods for the detection of proximal caries in primary teeth. METHODS: Two researchers independently involved in the search process to explore Medical Subject Heading terms "dental digital radiography," "dental radiography," "bitewing," "dental caries," and "primary teeth" using PubMed, Cochrane Library, Ovid SP, and SIGLE databases. Search was confined to the articles published in English language only, with time period limit January 1996 to April 2014 and a hand search was performed to retrieve additional citations. Explicit inclusion and exclusion criteria were applied to eliminate undesired studies. Critical appraisal of the retrieved articles was done using the quality rating based on Bader and co-workers criteria. RESULTS: A total of 129 articles were retrieved, among which 4 articles were included. All the four studies included were in vitro, of which two studies attained a high-quality score, whereas the other two attained average, and low scores based on Bader et al.'s criteria. CONCLUSIONS: A big lacuna exists in the literature, regarding the evaluation of radiographic systems in primary teeth, suggesting an immediate need for well conducted in vivo studies. The quality of available evidence can be regarded as fair but cannot be suggested to set a baseline, indicating a need to perform high-quality studies in a randomized sample to find out the accuracy of digital and conventional radiographs.

Primary Dentition Analysis: Exploring a Hidden Approach.

BACKGROUND: Accurate prediction of the mesiodistal widths (MDWs) of canines and premolars in children with primary dentition facilitates interception of malocclusion at an early age. Boston University (BU) approach is one, i.e., based on primary teeth for predicting canine and premolar dimensions. AIM: To predict the canine and premolar dimensions, in the contemporary population, using BU approach and compare with the values obtained using Tanaka-Johnston (T/J) approach. DESIGN: Children in the age range of 7-11 years with presence of all permanent mandibular incisors and primary maxillary and mandibular canines and first molars were included in the study. Those with interproximal caries or restorations, abnormalities in shape or size and history of orthodontic treatment were excluded. Impressions of both arches were made using irreversible hydrocolloid and poured with dental stone. The MDWs of the required teeth were measured on the models using electronic digital vernier caliper from which widths of permanent canines and premolars were predicted using both T/J and BU approaches. RESULTS: Statistically significant (p = 0.00) positive correlation (r = 0.52-0.55) was observed between T/J and BU approaches. A statistically significant (p = 0.00) strong positive correlation (r = 0.72-0.77) was observed among girls, whereas boys showed a statistically nonsignificant weak positive correlation (r=0.17-0.42) based on gender. CONCLUSION: Boston University approach can be further studied prospectively to make it possible as a prediction method of permanent tooth dimensions for children in primary dentition stage. How to cite this article: Nuvvula S, Vanjari K, Kamatham R, Gaddam KR. Primary Dentition Analysis: Exploring a Hidden Approach. Int J Clin Pediatr Dent 2016;9(1):1-4.

Expression of pain and distress in children during dental extractions through drawings as a projective measure: A clinical study.

AIM: To evaluate the efficacy of drawings as a projective measure of pain and distress in children undergoing dental extractions. METHODS: Children in the age range of 4-13 years with existence of untreatable caries or over-retained primary teeth, indicated for extractions were included. Pain was assessed using one behavioral [faces, legs, activity, cry and consolability (FLACC)] scale; and a self report measure; faces pain scale-revised (FPS-R), at two points of time, after completion of local anesthetic administration and after extraction. The general behavior of children was assessed with Wright's modification of Frankl rating scale. At the end of the session, children were instructed to represent, themselves along with the dentist and their experiences of the dental treatment through drawing. The drawings were scored utilizing Child drawing: Hospital scale (CD: H) manual and correlated with FLACC, FPS-R and Frankl using Pearson correlation test. RESULTS: A positive correlation, though statistically not significant, was observed between CD: H scores and all other considered parameters (Frankl, FPS-R and FLACC) in the present study. CONCLUSION: Drawings could not act as surrogate measure of child's pain; however, they acted as a narrative of his/her experiences and reflection of inner emotions. Hence, drawings can be used as an additional dental armamentarium.

Prediction of canine and premolar size using the widths of various permanent teeth combinations: A cross-sectional study.

AIMS: To suggest the best predictor/s for determining the mesio-distal widths (MDWs) of canines (C) and premolars (Ps), and propose regression equation/s for hitherto unreported population. METHODS: Impressions of maxillary and mandibular arches were made for 201 children (100 boys and 101 girls; age range: 11-15 years) who met the inclusion criteria and poured with dental stone. The maximum MDWs of all the permanent teeth were measured using digital vernier caliper. Thirty-three possible combinations (patterns) of permanent maxillary and mandibular first molars, central and lateral incisors were framed and correlated with MDWs of C and Ps using Pearson correlation test. RESULTS: There were significant correlations between the considered patterns and MDWs of C and Ps, with difference noted between girls (range of r: 0.34-0.66) and boys (range of r: 0.28-0.77). Simple linear and multiple regression equations for boys, girls, and combined sample were determined to predict MDW of C and Ps in both the arches. CONCLUSIONS: The accuracy of prediction improved considerably with the inclusion of as many teeth as possible in the regression equations. The newly proposed equations based on the erupted teeth may be considered clinically useful for space analysis in the considered population.