Diagnosis and Dental Management of a Child with Moebius Syndrome: A Case Report.

Moebius syndrome (MBS) is a rare congenital nonprogressive neuromuscular disorder characterized by partial or complete, unilateral or bilateral paralysis of the facial (VII) and abducens (VI) cranial nerves (CNs). In this syndrome bilateral facial palsy may occur with the involvement of VII CN and impaired eye movements can be there because of the involvement of VI CN. It can also be associated with other CN palsies, orofacial anomalies, and limb defects. MBS is diagnosed exclusively on the basis of clinical criteria, although causative genetic patterns are being documented in recent studies. The present case report describes the dental management of a 5-year-old child diagnosed with MBS. The child presented with the abnormal shape of legs, incomplete eye closure during sleep, inability to smile, lingual hypoplasia, microstomia, and hypoplastic teeth among other dental-skeletal abnormalities, and a clinical diagnosis of MBS was made. How to cite this article: Mittal M, Kumar A, Chopra R, et al. Diagnosis and Dental Management of a Child with Moebius Syndrome: A Case Report. Int J Clin Pediatr Dent 2023;16(S-1):S109-S112.

Ameliorative potential of vitamin C and E against Roundup-glyphosate induced genotoxicity triggering apoptosis in caprine granulosa cells.

The present study was aimed to investigate the genotoxic and apoptotic effects of glyphosate (GLP) in Roundup formulation along with mitigation of two potent antioxidants that is, vitamin C and E in caprine granulosa cells in vitro. The entire work was done in a dose and time dependent manner where different concentrations of GLP (0.1, 2.0, and 4.0 mg/ml) in Roundup and antioxidants (0.5 and 1.0 mM) were employed to culture of granulosa cells for exposure durations of 24, 48, and 72 h. Analysis of GLP-induced geno-toxicity was accomplished by using single cell gel electrophoresis (comet assay) assay. Results have shown increased incidences of DNA fragmentation, evidenced by presence of different types of comets (Type 1-Type 4) in Roundup-GLP- exposed groups in contrast to the control group (Type 0 comet). However, mitigation by both vitamin C and E was significant (p < .05) in combating the GLP-induced genotoxicity in granulosa cells in a concentration- and time-dependent manner. The results of our study provide a clear indication of the ameliorative actions of vitamin C and E against Roundup-GLP-induced genotoxicity that instigate apoptosis in ovarian granulosa cells of caprine.

Clinical, microbiological, and radiographic evaluation of sealed carious dentin after minimal intervention in primary molars.

BACKGROUND: In continuation with the ultraconservative minimal intervention approach for carious lesions treatment, lesion sterilization and tissue repair (LSTR) is a novel concept of using antibacterial drugs to disinfect dentinal, pulpal, and periapical lesions. AIMS: The purpose of this study is to evaluate the clinical, radiographic, and microbiologic success rate of indirect pulp treatment (IPT) using a new technique minimal excavation and LSTR with triple antibiotic paste (TAP), for primary molars. SETTINGS AND DESIGN: This was randomized controlled trial design. MATERIALS AND METHODS: Forty-two healthy cooperative children aged 5-10 years having deep carious lesion in primary molars were randomly assigned to receive either traditional IPT with calcium hydroxide or minimal excavation and LSTR with TAP. Follow-up was done at 6 weeks, 3, 6, and 15-18 months intervals, and treatment success or failure was determined by a combination of clinical, microbiological, and radiographic findings. STATISTICAL ANALYSIS USED: Qualitative data were analyzed using Pearson's Chi-square test. Mann-Whitney U nonparametric test was used for statistically significant differences between the bacterial counts (median values and percent reduction) between the two groups and the Wilcoxon sign rank test for the intragroup evaluation of bacterial counts. RESULTS: LSTR with TAP was found to be as effective as traditional indirect pulp treatment (P < 0.05). CONCLUSIONS: Minimal excavation and LSTR with TAP can be an effective treatment methodology for the management of deep carious lesions in primary molars.

Interim use of a maxillary lip bumper during interdisciplinary management of ectopically erupted incisor teeth.

INTRODUCTION: Ectopic eruption, manifesting as an aberration in the normal path of eruption of a tooth, can adversely impact facial aesthetics, phonetics and psychosocial development. DESCRIPTION: This case series describes the orthodontic management of two adolescent patients with different clinical presentations of ectopically erupted maxillary central incisors secondary to trauma during the primary dentition period. The therapy primarily included periodontal soft-tissue surgery accompanied by orthodontic traction to align the ectopic incisors. Frenectomy was performed in one patient and surgical excision of a hypertrophied pseudo-pouch in the second patient. A modified maxillary lip bumper was used concomitantly for management of associated soft-tissue trauma, thus facilitating healing and aiding orthodontic traction. RESULTS: Appropriately planned interdisciplinary management involving the interim use of a modified lip bumper allowed proper alignment of the ectopically positioned incisors with a stable outcome at three-year follow-up. CONCLUSION: Fixed orthodontic therapy with concurrent use of modified maxillary lip bumper is an effective approach to treat incisors erupted ectopically in relation to the upper lip and frenum.

Comparison of Pain Perception Using Conventional Versus Computer-Controlled Intraligamentary Local Anesthetic Injection for Extraction of Primary Molars.

This study was conducted to compare pain perception of intraligamentary anesthesia (ILA) using a computer-controlled local anesthetic delivery system (CCLADS) versus a conventional intraligamentary injection for extraction of primary molars. A randomized controlled trial was designed where 82 children requiring 102 primary molar extractions were given ILA of 2% lidocaine with 1:80,000 epinephrine with either the conventional method or a CCLADS. Pain during injection and extraction was assessed using the Sound, Eye, Motor (SEM) scale and heart rate recording. Faces Pain Scale-Revised (FPS) scores were self-reported by patients. The Mann-Whitney test was used for evaluation of FPS and SEM scores and Student's t test for evaluation of heart rate readings. Heart rate values during injection were found to be higher, but not statistically significantly higher (p = .077), for conventional injection versus CCLADS; however, heart rate values during extraction were significantly higher for the conventional method (p = .009). Both FPS and SEM values were found to be significantly higher for conventional ILA technique (p < .05). ILA can be an effective alternative means of anesthesia for primary molar extractions, and CCLADS devices can make ILA more effective and less painful.

Effective attenuation of glyphosate-induced oxidative stress and granulosa cell apoptosis by vitamins C and E in caprines.

Pesticides are known to cause a wide range of reproductive problems that possess degenerative effects on mammalian fertility. Glyphosate (GLP), a broad-spectrum organophosphate herbicide, is known to be a potent mammalian toxicant. The present study aims at assessing the GLP-induced (0.1, 2.0, and 4.0 mg/ml) granulosa cells toxicity and evaluating the mitigating effects of vitamins C and E (0.5 mM and 1.0 mM) in healthy caprine antral follicles, cultured in vitro in a dose- and time-dependent manner (24, 48, and 72 hr) and subjected to various cytotoxic and geno-toxic analysis, namely, classic histology, EB/AO differential staining, oxidative stress parameters, and antioxidant enzymatic activity. The histomorphological analysis and EB/AO staining elucidated increase in the incidence of apoptotic attributes within granulosa cells with increasing dose and duration of the GLP treatment. The highest apoptotic frequency was observed at 4.0 mg/ml GLP after 72-hr exposure duration in comparison with the control. GLP exposure also led to a significant decline in the antioxidant enzymes' activity, namely, SOD, catalase, and GST along with enhanced lipid peroxidation and reduced FRAP activity in a dose- and time-dependent manner. Vitamins C and E supplementation decreased oxidative stress-mediated granulosa cells apoptosis, suggesting its efficiency to diminish GLP-mediated GCs cytotoxicity and thereby, preventing associated fertility disorders.

N-Acetyl-cysteine mediated inhibition of spermatogonial cells apoptosis against malathion exposure in testicular tissue.

Toxicological studies so far suggest that excessive use of malathion, an organophosphate insecticide, causes serious ill-effects in mammalian reproductive physiology. The present study aims at assessing malathion-induced toxicity in a dose- and time-dependent manner with mitigating effects of N-acetyl-l-cysteine. The testicular germ cell viability was monitored using MTT assay, where NAC, being an antioxidant significantly reduced malathion-induced toxicity by enhancing the frequency of cell viability. The histomorphological analysis showed that NAC successfully diminished several apoptotic features in testicular cells, induced by malathion. The differential EB/AO staining revealed a significant decline in the percentage of apoptosis after NAC supplementation. NAC also diminished the malathion-induced DNA fragmentation along with significantly reduction in oxidative stress parameters causing decrease in lipid peroxidation and enhancement of ferric reducing antioxidant power within testicular germ cells. Thus, NAC mitigated the malathion-induced toxicity, proving its potential in infertility treatment.

Multicomponent Synthesis of Some Molecular Hybrid Containing Thiazole Pyrazole as Apoptosis Inducer.

The present study describes a multicomponent synthesis of molecular hybrid containing pyrazole, thiazole moiety using hydrazone as a linker, which have been synthesized by condensation of 1-phenyl-3-(aryl)-1H-pyrazole-4-carbaldehydes 1A-B: , thiosemicarbazide and α-bromoketones 2A-C: .The target hybrid compounds, 1-((1-phenyl-3-aryl-1H-pyrazole-4-yl)methylene)-2-(4-arylthiazole-2-yl)hydrazine 3A-F: are characterized by 1H-NMR, 13C NMR, FT-IR and mass. Apoptosis inducing ability and cytotoxic nature of all the hybrid compounds having thiazole, pyrazole and hydrazone were assessed by using biological assays viz morphological, fluorescence and tunel assays on granulosa cells of ovarian antral follicles of goat (Capra hircus) in vitro. Apoptosis was recognized and quantified using differential staining of ethidium bromide and acridine orange where apoptotic cells exhibited red fluorescence and live normal cells with intact cell membrane and normal nucleus displayed bright green fluorescence. Among the tested compounds, compound 3E: and 3B: showed the maximum potency to induce apoptosis with percentage of apoptosis 25.61±2.95and 23.45±1.46 respectively followed by 3F: (20.95±0.40) and 3D: (20.44±1.60) in comparison with control (5.14±0.44).

Arteriovenous Malformation of Face.

Arteriovenous malformations (AVMs) are rare congenital vascular malformations accounting only 1.5% of all vascular anomalies with 50% occurrence in the oral and maxillofacial region. It usually results from birth defects of the vasculature. A literature search revealed only few case reports of AVMs in the facial region. Lack of meticulous diagnosis, scarcity of knowledge, and paucity of literature can result in their exsanguinations leading to fatal hemorrhagic incidents after various dental procedures such as tooth extraction, surgical intervention, puncture wound, or blunt injury in involved area. The present case describes the accidental diagnosis of asymptomatic high-flow AVMs in the facial region of pediatric patient reported primarily for the treatment of periapical abscess. This case report is unique because although there was no history of bleeding episodes, thorough examination and investigations diagnosed it as high-flow vascular malformation. It is important for the dental practitioner to be aware of AVM which may be present in the head and neck region that can produce fatal bleeding episodes during various dental procedures. Proper diagnosis of AVMs through complete history, precise clinical examination, and advanced imaging modalities can help in preventing serious life-threatening complications.

Reverse twin block for interceptive management of developing class III malocclusion.

Early correction of developing class III malocclusions remains a complex challenge. Treatment approaches for these young patients have been directed at growth modification. Encouraging outcomes have been reported with the use of Class III functional appliances including reverse twin block (RTB) appliance. The present paper tries to provide an insight into RTB appliance used for successful interceptive management of developing class III malocclusion in two children. RTBs were fabricated with bite registered in the position of maximum possible retrusion of mandible with interincisal clearance of 2 mm and vertical clearance of 5 mm in the buccal segments. Anterior crossbite was corrected, and there was a marked improvement in facial appearance of the children. RTB can be a viable and effective functional appliance treatment modality for early management of developing class III malocclusion.

Evaluation of Buccal Infiltration with Articaine and Inferior Alveolar Nerve Block with Lignocaine for Pulp Therapy in Mandibular Primary Molars.

OBJECTIVE: Failure of inferior alveolar nerve block in achieving profound anesthesia of the pulp due to various reasons has led to the introduction of more potent local anesthetic agents like articaine. This study was conducted to compare the efficacy of buccal infiltration with articaine in achieving pulpal anesthesia of primary molars as compared to inferior alveolar nerve block with lignocaine. STUDY DESIGN: 30 patients (4-8 years) with indication of pulp therapy in at least two mandibular primary molars were selected. Patients were randomly assigned to receive nerve block with lignocaine or infiltration with articaine on first appointment and the other solution on second appointment. All the pulpotomies and pulpectomies were performed by a pediatric dentist. Two researchers standing at a distance of 1.5 m recorded the Pain Scores and Sound, Eye, Motor (SEM) scores. After the completion of procedure, the patient was asked to record the Facial Image score and Heft-Parker Visual Analogue Score (HP-VAS). RESULTS: Pain Score recorded at the time of injection showed significantly more movements with block as compared to infiltration (p<0.001). SEM scores at time of pulp extirpation were also higher for block than infiltration (p<0.001). CONCLUSION: Articaine infiltration has the potential to replace inferior alveolar nerve block for primary mandibular molars.

Dental management of hypohidrotic ectodermal dysplasia: A report of two cases.

Ectodermal dysplasia (ED) represents a group of inherited conditions characterized by anomalies in two or more structures of ectodermal origin, which can be presented as problems related to hair, nail, teeth, sweat glands, and sebaceous glands. Based on clinical findings, there are two major types of this disorder: (1) Hypohidrotic/anhidrotic and (2) hidrotic ED. The anhidrotic/hypohidrotic ED (HED) is the more severe form and is associated with more dental defects. This article presents with prosthetic rehabilitation including removable partial and complete denture and implant supported overdenture of two male children of a family presenting with HED.

Management of a maxillary first molar having atypical anatomy of two roots diagnosed using cone beam computed tomography.

Most often, a clinician working on maxillary first molar when anticipates an aberration thinks of an extra canal but rarely does he preempt fewer canals. Maxillary first molar is a tooth, which has been extensively reviewed with respect to its external and internal morphology. Abundant literature related to its anatomy is available, but reports on incidence of two roots and two root canals in maxillary first molar are very limited. Here, a case of maxillary first molar is presented that had two roots: one palatal root with Type I canal configuration and one bulbous fused buccal root with Type V canal configuration; a unique root and canal configuration not seen in any of the earlier reported cases. Diagnosis of root canal aberrancy and subsequently, accurate management of the tooth was greatly facilitated by cone beam computed tomography (CBCT) scan. The relevance of CBCT in improving treatment prognosis is greatly emphasized in this report.

Comparison of Anesthetic Efficacy of Articaine and Lidocaine During Primary Maxillary Molar Extractions in Children.

PURPOSE: Recent evidence has shown that buccal infiltration with articaine alone can be used to anesthetize dental tissues for various dental procedures. The purpose of this study was to evaluate the efficacy of articaine compared to lidocaine for extraction of primary maxillary molars and assess whether palatal anesthesia could be achieved with buccal infiltration injection but without the need for palatal infiltration. METHODS: One hundred and two children requiring primary maxillary molar extraction were randomly selected to receive buccal infiltration using either articaine or lidocaine. During extraction, The Wong Baker Facial Pain Scale (FPS) was employed for subjective evaluation and Modified Behavior Pain Scale (MBPS) values, heart rate, and blood pressure were recorded for objective evaluation. Effectiveness of anesthesia was checked using subjective symptoms and probing. RESULTS: Palatal anesthesia with buccal infiltration could not be obtained in any of the groups. Statistically significantly higher MBPS pain scale values were seen with lidocaine as compared to articaine. FPS, heart rate, and blood pressure values presented no statistically significant difference in the two groups. CONCLUSIONS: Although buccal infiltration with articaine failed to provide adequate palatal anesthesia, it can still be considered a good alternative to lidocaine for local anesthesia in children.

CBCT diagnosis and endodontic management of a maxillary first molar with unusual anatomy of two palatal canals: A case report.

It is crucial for any clinician to have a thorough knowledge about the normal anatomy of tooth and always be vigilant for any variations to ensure endodontic success. An anatomic variant like additional canals in the palatal root of maxillary molar is not commonly reported. This clinical case report presents the application of cone beam computed tomography as a useful imaging technique in endodontics for the management of teeth with aberrant anatomy. Here, maxillary first molar having two canals in the palatal root, two canals in mesiobuccal root and one canal in distobuccal root was managed successfully using cone beam computed tomography scan as a diagnostic aid.

Endodontic and esthetic management of a dilacerated maxillary central incisor having two root canals using cone beam computed tomography as a diagnostic aid.

Traumatic injuries to the primary dentition are quite common. When primary teeth are subjected to trauma, force transmission and/or invasion of the underlying tooth germs lying in close proximity can result in a variety of disturbances in the permanent successors. Few of these disturbances include hypoplasia, dilaceration, or alteration in the eruption sequence and pattern. Dilaceration is defined as an angulation or sharp bend or curve in the linear relationship of the crown of a tooth to its root. A rare case of maxillary left central incisor having crown dilaceration and Vertucci's type II canal configuration with symptomatic periapical periodontitis is reported. Cone beam computed tomography was used for better understanding of the anomaly and complicated root canal morphology. The tooth was successfully managed by nonsurgical root canal therapy and restoration with resin composite to restore esthetics.

Oral health status of 5 years and 12 years old school going children in rural Gurgaon, India: an epidemiological study.

BACKGROUND AND AIMS: Oral health is an essential component of health throughout life. Hardly any information is available on the oral health status of children in Gurgaon. Thus, the present study was conducted among 5-year-old and 12-years-old children in schools in rural Gurgaon. MATERIALS AND METHODS: A total of 1003 children were examined of which 619 were in 5 years age group and 384 in 12 years group. The prevalence of dental caries was studied using dentition status and treatment needs index. For dental calculus criteria of Community Periodontal and for dental fluorosis Dean's index was used. RESULTS: In 5 years age group prevalence of dental caries was 68.5%, dental fluorosis was 22.5% and treatment needs were 63.7%. In 12 year age group prevalence of dental caries was 37.5%, dental fluorosis was 76.04%, highest community periodontal index score was 2, seen in 80.2% and overall treatment needs were 44.3%. CONCLUSION: Preventive approaches seem to be a viable alternative to tackle the overwhelming problem of dental caries and other oral diseases. Provision of oral health education in schools and school based preventive programs are important for improvement of this situation.

Buccal midazolam spray as an alternative to intranasal route for conscious sedation in pediatric dentistry.

OBJECTIVES: To evaluate the acceptance of midazolam spray through buccal route as compared to intranasal route and compare the efficacy of the drug through both the routes. STUDY DESIGN: 30 patients aged 2-8 years with Grade I or II Frankl's Behaviour Rating Scale were selected who required similar treatment under local anesthesia on two teeth. Midazolam spray was administered randomly through buccal or intranasal routes for the two appointments. Scoring was done for the acceptance of drug and Houpt's score was recorded for the behaviour of patients during the treatment. RESULTS: Acceptance of drug through buccal route was significantly better than the intranasal route (p < 0.05) but no statistically significant difference was found in the behaviour scores for the two routes of administration (p > 0.05). CONCLUSION: Midazolam spray can be effectively used through the buccal mucosa in children who give poor compliance with the intranasal administration.

Nutritional considerations and dental management of children and adolescents with HIV/AIDS.

The HIV infected child has increased caloric needs, yet multiple factors interfere with adequate nutritional intake. Nutritional support is needed to maintain optimum nourishment during the symptomatic period, in order to prevent further deterioration of the nutritional status during acute episodes of infection, and to improve the nutritional status during the stable symptom free period. With the advent of better methods of detection and better therapies, we are beginning to see HIV infected children surviving longer; and thus coming under the care of a host of affiliated medical personnel, including dentists. Oral health care workers need to provide dental care for HIV-infected patients and recognize as well as understand the significance of oral manifestations associated with HIV infection. The present article reviews, on the basis of literature, nutritional status, nutrition assessment and counseling in HIV/AIDS children and adolescents. Dental treatment considerations in these, as well as modifications in treatment if required, are also discussed.

AIDS in children--epidemiology, clinical course, oral manifestations and management.

HIV/AIDS has gained enormous proportion globally. In 2007, there were an estimated 33 million people living with HIV and an estimated 270,000 HIV infected children younger than 15 years died because of AIDS, HIV/AIDS can manifest in different forms and in present day scenario, it is imperative that dentists know its clinical presentation and management. Oral manifestations are one of the earliest indicators of HIV infection and progression in children, as in adults, although the specific manifestations differ between adults and children. The aim of this paper is to briefly review, on the basis of literature, the AIDS epidemiology, transmission, clinical course, oral manifestations and their management in children.