Inferior alveolar nerve block anesthesia in children: The effect of ibuprofen and phentolamine mesylate on pain perception.

CONTEXT: For successfully managing pediatric dental patients, local anesthesia is essential to eliminate pain during or after the operative period. An early recovery from soft-tissue anesthesia after an inferior alveolar nerve block (IANB) should benefit a young child patient by avoiding the risk of inadvertently biting the soft tissues. AIMS: Hence, the purpose of the study was to (1) evaluate and compare the efficacy of pre- and postoperative ibuprofen on pain perception in children who undergo IANB anesthesia with or without the use of PM and (2) evaluate the average time required for reversal of anesthesia symptoms using phentolamine mesylate. METHODS: The present study was a randomized, clinical trial performed among 60 children between 6 and 8 years of age using a convenient sampling method. The children were randomly assigned into four equal groups of 15 each using the computer-generated randomization sequence. IANB anesthesia was performed using 2% lignocaine with 1:100,000 epinephrine, and a mandibular primary molar pulpotomy was performed on each group. Group 1: the ibuprofen tablet was taken 1 h before the onset of the procedure. Group 2: ibuprofen tablet 30 min after the pulpotomy procedure. Group 3: the ibuprofen tablet was taken 1 h before the onset of the procedure, and the Phentolamine mesylate (PM) injection was administered. Group 4: immediately after the pulpotomy, the PM injection was administered, and an ibuprofen tablet was taken 30 min after the pulpotomy procedure. All children were assessed for the duration of soft-tissue anesthesia, their behavior scores and pain rating, as well as the incidence of postoperative self-inflicted injuries. STATISTICAL ANALYSIS USED: A one-way ANOVA was used to compare the average time needed for the reversal of anesthetic symptoms between groups. The effects of phentolamine, local anesthetics, and ibuprofen on the child's behavior and pain scores were compared using the Student's t-test. For the study, P < 0.05 was accepted as statistically significant. RESULTS: The time needed for the full reversal of anesthetic symptoms to manifest on the tongue and lip was substantially reduced by the injection of phentolamine (P < 0.001). The use of phentolamine for reversal or the intake of ibuprofen pre- or postoperatively did not exhibit any significant variation in the behavior, pain experience, or incidence of self-inflicted injuries in the child. CONCLUSION: It is evident that although phentolamine injections shorten the duration of anesthesia, the adjunctive use of pre- or postoperative ibuprofen did not significantly alter pain scores.

Prevalence of traumatic injuries to the anterior teeth among 3-17-year-old school children of Indore and correlating it with Kuppuswamy SES, occlusal relationship and ascertaining percentage of those seeking the treatment.

BACKGROUND: Orofacial trauma is one of the most prevailing oral health problems among the children. This study aimed to assess the prevalence and distribution of traumatic injuries and to correlate the causes, specific age groups, socio-economic status, occlusal relationship and ascertain the percentage of those seeking the treatment among school children in Indore (Madhya Pradesh, India). MATERIALS AND METHODS: Five thousand school going children aged between 3 and 17 years belonging to different zones of Indore were randomly selected and divided into three age groups, Group I - 3-5 years; Group II - 6-11 years and Group III - 12-17 years. The study was carried out by a single investigator and assisted by a well-trained cooperative alert assistant. An American Dental Association (ADA) type 3 examination was carried out using a mouth mirror and explorer under sufficient natural light. Traumatic injuries to the anterior teeth were recorded according to the Ellis and Davey classification. Details were noted concerning the gender, age and socio-economic status of patient; cause of trauma, number, type and relationship of teeth, lip competence and the level of unmet treatment needs. RESULTS: One thousand and seventeen children had traumatized anterior teeth with a mean prevalence of 20.34%. Prevalence was more in boys than in girls with a ratio of 2:1. Single tooth injury was observed in 81.7%. The prevalence of trauma was highest in the upper socio-economic class (31.4%) and least was seen in lower class (14.8%). The most common cause of trauma was from a fall (36.72%). Maximum prevalence was seen in either class II division 1 malocclusion or distal step terminal plane primary molar relationship. Only 2.95% of the children had undergone treatment for traumatically injured anterior teeth. CONCLUSION: High prevalence of traumatized teeth with the low percentage of children receiving treatment emphasizes the need for education programs about traumatic dental injuries that should be directed towards the children, parents and school teachers.

Maternal periodontal disease and preeclampsia in Jaipur population.

BACKGROUND: Preeclampsia is identified as an important cause for mother and newborn mortality. Inspite of extensive research, the exact etiological relations have not been established. Hence, an attempt has been made in this study to evaluate the relationship between the preeclampsia and maternal periodontal disease. MATERIALS AND METHODS: The case-control study comprised of thirty pregnant women distributed equally in the case (preeclampsia) and control (healthy) group. Gingival index, plaque index, bleeding on probing, clinical probing depth, and clinical attachment level were measured in both groups. Microbiologic examination for identification of one red complex organism Porphyromonas gingivalis and one orange complex organism Fusobacterium nucleatum were done in plaque and placental blood of cases and controls. The clinical examinations and collection of placental blood were done 24 h before delivery. RESULTS: Periodontal condition in the preeclamptic women was statistically worse compared with the normotensive women. There was no statistically significant association between microorganisms in plaque and placental blood between normotensive control and preeclamptic pregnant women. The preeclamptic women had significantly higher chances of having newborns weighing <2.5 kg than the normotensive women. CONCLUSION: The preeclamptic women were associated with significantly higher periodontitis and lower fetal birth weight than normotensive women.

Point of Care- A Novel Approach to Periodontal Diagnosis-A Review.

Periodontal disease, one of the prevalent oral diseases, is characterized by gingival inflammation and periodontal tissue destruction. Diagnosing this disease is challenging to the clinicians as the disease process is discontinuous and shows periods of exacerbation and remission. Traditional diagnostic methods basically tells about the past tissue destruction so new diagnostic methods are required which is able to detect the active state of the disease, determine the future progression and also estimates the response to the therapy, thereby helping in the better clinical management of the patient. Both saliva and Gingival crevicular fluid (GCF) are believed to be reliable medium to detect the biomarkers which plays a pivotal role in measuring the disease activity. Keeping these observations in mind rapid chairside tests are developed to diagnose periodontal disease called as Point of Care (POC) diagnostics which simplifies diagnosis and helps in improving the prognosis. This review article highlights about the biomarkers used in the diagnosis and throws light on the various available point of care diagnostic devices.

Hookah addiction among adolescents of five major cities in Central India.

INTRODUCTION: Hookah use among the Indian adolescents is on the rise without them being aware of its tobacco content. This prevalence study highlights the issues associated with hookah use among high school students of five cities of Central India. METHODS: A study among 3500 students of high schools was undertaken to estimate the prevalence of hookah users and its associated factors including initiation/cessation, patterns, perceptions and behavior. Responses were received from 225 hookah users. RESULTS: The prevalence of hookah users in the present study was found to be 6.4% (225). Most of the subjects first learned about hookah use from friends (64.5%) and smoked hookah in hookah lounges (90.7%). Generally, the adolescents were aware of various lounges in their locality. CONCLUSION: This study suggests that the use of hookahs is attracting adolescents at a very early age and is attributed to the presence of hookah lounges in various cities of Central India. Hence, the legality of hookah lounges in India should be reconsidered.

The effect of xylitol on dental caries and oral flora.

Dental caries, the most chronic disease affecting mankind, has been in the limelight with regard to its prevention and treatment. Professional clinical management of caries has been very successful in cases of different severities of disease manifestations. However, tertiary management of this disease has been gaining attention, with numerous methods and agents emerging on a daily basis. Higher intake of nutritive sweeteners can result in higher energy intake and lower diet quality and thereby predispose an individual to conditions like obesity, cardiovascular disorders, and type 2 diabetes mellitus. Non-nutritive sweeteners have gained popularity as they are sweeter and are required in substantially lesser quantities. Xylitol, a five-carbon sugar polyol, has been found to be promising in reducing dental caries disease and also reversing the process of early caries. This paper throws light on the role and effects of various forms of xylitol on dental caries and oral hygiene status of an individual.

External manifestations of Gardner's syndrome as the presenting clinical entity.

Gardner's syndrome is an autosomal dominant disease characterised by the presence of colonic polyposis, osteomas and a multitude of soft tissue tumours. Pathological features such as osteomas of the mandible, skull and facial skeleton are unaesthetic as well as incapacitating. We present the case of a 22-year-old man with pain and discharge from the left eye and a firm swelling in the left infraorbital region leading to proptosis of the left eye. A detailed examination of the patient led to the presence of a large osteoma in the left orbital region, multiple cystic lesion, corneal opacity and parapapillary atrophy in the left eye. Radiography revealed the presence of multiple unerupted supernumerary teeth and osteomas. Colonoscopic findings showed the presence of multiple polyps. Thus, external manifestations of the patient's facial region led to the establishment of the diagnosis of Gardner's syndrome. The importance of our case highlights the necessity of maintaining a high vigilance with regard to the occurrence of such an entity.

Gingival squamous cell carcinoma presenting as periodontal lesion in the mandibular posterior region.

Gingival squamous cell carcinoma (GSCC) is a relatively rare malignant neoplasm of the oral cavity. It represents less than 10% of diagnosed intraoral carcinoma. Because of its close proximity to the teeth and periodontium, the tumour can mimic tooth-related benign inflammatory conditions. This case report describes a patient diagnosed with GSCC presenting as localised periodontitis.

Management of sublingual ulceration in a 12-month-old child.

The case of sublingual ulceration associated with erupted primary mandibular incisors in a 1-year-old child is presented. Sublingual ulceration is termed as Riga-Fede disease if the patient is less than 2 years old. Generally, the treatment methods for Riga-Fede's disease are discing and extraction of the traumatised teeth. Here, the child was treated with photo-polymerised composite resin coverage of the incisal edges of erupted mandibular incisors. The photo-polymerised resin coverage proved to help in the rapid healing of the ulcerations.

'Mend the bend': a report of two cases of labial dilacerated and palatal dilacerated crown.

Dilaceration is the result of a developmental anomaly in which there has been an abrupt change in the axial inclination between the crown and the root of a tooth. Crown dilaceration of permanent tooth occurs due to the non-axial displacement of the already formed hard tissue portion of the developing crown at an angle to their longitudinal axis due to trauma to the primary predecessors. Thus endo-aesthetic management of such teeth helps in maintaining morphology as well as aesthetics in a growing child. This article depicts two cases of severely dilacerated crown.

Spindle cell lipoma.

Spindle cell lipomas (SCLs) are a group of benign lipogenic tumours, typically arising in the posterior neck, upper back and shoulder of elderly male patients. Approximately 80% of these tumours arise in characteristic location, but 20% arise in unusual locations, thereby making these cases more difficult to diagnose. We present a case of SCL occurring in the right periorbital region of a 14-year-old boy. The MRI was suggestive of possible malignancy. Diagnosis of neurofibroma was made on incisional biopsy. However, the histopathological and immunohistochemical analyses of the excised lesion confirmed the diagnosis of SCL.

Oral lichen planus in a young Indian child.

Lichen planus (LP) is one of the most distinct mucocutaneous diseases. It is common with the middle aged and elderly population but has rarely been described in children. Incidences of oral LP in children is most commonly reported amongst Asians. We present a 10-year-old Indian girl with the documented clinical aspects and histopathological studies.

Simplified design and precautionary measures in fabrication of a feeding obturator for a newborn with cleft lip and palate.

The immediate problem to be addressed in a new born with cleft lip and palate is the interference of feeding. Here we present a case of cleft lip and palate for which a feeding obturator was made to facilitate feeding till the defect could be surgically repaired. The design was modified by placing orthodontic wire on the acrylic plate for attaching the ties of mouth mask. Different precautionary measures undertaken while making impression for infant have also been described. Feeding appliance improved the sucking ability of the infant. The attachment of mouth-mask ties help in easy retrieval of the obturator intraorally in case of airway obstruction.

Fixed functional space maintainer: novel aesthetic approach for missing maxillary primary anterior teeth.

The first-line treatment of non-restorable traumatically injured or carious deciduous teeth is extraction which may be a curse for the future dentition as well as social activity of a child. Various therapeutic modalities from removable partial dentures to fixed space maintainer can be used for replacement of such lost teeth. Two types of fixed aesthetic space maintainers for replacing premature loss of maxillary deciduous incisors in 4-year-old children are discussed.

Management of an infant having natal teeth.

Eruption of teeth at or immediately after birth is a relatively rare phenomenon. These teeth are known as 'natal' teeth if present at birth and 'neonatal' teeth if they erupt during the first 30 days of life. Natal teeth might resemble normal primary dentition in size and shape; however, the teeth are often smaller, conical and yellowish and have hypoplastic enamel and dentin with poor or absent root formation. Complications include difficulty and discomfort during suckling, sublingual ulceration, laceration of the mother's breasts and aspiration of the teeth. These situations would warrant extraction. If the tooth does not interfere with breast feeding and is otherwise asymptomatic, no treatment is necessary. Negative cultural attitudes towards natal teeth demand good parental counselling and vigilant management in relation to child protection. Both general practice dentists and paediatric dental specialists may be involved in the supervision or treatment of patients with natal and neonatal teeth.

Primary intraosseous squamous cell carcinoma: a devil in disguise.

Primary intraosseous squamous cell carcinoma (PIOSCC) is a rare central jaw carcinoma derived from odontogenic epithelial remnants. When the tumour arises in an existing cyst, it may be difficult to recognise early PIOSCC and carry out necessary treatment. We report a case diagnosed in a 50-year-old man where timely intervention was delayed and prognosis was affected and the case diagnosed eventually by comprehensive clinical, radiological and histopathological examination.

Restoration of fractured anterior permanent teeth using reference guide technique.

The most common consequence of traumatic dental injury is uncomplicated crown fracture. The main techniques for reconstructing fractured teeth include the use of direct adhesive restorative materials. However, this type of treatment is time consuming and requires a skilled operator. An alternative to the direct restorative technique is the use of a reference guide. The advantage is that the restorative procedure can be carried out in two short clinical sessions with a drastic reduction in chair time. The size, shape and inclination of the teeth are determined in advance, which reduces the need for eventual adjustments. In addition, the use of a reference guide makes it possible for two or more teeth to be restored simultaneously; in contrast, with the conventional technique. This paper offers a step-by-step description, of a reference guide technique for restoration of permanent maxillary incisors fractured through trauma.