Efficacy of sucrose application in minimizing pain perception related to dental injection in children aged 3 to 9 years: a randomized control trial.

Background: Dental fear and anxiety are significant challenges in managing behavior in children. Oral administration of sucrose or sweet-tasting solutions has shown effectiveness in reducing procedural pain in infants and neonates. This study aimed to investigate whether pre-application of sucrose solution had an effect on minimizing pain perception during injection and to assess the potential impact of the child's age and sweet preference. Methods: A randomized control clinical trial was conducted on 60 children aged 3-9 years requiring buccal infiltration injections. Following parental consent, demographic data of the children were recorded. Sweet preferences was assessed using a modified forced-choice test. Children were equally and randomly allocated into study (sucrose) and control groups using a lottery method. Sucrose solution or distilled water, respectively, was applied to the lateral surface of the tongue for 2 min. Topical anesthetic was applied at the site of injection, followed by local anesthesia administration. The children rinsed their mouths thrice with water immediately after anesthetic injection. A video was recorded during injection which was then scored by three blinded examiners on the Sound Eye Motor (SEM) scale. The children also self-evaluated using Wong-Baker Faces Pain Rating Scale (WBFPS). Results: The mean SEM scores and WBFPS scores were analyzed using the Kruskall-Wallis test. The mean SEM score in the study group was 1.37 ± 0.61, compared to 3.17 ± 0.87 in the control group, showing a statistically significant difference (P < 0.001). Mean pain scores assessed by WBFPS in the study group were 0.60 ± 1.4, while in the control group, they were 6.27 ± 2.33, also showing a statistically significant difference (P < 0.001). Children with a sweet preference demonstrated a subjective reduction in pain perception. Conclusion: Application of sucrose before dental injections in children helps to minimize pain upon injection across all age groups.

Air-Abrasion in Dentistry: A Short Review of the Materials and Performance Parameters.

The selection of abrasive material and parameters of the Air-Abrasion device for a particular application is a crucial detail. However, there are no standard recommendations or manuals for choosing these details; the operator must depend on his experience and knowledge of the procedure to select the best possible material and set of parameters. This short review attempts to identify some of the effects that the selection of material and parameters could have on the performance of the Air-Abrasion procedure for a particular application. The material and parameter data are collected from various studies and categorized according to the most popular materials in use right now. These studies are then analyzed to arrive at some inferences on the performance of Air-Abrasion materials and parameters. This review arrives at a few conclusions on the effectiveness of a material and parameter set, and that there is potential for developments in the area of standardizing parameter selection; also, there is scope for further studies on Bio-Active Glass as an alternative to the materials currently used in Air-Abrasion.

Pediatric Mesenchymal Hamartoma of Liver: A Case Report with Histomorphological Differential Diagnosis and Review of Literature.

Mesenchymal hamartoma of liver (MHL) is a benign liver tumour that occurs mainly in children, especially those under 2 years old. The pathogenesis of this tumor is still unknown. It is believed that MHL is derived from the Ito cells and either a developmental malformation of primitive hepatic mesenchyme; result of toxic or ischemic insult; or a true neoplasm. It is amenable to treatment and has a good prognosis but presents with varied clinical, imaging and histological findings. However, it can be confused with other hepatic tumors and can mimic malignancy. Therefore, it is important to recognize this rare entity to avoid unnecessary over management. We present a case of MHL in a 3-year-old boy with abdominal distension. Based on the clinical presentation, laboratory and radiological findings a diagnosis of complex cyst of liver was made. A final diagnosis of MHL was given after histopathological examination.

Orthodontic bond strength with the use of non-aerosol producing bonding primers in lieu of conventional primers: An in vitro evaluation.

OBJECTIVE: To evaluate the efficacy of non-aerosol producing restorative self-etching primers (SEPs) as a substitute for conventional orthodontic bonding primers and to analyze the extent of residual composite on the tooth post-debonding. MATERIALS AND METHODS: Eighty-four extracted human premolars were randomly divided into seven groups based on the adhesive and the bonding protocol used. The study comprised Prime and Bond one select (Dentsply), G-Premio Bond (GC), which were each divided into three subgroups based on the method used for moisture control and the control group (Transbond XT conventional total etch). The three methods for moisture control in study groups were: without drying, air-drying with the use of a three-way syringe, and with the use of blotting paper. Shear bond strength (SBS) was tested using a universal testing machine (UTM), and after debonding, the enamel surface of each tooth was examined under 10× magnification to evaluate adhesive remaining index (ARI) scores. RESULTS: Groups 2A (Prime and Bond; without drying) & 1 (Transbond XT) had the lowest and highest SBS values, respectively (P = 0.001). Comparison of ARI between the control group and group 2b (Prime and Bond; air-drying with 3 in 1) showed a significant difference (P = 0.041). Comparison of ARI between control group and group 2c (Prime and Bond; blotting paper) showed a significant difference (P = 0.017). Rest all other comparisons were non-significant. CONCLUSIONS: Transbond XT had SBS values higher than the self-etch groups. Among the self-etch groups, G-Premio Bond had higher SBS values when the traditional methods of air-drying were followed. Use of blotting paper for drying that produced variable SBS values can be an effective alternative method. G-Premio Bond with its adequate bond strength under manufacturer's instruction seems promising in this regard.

An in vitro Investigation of the Sealing Ability of Biodentine and Mineral Trioxide Aggregate as Retrofilling Materials after the use of Various Irrigating Solutions.

Aim: The purpose of this study was to assess the sealing ability of Biodentine (BD) and mineral trioxide aggregate (MTA) as retrograde filling materials after irrigation with 17% ethylenediaminetetraacetic acid (EDTA) and QMix irrigating solutions. Materials and Methods: Decoronation of 48 permanent maxillary central incisors was done. Root canal instrumentation was carried out in the samples. The apical root was resected for about 3 mm and retrocavities were prepared. Teeth were allocated into two groups (n = 24). MTA was used in Group 1. BD was used in Group 2. Depending on irrigation, the groups were subdivided A, B, and C subgroups. Group A - 0.9% saline; Group B - 17% EDTA; and Group C - QMix were used. The resected root end was irrigated with 5 ml of all irrigating solutions for 1 min. After final irrigation, cavities were filled with retrofilling materials in each group. Nail enamel was applied to the surfaces of the roots apart from the resected end. Roots were placed in India ink for 72 h. Teeth were sectioned longitudinally and microleakage was determined with a stereomicroscope. Statistical Analysis: Analysis was done using the one-way analysis of variance, Independent t-test, and post hoc test. Results: Statistically significant difference in the degree of microleakage was observed between irrigating solutions and the retrofilling materials. Conclusion: BD exhibits a better sealing ability compared to MTA as a retro filling material following QMix irrigation.

Cystic Ovarian Mucinous Carcinoma With Carcinosarcomatous Mural Nodules: An Uncommon Entity.

Mural nodules in ovarian mucinous cystic tumors are uncommon, with only 80 cases reported over the last 30 yr. The literature describes only 5 cases of carcinosarcomatous mural nodules with mucinous ovarian neoplasm. We compared and summarized the literature related to mural nodules in mucinous ovarian tumors to elaborate on the clinical and histomorphologic features. A 21-yr-old woman presented with 2 mo history of abdominal distension. Physical examination showed a palpable pelvic mass. Radiologic investigation showed a 31×18.6×25 cm large right ovarian cyst. Few nodular solid masses were also seen, the largest mass measured 3.5×3.1 cm. On histomorphology and immunohistochemistry, it was a mucinous ovarian carcinoma with carcinosarcomatous mural nodules. Carcinosarcomatous mural nodules with ovarian mucinous neoplasm affects younger females. It presents at an early stage and does not carry an adverse prognosis.

Effect of antimicrobial agents on the oral microflora in patients undergoing fixed orthodontic therapy-An ex vivo comparative analysis.

AIM: To evaluate and compare the efficacy of Ozonated Olive Oil Gel, Chlorhexidine gel, and Amflor (Fluoridated) mouthwash on reducing the count of Streptococcus mutans and Lactobacillus in patients undergoing fixed orthodontic therapy evaluated at different time intervals. METHODS: Sixty patients undergoing orthodontic treatment were randomly divided into three groups (n = 20) based on antimicrobial agents used (Group 1: Ozonated olive oil gel; Group 2: Chlorhexidine gel; Group 3: Fluoridated mouthwash). Elastomeric modules from brackets were collected at T0 (Fresh samples) and T1 (2nd week) and T2 (4th week) for assessment of the microbial growth. These collected modules were cultured and evaluated for the presence of Streptococcus Mutans and Lactobacilli and numbers of colonies were counted at each interval. Data obtained was subjected to statistical analysis using SPSS software (Version 20.0). Level of significance was kept at 5%. Intra-group and inter-group comparison between pretreatment, 2nd week and 4th week was done for each group using Wilcoxon signed rank test and Mann-Whitney U test. RESULTS: There was presence of Streptococcus Mutans and Lactobacilli during orthodontic treatment which progressively increased from To to T1 and then declined from T1 to T2. The colony counts were maximum for Fluoridated mouthwash and least for Chlorhexidine and the results were statistically significant (P < 0.05). CONCLUSION: All three antimicrobial agents used were effective against Streptococcus mutans and Lactobacillus. Chlorhexidine proved to be more efficacious whereas Fluoridated mouthwash proved to be least effective against both Streptococcus mutans and Lactobacillus bacteria.

Comparison of two different initial archwires for tooth alignment during fixed orthodontic treatment-A randomized clinical trial.

OBJECTIVES: The aim of the study was to clinically evaluate and compare 0.016-inch superelastic nickel-titanium (NiTi) and 0.016-inch heat-activated nickel-titanium (NiTi) archwires in terms of alignment efficiency, root resorption, and pain intensity. METHOD: A total of 20 patients requiring fixed orthodontic treatment, having Little's irregularity index of 5-8, and requiring first premolar extractions were recruited. They were randomly allocated to receive two different archwires (0.016-inch superelastic NiTi or 0.016-inch thermoelastic NiTi). Good-quality impressions were taken of the lower arch before archwire placement (T0) and at every month after that till the alignment was complete. The rate of tooth alignment was measured on casts by determining Little's irregularity index. The pain experienced by the patient was assessed 24 hours and 1 week after the placement of the archwire on a visual analogue scale. Cone beam computed tomographic radiographs of lower anterior teeth were taken before and after alignment to assess root resorption. Data obtained were subjected to statistical analysis using the SPSS software (version 20.0). The level of significance was kept at 5%. RESULTS: The repeated measures ANOVA indicated that there was no significant difference in the aligning efficiency of superelastic and heat-activated NiTi wires. (p = 0.45). The Mann Whitney U test showed that superelastic NiTi wires had statistically significant higher VAS scores than heat-activated NiTi at 24 hours and 1-week interval (p < 0.05). Student's t-test indicated greater root resorption with superelastic NiTi but the difference was not statistically significant. CONCLUSION: Both the wires showed similar aligning efficiency and resulting root resorption. Superelastic NiTi was observed to produce more pain compared to heat-activated NiTi in the aligning phase.

Primary Versus Secondary NAFLD: Perspective on Advanced Fibrosis.

BACKGROUND: The presence of macrovesicular steatosis on liver biopsy is the commonest histopathological finding. Nonalcoholic fatty liver disease (NAFLD) is the presence of ≥5% macrovesicular steatosis without significant alcohol use. It is subdivided into primary and secondary NAFLD; information on their differences is limited. AIM: To determine the histopathological differences between primary and secondary NAFLD and establish whether the prevalence of advanced fibrosis varies between the two types. METHODOLOGY: Three years of retrospective study of 90 liver biopsies with ≥5% macrovesicular steatosis. Age, gender, clinical history, serum transaminase levels were noted. The biopsy was reviewed for steatosis, inflammation, and fibrosis. Differences between primary and secondary NAFLD for age, gender, AST/ALT ratio, histopathological features were determined. Descriptive statistical analysis, 2-tailed Student's t test, Chi-square test, Fisher's exact test were used, where p < 0.05 was considered significant. RESULT: Primary and secondary NAFLD were 42 (46.7%) and 48 (53.3%), respectively. Inflammation was noted in 50 (55.5%) and fibrosis in 31 (34.4%). The prevalence of advanced fibrosis was 24.4%. Primary and secondary NAFLD differed significantly on ballooning degeneration, Mallory Denk bodies (MDBs), glycogenated nuclei, and fibrosis stage (p < 0.05). There were no significant differences among AST/ALT ratio, steatosis, and inflammation grade. CONCLUSION: Primary NAFLD is a more severe type of liver disease. On histopathology, ballooning degeneration, MDBs, glycogenated nuclei, and advanced fibrosis was more prevalent in primary than secondary NAFLD.

Cytomorphologic analysis of dyshormonogenetic goiter.

Dyshormonogenetic goiter is a rare cause for congenital hypothyroidism because of the lack of enzymes needed for the synthesis of thyroid hormones. They are usually treated with hormonal treatment. Cytomorphological features can lead to misdiagnosis of malignancy. Elaboration on the cytomorphological features of dyshormonogenetic goiter is scarce, with only four case reports in the literature. We present a case of a child with dyshormonogenetic goiter, highlighting its cytological features, and common differential diagnosis. We also compared cytomorphologic features with other cases reported in the literature.

Efficient removal of 2,6-xylidine precipitate using different agitation protocols: An in vitro field emission scanning electron microscopic study.

Background: Any solution of chemical nature when combined will result in the formation of a precipitate, which in the root canal system will interfere with the hermetic seal. In clinical practice presence of any precipitate, especially carcinogenic in nature, should be eliminated. Aim: To evaluate whether final irrigation with different agitation protocols will remove the precipitate formed following lidocaine hydrochloride and sodium hypochlorite combination at the coronal, middle, and apical-root thirds. Materials and Methods: Forty-four uniradicular teeth were standardized at 17 mm. All specimens were injected with 2% lidocaine hydrochloride and 2.5% sodium hypochlorite, followed by mechanical instrumentation using rotary files. Further, specimens were arbitrarily divided into four groups (n = 11) based on the final irrigation protocol: Group 1: No irrigation; Group 2: Manual irrigation; Group 3: Mechanical irrigation; Group 4: Ultrasonic irrigation. Samples were sectioned and Field Field Emission Scanning Electron Microscopic (FESEM) analysis of the canal wall was done at coronal, middle, and apical thirds. Results: FESEM images revealed occluded dentinal tubules with the presence of precipitate seen in all-thirds of each specimen. Conclusion: No irrigation protocol was successful in removing the precipitate formed; but when compared ultrasonic irrigation had the least precipitate seen at-coronal,-middle and apical thirds.

Papillary Endothelial Hyperplasia of Scalp with Bone Erosion: A Case Report with Review of Literature.

BACKGROUND: Papillary endothelial hyperplasia (PEH) is a reactive pseudoneoplastic proliferation of endothelial cells. They are typically well-circumscribed, indolent lesions and curable by complete excision. Description: We present a four-year-old girl with post traumatic scalp swelling, clinically considered to be a capillary hemangioma. Computed tomography revealed a 3.3 × 1.5 cm scalp mass with erosion of outer table and diploic space of the occipital calvarial bone, suggesting a vascular or soft tissue tumor. Histologically it was a PEH within a hemangioma. Literature Review: PEH presenting as a scalp swelling with bone erosion has only been reported thrice in the literature. Conclusion: Scalp PEH with skull bone defect can affect the pediatric age group. Bone erosion is not stage dependent; it can occur in the early stages.

Comparison of demineralization around orthodontic brackets cured by conventional method and transillumination technique-an in vitro evaluation.

OBJECTIVE: To compare demineralization around orthodontic brackets cured by conventional method and transillumination method. MATERIALS AND METHOD: Sixty freshly extracted human premolar teeth were divided into four groups. Group 1: Brackets bonded with conventional method of bonding by curing labially for 40 sec. Group 2: Brackets bonded with transillumination method of bonding for 50 sec. Group 3: Brackets bonded with conventional method of bonding by curing labially for 20 sec followed by 30 sec of transillumination. Group 4: Brackets bonded with transillumination method of bonding for 30 sec followed by labial curing for 20 sec. Ground sections were prepared of each tooth and microleakage was evaluated using a binocular microscope at 40× magnification (Olympus BX53) and an image was taken using a digital camera (Olympus EPL3) connected to the microscope. The images were analyzed using Magnus Pro Image software. Scores were assigned to different degrees of microleakage at the demineralization zone around enamel-adhesive-bracket complex at the occlusal, middle, and gingival margins using linear measurement tool. Data obtained was subjected to statistical analysis using SPSS software (Version 20.0). Level of significance was kept at 5%. Intragroup comparison was done using Kruskal-Wallis test followed by Mann-Whitney U-tests for pairwise comparison. RESULTS: Group 4 showed least mean demineralization in occlusal, middle, and cervical areas as compared to other groups and the results were statistically significant (P < 0.05). CONCLUSION: Transillumination can be employed as a method synergistically with conventional curing to achieve minimum amount of demineralization during fixed orthodontic treatment.

Detection of Dentinal Microcracks in Radicular Dentin after Shaping with XP-endo Shaper, Neoendo Flex Files, and Hero Shaper Using Scanning Electron Microscope: An In Vitro Study.

The study aimed to compare the extent of dentinal microcracks in the radicular dentin using hand K files and various types of rotary nickel-titanium (NiTi) file systems. Forty mandibular incisor teeth (human) were grouped for the study. The root apices were closed, and the canals were straight (<5°). The samples were divided into four groups (n = 10). Group 1-Hand K file system (SybronEndo, SA), Group 2-XP-endo Shaper (FKG Dentaire, La Chaux-de-Fonds, Switzerland), Groups 3-Neoendoflex file (Neoendo, Orikam, India), and Group 4-Hero Shaper files (Micro-Mega, Becacon, France). Sectioning was done at 3, 6, and 9 mm from the apex, perpendicular to the long axis using a diamond disc under water coolant. The cut samples were then observed through a scanning electron microscope at ×50 enlargement. The control group showed no microcracks except one sample in the coronal third, which was less significant. The difference in the amount of crack detected on comparing the different groups was significant. In the experimental groups, XP-endo Shaper group showed significantly less number of cracks than the Neoendo flex, and Hero Shaper groups. Within the limitations of this study, all the system, except hand K files, produced remarkable dentinal microcracks. Least cracks were seen in canals instrumented with XP-endo Shaper. It can also be noted that single file system causes less number of microcracks.

The Effect of Root End Cavity Preparation Using Er,Cr:YSGG Laser, Ultrasonic Retrotip, and Bur on the Apical Microleakage of Retrograde Cavity Filled with MTA Plus.

AIM: The sealing ability of the retrograde material is greatly affected by the technique used for root end preparation. Advances in retrograde preparation techniques such as lasers has shown to provide an efficient outcome. The study was to evaluate and compare the effect of various techniques of retrograde cavity preparation on apical microleakage. MATERIALS AND METHODS: Forty-five single rooted teeth were decoronated. Biomechanical preparation was carried out up to size F2 ProTaper system and obturated. Glass-ionomer cement was used as an access restorative material. The apical root resection was done at 3 mm from the apex at angulation of 90° to the long axis of the root. The allocation of the samples was done into three groups of 15 each. Group A: Retrograde cavities prepared using conventional round bur; Group B: Retrograde cavities prepared using ultrasonic retro preparation diamond tip; and Group C: Retrograde cavities prepared using "Erbium, chromium: yttrium, scandium, gallium, garnet" (Er,Cr:YSGG). The retrograde cavities hence prepared were filled with MTA Plus. Nail varnish was used to coat the samples except at the apical end. Samples were immersed in methylene blue for 24h. Stereomicroscope was used for examination of the sectioned teeth. The data were analyzed using one-way analysis of variance (ANOVA) and post hoc Tukey test. RESULTS: Results showed very highly significant difference between laser and bur (P value = 0.001). CONCLUSION: Retrograde preparation with Er,Cr:YSGG showed significantly less microleakage when compared to the use of ultrasonic retrotip and burs.

Intriguing case of giant intra-abdominal pseudocyst: Diagnostic dilemma.

We present a case of a giant intra-abdominal pseudocyst in a 24-year-old male as a complication of ventriculoperitoneal (VP) shunt. Ultrasonography and computed tomography abdomen detected a 20 × cm 14.5× cm 9 cm thin-walled cystic lesion with few septae occupying a large space in the left side of the abdomen with a VP shunt tip within it. Histopathological findings suggested a pseudocyst. However, multiple epithelioid cell granulomas on cyst wall resulted in a diagffignostic dilemma.

Great mimickers: Tumor-like lesions of uterine corpus.

OBJECTIVE: The objective of the study was to evaluate the relative occurrence of uterine corpus tumor-like lesions and to establish a clinicopathological correlation. METHODS: A 5-year study was conducted on histopathologically diagnosed cases of tumor-like lesions of the uterine corpus. The lesions were classified according to the recent World Health Organization classification. Relevant clinical findings and histomorphologic details were noted and analyzed. RESULTS: A total of 85 cases of tumor-like lesions were included in the study. Multiparous women (88.2%) were most commonly affected and endometrial polyp (89.4%) was the most common lesion. Endometrial polyp showed a definite predilection during the 3rd and 4th decades of life (56.6%) whereas Arias-Stella reaction was seen in pregnant women and squamous metaplasia was seen in peri and postmenopausal women. Patients with endometrial polyp presented mostly with heavy menstrual bleeding (HMB) (32%) and Arias-Stella reaction with HMB. Two cases of squamous metaplasia one presented with HMB and pain in the abdomen. Most of the endometrial polyps were single (90.8%) and sessile (68.4%), hyperplastic type (56.6%) and the adjacent endometrium were mostly atrophic (42.1%) or in proliferative phase (34.2%). The mean age in years of premenopausal women was 39.34 ± 5.01 and postmenopausal women were 62.66 ± 7.26. The mean size of the polyp, parity, number of polyps and association with leiomyoma was not significantly different between premenopausal and postmenopausal women. Adenomyosis was seen in 11 cases of the endometrial polyp. CONCLUSIONS: Although tumor-like lesions of the uterine corpus as the name suggests tend to mimic the tumors, certain clinical and histopathological features can help in making the accurate diagnosis and thus avoid unnecessary radical surgeries.

Clinicopathological Study of 117 Body Fluids: Comparison of Conventional Smear and Cell Block Technique.

BACKGROUND: Cell block method (CB) has emerged as an invaluable tool for diagnosis of effusions. It can help overcome the problems faced by conventional smear (CS) by differentiating between reactive, inflammatory and malignant cells. The aim of the study is to compare and correlate the CB diagnosis with the CS findings of various pathological conditions including malignancy. MATERIALS AND METHODS: Two years prospective cross-sectional study of 117 fluids received for routine examination and/or for cytology was conducted. CS as well as CB was simultaneously prepared from the fluid and the results were correlated and tabulated for statistical analysis. RESULTS: Mean age of presentation was 43±21.1 years and male: female ratio was 1.3:1. Ascitic fluid (46.2%) was the most common followed by pleural (40.2%). Among malignancies, primary ovarian and lung carcinoma were the most common to present with malignant ascites (33.3%) and pleural effusion (66.7%) respectively. Six suspicious for malignancy on CS were provided a definitive diagnosis of malignancy on CB. Overall, CB increased the yield of malignancy by 8.3%. The agreement between CB and CS for malignant effusions and suspicious for malignancy were 41.7% and 14.3% respectively. Sensitivity of CS method when compared to CB, for malignant peritoneal and pleural effusions was 90% and 75% respectively while the specificity was 68% and 79% respectively. CONCLUSION: CB has a better diagnostic yield of malignancy and helps in providing a definitive diagnosis for cases that are suspicious for malignancy on CS. Hence, CB should be routinely employed along with CS for all effusions.

Antibiotic Prescription Practices for Surgical Prophylaxis in India: An Observational Study.

Perioperative prophylactic antibiotics following surgeries have been shown to reduce surgical site infections, and their administration is common practice. Despite clear guidelines regarding this being set forth by the Infectious Disease Society of America (IDSA), adherence to them is yet to translate to common practice in many parts of the world. A retrospective chart review of 409 patients who underwent elective surgeries over a period of 7 months at three different hospitals in India was performed. In-hospital antibiotic prescriptions of these patients were examined for any apparent inappropriateness (use of antibiotics with coverage broader than the target microbes and use of antibiotics with overlapping spectrum of target microbes). Four hundred ninety-five (48.9%) of the 1,012 patient intensive care unit (ICU) days had apparent inappropriateness in the choice of their prophylactic antibiotics and only 3.2% of the antibiotic units used were in accordance with the present IDSA guidelines. Injudicious use of broad-spectrum antibiotics for surgical prophylaxis is prevalent in low- and middle-income countries such as India. This poses the risk of emergence of resistant microorganisms in these areas and their potential spread across the borders. There is an acute need for diligent antibiotic stewardship programs in these areas to curb such practices.