Addition of nisin to high-viscosity glass-ionomer cement: a comparative in vitro study on antibacterial and physical properties.

PURPOSE: Nisin is a lantibiotic effective against Gram-positive microorganisms such as Streptococcus mutans. The study aimed to determine the effect of the addition of nisin to high-viscosity glass-ionomer cement (HVGIC) on its antibacterial activity, setting time, surface microhardness, and compressive strength. METHODS: 1 and 3% w/w nisin were added to HVGIC before mixing. Unmodified HVGIC was the control. Agar disc diffusion, direct contact test, and scanning electron microscopy (SEM) analysis were used to evaluate antibacterial activity against S. mutans. Setting time, surface microhardness, and compressive strength were measured using Gilmore needle apparatus, digital microhardness tester, and universal testing machine, respectively. Statistical analysis included Student's t test, one-way ANOVA with Tamhane's post hoc test, and repeated-measures ANOVA. RESULTS: As evidenced by the agar disc diffusion (p < 0.001), direct contact tests (p = 0.025), and SEM analysis of the S. mutans cell count and cell surface area (p = 0.049 and 0.003), 3% nisin had the strongest antibacterial activity. There was a dose-dependent increase in setting time (p = 0.005) and surface microhardness (p = 0.006), with no significant difference in compressive strength compared to control. CONCLUSION: The addition of 3% nisin to HVGIC enhances the antibacterial action against S. mutans and surface microhardness without adversely affecting setting time and compressive strength.

Early Childhood Caries and Dental Care Utilization in Mangalore, India: Parents' Perceptions.

BACKGROUND: Parents often underuse dental care services for their children with early childhood caries (ECC), resulting in a high burden of untreated dental caries. AIM: To describe parental perceptions and challenges in dental care utilization for their children with ECC. DESIGN: A descriptive qualitative study was conducted with parents of children with ECC seeking dental care in Mangalore, India. Data were collected through focus group discussions using an interview guide. Manual line-by-line coding and content analysis methods were used for data analysis. RESULTS: Three categories were generated from data obtained through 5 focus groups of 27 participants: dental care visiting patterns, the significance of dental visits, and challenges to dental care utilization. Parents would only visit the dentist when they perceived their children's tooth problems. The challenges faced include time constraints, misinformation, lack of awareness and motivation, costs, fear, and anxiety of the children and the parents themselves. Parents perceived improvements in the awareness of their children's oral health and quality of life after dental visits. CONCLUSION: Attending dental services to treat their children's tooth problems was the primary way of attaining awareness about prevention among the parents of children with ECC. Increased oral health awareness and improved quality of life can motivate parents to seek further dental care for their children. Collaboration with multidisciplinary stakeholders is required to improve oral health awareness among parents of children with ECC. KNOWLEDGE TRANSFER STATEMENT: The study's results will help plan targeted preventive programs for children with ECC. The study suggests dental care utilization by children with ECC is based on parental perceptions of their children's tooth problems. It outlines the challenges that affect dental visits of children with ECC and the role of multidisciplinary stakeholders. Improved oral health awareness and quality of life following dental treatment can facilitate further dental visits.

Clinical effectiveness of alkasite versus nanofilled resin composite in the restoration of occlusal carious lesions in permanent molar teeth of children: a randomized clinical trial.

PURPOSE: To evaluate and compare the clinical effectiveness of alkasite with nanofilled resin composite restorations for occlusal caries lesions in permanent molar teeth of children, at one-year follow-up. METHODS: In this randomized controlled clinical trial with parallel design, 38 children aged 7-13 years with occlusal caries lesions on 59 first permanent molars were randomly allocated into two groups, Group 1: Filtek™ Z350XT (nanocomposite) and Group 2: Cention N® (alkasite resin composite). The restorations were evaluated at one year using the United States Public Health Service (USPHS) criteria. Data were analyzed using Chi-square or Fisher's exact test. RESULTS: All restorations had either Alpha or Bravo scores at one-year follow-up. In Group 1, all restorations scored Alpha, while one restoration each (3.6%) in Group 2 scored Bravo for fracture and marginal adaptation. All restorations in both groups scored Alpha for retention, secondary caries, and post-operative sensitivity. For anatomic form, all restorations in Group 1 scored Alpha, while three (10.7%) restorations in Group 2 had Bravo scores. For marginal discolouration, three restorations in both groups scored Bravo (11.5% and 10.7%, respectively). For surface roughness, one restoration (3.8%) in Group 1 and three restorations in Group 2 (10.7%) scored Bravo. The comparative results between the two groups for all the variables in the USPHS criteria were not statistically significantly different. CONCLUSIONS: The performances of the nanofilled composite and alkasite were clinically acceptable and comparable. Alkasite can be an alternative material for the restoration of occlusal caries lesions in permanent molars of children. CLINICAL TRIAL REGISTRATION: The clinical trial was registered at Clinical Trials Registry-India (CTRI Reg no: CTRI/2020/12/029830 Dated: 15/12/2020).

Early Feeding and Weaning Practices of Indian Children with Early Childhood Caries: A Qualitative Exploration.

OBJECTIVE: To describe the early feeding, weaning, and oral hygiene practices of children with early childhood caries (ECC), their parents' knowledge and attitudes regarding infant feeding, and the feeding-related challenges faced by the parents. METHODS: This descriptive qualitative study involved parents of children with ECC who sought dental treatment at an academic dental college in India. Data were collected though focus groups conducted with the 27 parents of children with ECC, using a focus group discussion guide. Data were analyzed using the content analysis method. RESULTS: Community norms, such as learning from the older women in the families or neighborhoods, guided the feeding method, duration of feeding, and weaning. Breastfeeding or bottle-feeding at bedtime beyond 12 mo of age and feeding sugary drinks during weaning were standard practices, despite knowing the risk for dental caries. Parents faced multiple challenges regarding weaning and were unaware of the significance of infant oral hygiene practices. CONCLUSION: In children with ECC, infant feeding practices included prolonged breastfeeding or bottle-feeding beyond the required age, feeding at bedtime, and feeding sugary drinks. Although the parents knew that these feeding habits could increase the risk for caries, they lacked the self-efficacy to translate their knowledge into action during weaning. Also, they lacked awareness regarding infant oral hygiene practices. KNOWLEDGE TRANSFER STATEMENT: The study provides information on the feeding habits of infants that can increase the risk for caries, the challenges faced by the parents of these children in altering these risky habits, and their lack of knowledge on infant oral hygiene practices. Policy/decision makers can advocate for pediatricians and pediatric dentists to incorporate anticipatory guidance or motivational interviewing techniques to tailor the preventive program for ECC for Indian children.

Comparative Evaluation of the Sealing Ability of an Alkasite Restorative Material and Resin-Modified Glass Ionomer Cement in Primary Molars: An In vivo Study.

Background: Cention N is relatively new and an "alkasite" restorative material, indicated for direct restorations. Aim: The aim of this study was to comparatively evaluate the sealing ability of Cention N and resin-modified glass ionomer cement (GIC) when used to restore primary molars. Methods and Materials: It is a split-mouth study. Twenty children having bilateral deep dentinal caries involving primary molars requiring restoration were selected. After caries excavation under the rubber dam, samples were collected from the cavity. Restorations of the teeth were done using either resin-modified GIC (RMGIC) or Cention N. Patients were recalled after 6 weeks and the restorations done previously were removed using contra angled micromotor handpiece under rubber dam isolation. The samples were collected again. The collected samples were used to estimate the total viable count. Statistical Analysis: The pretreatment, posttreatment colony counts, and the differences between the groups were analyzed using paired t-test. Results: No statistically significant difference was observed in the mean differences of the pre- and posttreatment colony count between alkasite restorative material and RMGIC (P = 0.056). Conclusion: Restorations done using alkasite restorative material and RMGIC performed equally in terms of sealing ability.

Effect of active and passive distraction techniques while administering local anaesthesia on the dental anxiety, behaviour and pain levels of children: a randomised controlled trial.

PURPOSE: The aim of the study was to compare the effect of a stress ball, an active distraction technique with audio-visual eyeglasses, a passive distraction technique during local anaesthesia administration, on dental anxiety (primary outcome), behaviour and pain levels of children (secondary outcomes). METHODS: In this randomised controlled parallel arm trial involving 123 children aged 8-12 years, who required dental treatment under inferior alveolar nerve block, children were randomly allocated into the following three groups: Group 1: Stress ball, Group 2: Audio-visual eyeglasses, Group 3: Control group (basic behaviour guidance without distraction). Dental anxiety was measured using modified child dental anxiety scale and pulse rate, behaviour was rated using Venham's scale and pain was measured by both self-reporting and observational scales. RESULTS: No significant difference between the groups was observed for dental anxiety, but a significant decrease was seen in dental anxiety scores within all groups. No significant differences were seen between the groups for behaviour ratings and pain scores. CONCLUSION: Use of active stress ball distraction or passive audio-visual eyeglasses during local anaesthesia administration decreased dental anxiety but did not result in a significant improvement in the dental anxiety, behaviour and pain levels when compared to basic behaviour guidance without distraction. CLINICAL TRIAL REGISTRATION: The clinical trial was registered at Clinical Trials Registry-India (CTRI Reg no: CTRI/2019/04/018768, Dated 24 April 2019).

Effectiveness of laser fluorescence-based device in detecting the extent of re-mineralisation in primary teeth compared to the conventional method: An In vitro study.

Background: Laser fluorescence (LF)-based clinical device DIAGNOdent™ is at present being used to detect caries. Can the same be used to detect therapeutic remineralisation of early white spot lesions? Aims: To explore the feasibility of using LF-based device in monitoring the changes following remineralisation of demineralised primary teeth. Materials and Method: The sample number for the present experimental in vitro study was 10. The LF based device readings were correlated with surface microhardness (SMH) test values to evaluate its efficiency. SMH analysis was performed using a microhardness tester (Tescol-HT1000AD). All the samples were demineralised, followed by remineralisation using fluoride varnish and pH cycling. The data was analysed using the Statistical Package for the Social Sciences (SPSS) version 17.0 (IBM SPSS®) software. Paired t-test was performed to compare laser fluorescence readings and SMH test result values at baseline, after demineralisation, and after remineralisation. Pearson's correlation was used to compare the relation between the laser fluorescence and SMH test. Results: A good negative correlation was seen between the two methods at the baseline readings even though it was not statistically significant (P = 0.069). A positive correlation between the methods existed following demineralisation which was not significant (P = 0.074). The correlation between the parameters following remineralisation showed a moderate negative correlation but was not significant (P = 0.55). Conclusion: DIAGNOdent™ values at baseline, after demineralisation, and after remineralisation was consistent with SMH values. Thus, DIAGNOdent™ can be explored to provide chairside assistance in identifying remineralisation of white spot lesions.

Comparative Evaluation of Three Obturating Techniques in Primary Molars: An in Vivo Study.

Objectives: The purpose of this study was to evaluate and compare the quality of obturation between the two tested methods for root canal filling with a newer system in primary teeth. Study design: A total of 104 canals were prepared and obturated using zinc oxide eugenol paste. The three delivery systems compared were: Rotary lentulospiral and Navitip® withNavitip® Double Sideport. Radiographs were used to evaluate the canals for length of obturation and presence of voids. Results: The data were analyzed using chi-square tests. Significant differences was seen between the three groups for the presence of voids (p value =0.042) with less voids in Navitip® Double Sideport. There were no difference between the three groups for the extent of filling (p value=0.170). Conclusion- Navitip® Double Sideport showed the better results in terms of extent of obturation and absence of voids when compared to the Rotary lentulospiral and Navitip®.

Stress-mediated quality of life outcomes in parents of disabled children: A case-control study.

BACKGROUND: The purpose of the present study was to resolve whether caregiving for a child with disability influences the physical and mental health of the caregivers and whether stress is related to the quality of life of the caregivers. METHODS: The Parental Stress Scale questionnaire for the assessment of parental stress and the Short Form-12 version 2 questionnaire for the assessment of physical and mental health quality of life were distributed among 69 parents of developmentally disabled children and 137 parents of healthy children (control group). Various sociodemographic factors were also included. RESULTS: A significant difference was seen between the two groups in terms of employment, presence of disabled sibling, smoking, and physical activity. Parents of developmentally disabled children had significantly higher stress levels and worse mental health-related quality of life. Overall physical health quality of life was similar between cases and controls. Stress had a negative correlation with both mental and physical health quality of life of the parents. CONCLUSION: Stress related to raising a child with disability negatively influences the parental quality of life. Stress management aiming at its prevention and reduction might be significant aspects of intervention for the improvement of the quality of life of the caregivers.

Surgical Management of Complex Odontoma Associated with Agenesis of a Molar.

Odontomas are mixed odontogenic tumors composed of mineralized tissue of ectomesenchymal origin. These are usually detected in routine radiographs and may have a variable etiology such as local trauma, genetic mutation, or infection. They are classified into two main types: complex and compound. Complex odontomas are rare and they rarely erupt into the oral cavity as they lack periodontal ligament. This is the report of one such case of complex odontoma where an 11-year-old girl reported with an asymptomatic swelling, in relation to the left angle of the mandible. The case report highlights the clinical and radiographic findings, investigations done to arrive at the diagnosis and the treatment rendered. This report is of clinical importance because of its rare association with the agenesis of a molar tooth.

Knowledge, attitude, and behavior of nurses toward delivery of Primary Oral Health Care in Dakshina Kannada, India.

Majority of young children in many countries do not visit dental clinics for examinations before the age of three though they frequently visit primary health care providers for routine medical check-ups. Nurses are easily accessible and are in frequent contact with waiting mothers and children for routine check-ups and this provides an opportunity to integrate oral health promotion and care into health care. The purpose of this study was thus to study the knowledge, attitude and behaviour towards oral health care among nurses. METHODS: The study was a cross-sectional questionnaire survey. Total of 170 medical nurses working in the Institutional Hospital and who provided care for paediatric patients and pregnant mothers participated in the study. STATISTICAL ANALYSIS: Chi-Square test was used to analyse the data using SPSS version 17.0 with a significance value of P < 0.05. RESULTS: All the nurses were aware that good oral health is important for overall health of the child. About 70% of the respondents had poor knowledge regarding dental caries. Good response was obtained regarding importance of oral hygiene maintenance for both the child and mother for prevention of caries. Majority of the nurses showed positive attitudes toward preventive OHC and the role of medical nurses. Routinely the nurses do not refer pregnant mothers and children for dental check up nor do they counsel them regarding oral hygiene and its importance. CONCLUSION: Appropriate training and encouragement for promotion of oral health and to provide suitable care for the prevention of dental diseases should be included in the curriculum of nurses training.

Association of level of education and utilization of restorative dental care among rural women in India: Cross-sectional study.

BACKGROUND: The utilization of restorative dental care is very scarce in rural India. Association between level of education and health of a person has been well-documented in many countries and time periods with a range of potential factors shaping the connection between both. OBJECTIVES: This cross-sectional survey was conducted to evaluate an association between the level of education (educational qualification) and utilization of restorative dental care among rural women associated with self-help groups. MATERIALS AND METHODS: A semi-structured questionnaire was administrated to 660 rural women associated with self-help group by trained research assistants. The 604 completed questionnaires were received and reviewed. The education levels were divided into three groups: Group 1 - illiterates (17.2%), Group 2 - school educated (69.4%), and Group 3 - college educated (13.4%). Chi-square test was applied to evaluate the utilization of dental services by rural women, and logistic regression was applied to evaluate the influence of their educational qualifications on utilization. RESULTS: A total of 604 properly filled questionnaires out of 660 (91.51% response rate) were included in the analysis. Only 56.9% of the sampled rural women indicated that they have visited dentists earlier. The maximum number of individuals who have never visited the dentist belonged to illiterate group (55.7%), and the association was statistically significant (0.004) when compared with educated individuals. CONCLUSION: The results of this study concluded that the level of education has a significant influence on the utilization of dental care.

Evaluation of Plaque pH Changes Following Consumption of Health Drinks by Children: A Pilot Study.

INTRODUCTION: With increased trend among people to choose a healthy diet, there is an increased consumption of health drinks by children. Thus, it is important to know their cariogenicity. AIM: To evaluate the effect of consumption of health drinks viz., Horlicks, Boost and Complan on plaque pH in children. MATERIALS AND METHODS: The study consisted of four groups: Group I (control)- 10% sucrose solution, Group II- Horlicks, Group III- Boost, Group IV- Complan. Samples of plaque from representative teeth were collected and pH was measured using an electrode outside the mouth. After baseline pH was recorded, children were given their respective drinks and were asked to consume slowly over a period of three to five minutes following swish with 20 ml of the test drink for one minute. The pH was then recorded after 10, 20, 30, 40 and 60 minutes of the post consumption period. Obtained values were subjected to one-way ANOVA test for multiple group comparison followed by Post-Hoc Tukey's test for group wise comparison. RESULTS: Twenty minutes after consumption of Complan and Boost, pH was decreased, but not to the critical pH value as in case of sucrose. The pH was found to be slightly increased, 20 minutes post Horlicks consumption. Post 60 minutes consumption of all the drinks including sucrose solution, the pH was increased in comparison to post 20 minutes. However, 60 minutes post consumption of Boost and Horlicks, pH increased above the baseline. CONCLUSION: Consumption of health drinks viz., Complan and Boost did not lower the plaque pH to the level of critical pH. Consumption of Horlicks increased the plaque pH.

Evaluation of Pulp Chamber Dimensions of Primary Molars From Bitewing Radiographs.

PURPOSE: The purpose of this study was to measure key anatomic landmarks related to pulp chamber morphology in primary maxillary and mandibular first and second molars. METHODS: Bitewing radiographs of 42 subjects were taken under standardized conditions using a millimeter X-ray grid. One hundred fifty-three primary molars (44 maxillary first molars, 49 maxillary second molars, 30 mandibular first molars, and 30 mandibular second molars) were analyzed for the required anatomic landmarks using Image J Analysis Software. The data were analyzed in terms of mean, standard deviation, and coefficient of variance for each measurement. Mean measurements were compared using one-way analysis of variance followed by Tukey's post-hoc HSD test. RESULTS: The distance between cusp tip to pulp chamber ceiling was approximately four mm, the distance between pulpal floor to furcation was approximately 1.7 mm, and the average height of the pulp chamber was observed to be in the range of two to three mm. CONCLUSION: The key measurements involved in access cavity preparation were consistent across the different types of primary molars.

Bond strength of a sealant to enamel after a cariogenic challenge using three bonding protocols: an in vitro study.

PURPOSE: The purpose of this study was to evaluate in vitro the tensile bond strength of a resin-based pit and fissure sealant to enamel after a cariogenic challenge using three bonding protocols. METHODS: The demineralized tooth specimens were assigned to three groups of equal size: Group 1 (37 percent phosphoric acid gel), Group 2 (total-etch adhesive system), and Group 3 (one-step self-etch adhesive system). After the surface treatment, a resin-based sealant was applied and cured. The specimens were thermocycled and tensile bond strength was measured using a universal testing machine by an investigator who was blinded to the group distribution. RESULTS: The mean tensile bond strength was highest with the total-etch adhesive system, which was statistically significant (P<.001). A post hoc test revealed a significant difference between Groups 1 and 2 (P<.001) and Groups 2 and 3 (P<.001), but none between Groups 1 and 3 (P=.44). CONCLUSION: The total-etch bonding system resulted in significantly higher tensile bond strength with incipient enamel caries.

Efficacy of lignocaine in gel and spray form during buccal infiltration anesthesia in children: a randomized clinical trial.

AIM: To compare the efficacy of 15% lignocaine spray and 8% lignocaine gel as a topical anesthetic, in reducing pain, during buccal infiltration in children. MATERIALS AND METHODS: Forty-two patients aged between 7 and 12 years requiring restorative procedures/extraction/pulp therapy of primary/ permanent teeth in the maxillary arch, under buccal infiltration anesthesia were selected for the study. The participants were randomly allocated into 2 groups of 21 each. In group A, 8% lignocaine gel and in group B, 15% lignocaine spray was applied prior to buccal infiltration. Pain was assessed using Wong-Baker faces pain rating scale (WBFPRS) and faces legs activity cry and consolability (FLACC) painscale. RESULTS: Pearson's chi-square test revealed that there was no significant difference in the FLACC scores of the two groups (p = 0.54). Independent t-test demonstrated that there was no significant difference in Wong-Bakers faces pain score between the two agents (p = 0.07). CONCLUSION: There is no significant difference in the efficacy of 15% lignocaine spray and 8% lignocaine gel as a topical anesthetic in controlling pain during buccal infiltration anesthesia, in children.

Child dental fear and behavior: the role of environmental factors in a hospital cohort.

INTRODUCTION: Information on the origin of dental fear and uncooperative behavior in a child patient is important for behavior management strategy. The effects of environmental factors have been comparatively less studied, especially in an Indian scenario. OBJECTIVES: To find the association of (1) age, gender, family characteristics, previous medical, and dental experiences with dental fear and behavior (2) dental fear with dental behavior. MATERIALS AND METHODS: A cross-sectional questionnaire study involving 125 children aged between 7 and 14 years undergoing dental treatment under local anesthesia. The parent completed a questionnaire on family situation, medical history, and past dental experiences of the child. Child's dental fear was recorded using Children's Fear Survey Schedule-Dental Subscale and behavior was rated using Frankl Behaviour Rating Scale. STATISTICAL ANALYSIS: Data were analyzed using chi square test and binary logistic regression analysis. RESULTS: Unpleasant experience in dental clinic and age of the child significantly influenced dental behavior. Visited pediatrician in the past one year, prior history of hospital admission, previous visit to dentist, experience at the first dental visit, and age of the child were contributing factors for dental fear. There was also significant association between dental fear levels and behavior. CONCLUSIONS: In 7 to 14 year olds, dental fear influences dental behavior, but the factors affecting them are not the same. Although dental fear decreases and dental behavior improves with age, experiences at the previous dental visits seem to influence both dental fear and behavior. Past medical experiences are likely to influence dental fear but not dental behavior.

An unusual case of non-syndromic occurrence of multiple dental anomalies.

Dental anomalies have been known to occur in humans due to a variety of genetic and environmental factors. Combinations of dental anomalies are known to be associated with specific syndromes. A few cases of multiple dental anomalies have been reported in patients with no generalized abnormalities. This case report describes an unusual occurrence of a combination of dental anomalies in an apparently normal healthy 12-year-old female patient. The dental anomalies in this patient were multiple dens invaginatus, generalized enamel hypoplasia, generalized microdontia, root resorption and multiple periapical lesions, shovel shaped incisors, cup shaped premolars, taurodontism, hypodontia and supernumerary teeth.

Management of a rare combination of dental trauma: a case report.

The occurrence of combined injury of intrusion, avulsion and lateral luxation is rare and the mechanism responsible for this is intriguing. This case report describes such a combined injury and its management. The rationale behind the treatment modalities is discussed.

Permanent molars: delayed development and eruption.

Delayed development and eruption of all the permanent molars is a rare phenomenon, which can cause disturbance in the developing occlusion. The eruption of permanent first and second molars is very important for the coordination of facial growth and for providing sufficient occlusal support for undisturbed mastication. In the case described, the first permanent molars were delayed in their development and were seen erupting at the age of nine and a half years. Severe disparity between the left and the right side of the dentition with respect to the rate of development of molars were also present.