Role of Hypnosis in Dental Treatment: A Narrative Review.

AIM: This narrative aims to outline the use of hypnosis in managing dental anxiety in during dental treatment. The PICO used to answer the objectives are (P) dental patients, (I) hypnosis, (C) conventional behaviour management techniques & (O) reduced pain/anxiety. MATERIALS AND METHODS: An electronic search of three databases; PubMed, Scopus and EBSCOhost was conducted using the keywords "hypnosis or hypnotherapy" AND "dentistry or dental" between the year 2000 and 2020. A total of 19 studies were selected based on eligibility. Data extracted were study subject, design of study, parameters used to assess, type of hypnosis script used and the study outcome. RESULTS: The studies show that hypnosis is effective in pain management and dental anxiety. It can also be used for improving compliance in patients who are wearing orthodontic appliances (Trakyali et al, 2008) and reducing salivary flow during dental treatment (Satlz et al, 2014). CONCLUSION: Hypnosis has the potential to be a useful tool in the management of children and adults.

Preventive orthodontic approach for functional mandibular shift in early mixed dentition: A case report.

The case reported here highlights the importance of examination of functional occlusion along with static occlusion. Any undetected malocclusion during early mixed dentition has potency to alter the growth and function of stomatognathic system. Premature contacts in primary canine region is the most prevalent cause of functional mandibular shift and can lead to TMJ problems for the prevalence of self correction of such malocclusion is very low if not intervened. A case of functional mandibular shift due to faulty canine guidance because of premature contacts is discussed here. Selective grinding of premature contacts and myofunctional exercise resulted in well balanced centric occlusion coinciding with centric relation.

Polymorphism in emergence of deciduous dentition: A cross-sectional study of Indian children.

AIM: The aim of the present study was to evaluate the timing and sequence of the eruption of deciduous teeth in Indian children. METHOD: This cross-sectional study focused on children aged 5-36 months. One hospital was randomly selected from four geographic zones of the city. A total of 400 children from each hospital, fulfilling the inclusion criteria, constituted the sample. The examination was carried out by a single, trained examiner. The tooth was recorded as "present" or "absent" on the day of examination. The mean age of emergence was calculated using a probit model. Independent sample t-test was used to assess the statistical significance of differences in the mean age of tooth emergence. RESULTS: The deciduous mandibular central incisor was the first tooth to erupt in the oral cavity (8.15±1.69 months). Girls showed delayed eruption compared to boys; however, no interarch variation was observed in the mean age of tooth eruption. There was also no difference in the sequence of eruption of deciduous teeth, as reported in other studies. CONCLUSIONS: The present study establishes a chronological table for the eruption of deciduous teeth in Indian children. There was delayed eruption of deciduous teeth when compared to the reference ranges of Western populations.

Relationship of salivary CD14 concentration with dental caries in young children.

BACKGROUND: Dental caries is a chronic disease among children and there is need for studies assessing the caries risk factors using saliva. This study aimed to evaluate the association of salivary soluble CD14 and dental caries in young children. MATERIAL AND METHODS: A cross-sectional study was done among 300, 3-6 year old school children of Udupi district. A total of 40 children who were caries free, with no past systemic illness or craniofacial anomalies and 40 children with dental caries with no history of dental treatment for caries, with no past systemic illness or craniofacial anomalies were included in control and test groups respectively. Salivary CD14 was evaluated using ELISA test. RESULTS: The mean salivary soluble CD14 concentration was significantly higher in caries free (1.34±0.35 µg/ml) children than caries experienced (0.54±0.36 µg/ml) (p<0.001). There was significant strong negative correlation between number of decayed teeth and soluble salivary CD14 (r = -0.868, P< 0.001) among all the children. Similarly, sub-group analysis of caries experienced children also showed significant strong negative correlation between number of decayed teeth and soluble salivary CD14 (r = -0.774, P<0.001). CONCLUSIONS: Results obtained in our study suggested that salivary CD14 can be a indicator of dental caries in young children. Key words:Caries, CD14, Children, Saliva.

Recent research trends in dentistry.

Research being an investigative process is employed to increase or revise the current knowledge. Scientific research involves the conduct of a methodical study to prove a hypothesis or give an answer to a specific question with the main aim of finding definitive answer. This paper aims to advance knowledge of research and develop interest in the postgraduate students. It also throws light on the existing and emerging research strengths within a "high-performance culture." The trends in dental research worldwide are looked at, in particular, a comparison between the publication status in two countries, namely India and Australia. The current themes in dental research are also discussed to facilitate future projects for the aspiring pediatric dentists. Stress is given to the importance of evidence-based dentistry as the current times call for high-quality and ethical papers which are devoid of plagiarism. The common reasons for failure of a research are explored and the strengthening factors are highlighted. Proper planning of a pertinent research project is beneficial to the researcher as well as the dental community.

Comparative Evaluation of Electronic Apex Locators and Radiovisiography for Working Length Determination in Primary Teeth in vivo.

AIMS: The aim of this study was to evaluate the effectiveness of two different varieties of electronic apex locators and radiovisiography (RVG) for working length determination in primary teeth. MATERIALS AND METHODS: A total of 30 primary teeth indicated for pulpectomy in children aged 3 to 8 years were randomly selected and subjected to working length determination using two varieties of electronic apex locators and RVG separately. The data were then subjected to statistical analysis. RESULTS: A very strong correlation between electronic measurement methods and RVG length was observed. CONCLUSION: Radiovisiography and apex locators are equally effective in determining working length in primary teeth. How to cite this article: Abdullah A, Singh N, Rathore MS, Tandon S, Rajkumar B. Comparative Evaluation of Electronic Apex Locators and Radiovisiography for Working Length Determination in Primary Teeth in vivo. Int J Clin Pediatr Dent 2016;9(2):118-123.

Antimicrobial Efficacy of Probiotic and Herbal Oral Rinses against Candida albicans in Children: A Randomized Clinical Trial.

BACKGROUND: A growing number of dentists are embracing the philosophy that natural agents are better for children's oral health. Knowledge of probiotics on host immune system has entered a new phase of research, and progression in this field is likely to offer novel means by modulating host immunity for prevention and treatment of a wide variety of oral diseases. AIM: To compare the antimicrobial efficacy of probiotics in reducing salivary Candida albicans counts with commonly used antimicrobial agents like 0.2% chlorhexidine and herbal rinse. MATERIALS AND METHODS: A randomized clinical trial was conducted on 60 subjects aged between 6 and 14 years, for a period of 9 months. The subjects were randomly divided into three groups comprising 20 subjects in each group. Three oral agents were administered twice daily for a maximum period of 1 week. Candida albicans counts were recorded before and after intervention and the results were submitted for statistical analysis using Statistical Package for the Social Sciences (SPSS) version 15.0 software. RESULTS: The change in mean log10 colony-forming unit (CFU)/ ml of C. albicans in groups A to C was 0.43 ± 0.72, 0.68 ± 1.05 and 0.22 ± 0.66 CFU/ml respectively. CONCLUSION: Data obtained from the study demonstrated that probiotic rinse was equally effective as 0.2% chlorhexidine digluconate rinse in reducing C. albicans counts after 1 week of intervention. Herbal oral rinse was least effective. Probiotic oral rinses have opened new horizons in improvement of oral health by maintaining healthy ecosystem. However, a longitudinal study with larger sample size needs to be undertaken to evaluate the therapeutic effects of probiotics and herbal agents. How to cite this article: Mishra R, Tandon S, Rathore M, Banerjee M. Antimicrobial Efficacy of Probiotic and Herbal Oral Rinses against Candida albicans in Children: A Randomized Clinical Trial. Int J Clin Pediatr Dent 2016;9(1):25-30.

Clinical performance of ICDAS II, radiovisiography, and alternating current impedance spectroscopy device for the detection and assessment of occlusal caries in primary molars.

OBJECTIVE: To investigate the clinical performance of International Caries Detection and Assessment System II (ICDAS II) (a ranked visual scale), radiovisiography (RVG) (a digital radiography device), and an alternating current impedance spectroscopy (ACIS) device for the detection and assessment of occlusal caries in primary teeth. MATERIALS AND METHODS: Twenty-five molars were assessed using all three systems under standardized in vivo conditions. They were then extracted and also assessed by examiners in vitro. Downer's histological scoring criterion was the validation gold standard. Sensitivity, specificity, positive and negative likelihood ratios, and area under the receiver-operator curves were calculated for enamel caries and dentine caries. Repeatability was analyzed using intraclass correlation coefficient (ICC). The performances of the systems between in vivo and in vitro settings by the same examiner were also compared. STATISTICAL ANALYSIS: SPSS version 17.0 (SPSS Inc., Chicago, IL, USA) was used to analyze the data. Comparison of the performance of all three systems for all caries and dentine caries using receiver operating characteristic curves was calculated using a range of cutoffs. Reliability was assessed using ICC method. RESULTS: ICDAS II system showed the highest validity and repeatability for assessing occlusal caries in the primary molars. RVG was less accurate than the ICDAS II for detecting caries lesions confined to enamel. However, when dentine was involved, RVG was found to be as effective as ICDAS II. CONCLUSION: Within the limitations of the study, the in vivo results of ICDAS II and RVG were satisfactory and comparable to those obtained in vitro, with ICDAS II performing better. The ACIS device was least accurate among the three systems for caries assessment.

Efficacy of Concomitant Therapy with Fluoride and Chlorhexidine Varnish on Remineralization of Incipient Lesions in Young Children.

AIM: To assess the effect of combined use of chlorhexidine and fluoride varnish on the remineralization of incipient carious lesions in young children. MATERIALS AND METHODS: Twenty caries-active children (80 lesions) were randomly divided into four groups and subjected to initial examination. Caries status was assessed visually and with the aid of DIAGNOdent. Baseline enamel biopsies were obtained. Subjects of groups I and II received fluoride and chlorhexidine varnish respectively. Group III received both fluoride and chlorhexidine varnish alternatively, for a period of 4 weeks. Group IV served as the control. At 3-month follow-up, the incipient lesions were assessed again with DIAGNOdent and enamel biopsy. RESULTS: Increased calcium, phosphate, and fluoride levels were noticed in groups I, II, III compared to group IV, at the 3-month follow-up (p < 0.001). CONCLUSION: The combined therapy with fluoride and chlorhex-idine varnish may be considered an alternative therapy for early reversal of incipient lesions. HOW TO CITE THIS ARTICLE: Naidu S, Tandon S, Nayak R, Ratnanag PV, Prajapati D, Kamath N. Efficacy of Concomitant Therapy with Fluoride and Chlorhexidine Varnish on Remineralization of Incipient Lesions in Young Children. Int J Clin Pediatr Dent 2016;9(4):296-302.

Antimicrobial and plaque inhibitory potential of herbal and probiotic oral rinses in children: a randomized clinical trial.

BACKGROUND: Antimicrobial agents serve as an effective adjunct with mechanical means in plaque control. Chlorhexidine has been the gold standard in the field of dentistry, but these days a growing number of dentists are embracing the philosophy that natural agents are better for children's oral health, and the focus is shifted toward biogenic agents for oral hygiene maintenance in children. AIM: The aim was to evaluate antimicrobial and plaque inhibitory potential of herbal and probiotic rinses against Streptococcus viridans with commonly used antimicrobial agent like 0.2% chlorhexidine digluconate. MATERIALS AND METHODS: A randomized clinical trial was conducted on 60 subjects aged between 6 and 14 years and were divided into three groups comprising 20 subjects in each group. Three oral rinses were administered twice daily for a period of 1 week. Estimation of plaque scores and S. viridans counts was done before and after intervention, and the results were statistically analyzed. RESULTS: The change in mean plaque index in Groups A, B, and C was 0.28 ± 0.16, 1.37 ± 0.43, and 0.60 ± 0.35 respectively. Furthermore, change in mean log 10 colony forming unit (CFU)/ml of S. viridans in Groups A, B, and C was 0.13 ± 0.06, 0.53 ± 0.17, and 0.22 ± 0.06 CFU/ml, respectively. CONCLUSION: Based on observations done during the course of study herbal rinse proved equally effective as 0.2% chlorhexidine digluconate in reducing S. viridans counts and plaque accumulation after 1 week of intervention, whereas probiotic rinse was least effective. However, long-term clinical trial with larger sample size needs to be undertaken, especially to evaluate beneficial effects of biogenic agents such as herbal and probiotic rinses.

Fibre reinforced composite: post and core material in a pediatric patient - an alternative to usual.

Fractured teeth are always a challenge to the dentist. The root canal therapy today can retain even very badly broken teeth. One of the most accepted techniques involve restoration of extensively carious or badly fractured teeth by the fabrication of a post and core while utilizing the root canal space for anchorage. So far, the only materials that are available to the dentist for this procedure have been a variety of metallic alloys. These materials are hard and need to be cast precisely so that they can fit the canals. Today materials are available which usually eliminates all the intermediate steps which are done in laboratories and the total control is rendered in the hands of the dentist, to fabricate on the chair, a resilient, aesthetic and bonded post and core. One such material is discussed here in a pediatric permanent anterior tooth.

Low resource screening method of pre-cancerous lesions and its reversal by Triphala in teen-age Indian population.

BACKGROUND: Cancer screening is the main weapon for early detection at a pre-invasive or premalignant stage. It has been reported that over 12 million people use some form of tobacco, which is one of the high risk factors and has hence become an alarming world-wide problem. AIM: To evaluate the effective diagnostic screening of disease in its early stage by inexpensive method and also to evaluate the effect of indigenous mouthrinse on reversal of pre-cancerous lesions. MATERIALS AND METHODS: The screening for teenagers belonging to low socio-economic status was carried out. Suspected subjects were evaluated for the reversal of the lesions by use of Ayurvedic preparation as a mouthwash. From 13 to19 years working-child population of North India was selected for the study. Screening was performed by new method-visual inspection with acetic acid. The positive subjects were further investigated by pap smear and biopsy was done as a confirmatory histopathological report. In second phase, the subjects showing positive lesions were advised indigenous anti-cancer mouth rinse and its effect was evaluated after 6 month and 9 month of prescribing the rinse. RESULTS: The total 1095 children were screened (831 boys and 264 girls). Out of total 34 teenager boys were diagnosed, as acetowhite positive lesion. All the acetowhite positive lesions were found exclusively in males. Histological findings after 9 month use of Triphala mouth rinse revealed no changes in cells in 23 (85.2%), hyperkeratinization in 2 (7.4%), hyperkeratinization and spongiosis was evident in 1 (3.7%), mild pleomorphism in 1 (3.7%) patient. Comparative evaluation from 0-9 month showed statistically highly significant test (P < 0.01). CONCLUSION: Use of different forms of tobacco and betel nut showed convincing relationship between developments of oral pre-cancerous lesions. Triphala was found to have great potential for reversal of these lesions.

Evaluation of the remineralization potential of amorphous calcium phosphate and fluoride containing pit and fissure sealants using scanning electron microscopy.

AIM: To evaluate the remineralization potential of Amorphous Calcium Phosphate (ACP) and Fluoride containing pit and Fissure Sealants using Scanning Electron Microscopy. MATERIALS AND METHODS: Thirty maxillary first premolars were divided into three groups of ten each and were randomly selected for ACP containing (Aegis- Opaque White, Bosworth Co. Ltd.), Fluoride containing (Teethmate F1 Natural Clear, Kuraray Co. Ltd.), resin based (Concise- Opaque White, 3M ESPE Co. Ltd.) pit and fissure sealant applications. The Concise group served as a control. The teeth weresubjected to the pH-cycling regimen for a period of two weeks. After two weeks, the teeth were sectioned bucco-lingually into 4mm sections and were observed under Scanning Electron Microscope at 50X, 250X, 500X, 1000X and 1500X magnifications. The qualitative changes at the tooth surface and sealant interface were examined and presence of white zone at the interface was considered positive for remineralization. RESULTS: Both ACP containing (Aegis) and Fluoride containing (Teethmate F1) group showed white zone at the tooth surface-sealant interface. The resin based group (Concise) showed regular interface between the sealant and the tooth structure, but no clear cut white zone was observed. CONCLUSION: Both, Aegis and Teethmate F1 have the potential to remineralize. Release of Amorphous Calcium Phosphate molecules in Aegis group and formation of Fluoroapetite in Teethmate F1 group, were probably responsible for the remineralization.

Chondroid choristoma: report of a rare case.

An 11-year-old girl reported with an intraoral swelling which was noticed by her mother at birth and increased to its present size during the last year A thorough clinical examination did not shed a conclusive diagnosis. This case highlights and discusses the history, clinical features, histologic features, differential diagnosis and the clinical management of this lesion. Awareness of such an entity will enrich the knowledge of the pediatric dentists who may be the first ones to encounter such cases in their day-to-day practice.

The effect of early childhood caries on the quality of life of children and their parents.

OBJECTIVE: To determine the effect the early childhood caries (ECC) has on quality of life (QOL) parameters of both children and their parents. MATERIALS AND METHODS: A cross-sectional study was carried out in the Department of Pedodontics and Preventive Dentistry, Manipal College of Dental Sciences, Manipal, India. CLINICAL SETTING: The study consisted of 500 children-parent pairs. The study was performed in Manipal and Bhubaneswar (250 children-parent pairs in each group), fulfilling the inclusion requirements of healthy children aged between 3 and 6 years old and children having ECC. The two groups were equally divided as follows: Group I - 250 child-parent pairs (Bhubaneswar) and Group II - 250 child-parent pairs (Manipal and Udupi). INTERVENTIONS: This was a questionnaire-based study and the parents and their children were provided the questionnaires with various questions on QOL parameters. Questionnaires were validated in the respective local languages. RESULTS: The data collected were analyzed using the SPSS (version 10.0) package. For assessing the internal consistency of the questionnaire, Cronbach's alfa test was used. To find the comparison between groups, Chi square test and "t" test were used. CONCLUSIONS: Oral health has a definite effect on the QOL of children. The most affected parameters by ECC were consumption of food and sleep in children, which significantly influence the parents. The questionnaire had good internal consistency in both Kannada and Oriya versions.

The effect of Triphala and Chlorhexidine mouthwash on dental plaque, gingival inflammation, and microbial growth.

The objective of this study was to ascertain the effects of a mouthwash prepared with Triphala on dental plaque, gingival inflammation, and microbial growth and compare it with commercially available Chlorhexidine mouthwash. This study was conducted after ethics committee approval and written consent from guardians (and assent from the children) were obtained. A total of 1431 students in the age group 8-12 years, belonging to classes fourth to seventh, were the subjects for this study. The Knowledge, Attitude and Practice (KAP) of the subjects was determined using a questionnaire. The students were divided into three groups namely, Group I (n = 457) using Triphala mouthwash (0.6%), Group II (n = 440) using Chlorhexidine mouthwash (0.1%) (positive control), and Group III (n = 412) using distilled water (negative control). The assessment was carried out on the basis of plaque scores, gingival scores, and the microbiological analysis (Streptococcus and lactobacilli counts). Statistical analysis for plaque and gingival scores was conducted using the paired sample t-test (for intragroup) and the Tukey's test (for intergroup conducted along with analysis of variance test). For the Streptococcus mutans and Lactobacillus counts, Wilcoxon and Mann-Whitney test were applied for intragroup and intergroup comparison, respectively. All the tests were carried out using the SPSS software. Both the Group I and Group II showed progressive decrease in plaque scores from baseline to the end of 9 months; however, for Group III increase in plaque scores from the baseline to the end of 9 months was noted. Both Group I and Group II showed similar effect on gingival health. There was inhibitory effect on microbial counts except Lactobacillus where Triphala had shown better results than Chlorhexidine. It was concluded that there was no significant difference between the Triphala and the Chlorhexidine mouthwash.

Fiber-reinforced composites as a fixed space maintainer in case of primary tooth loss.

Restorative dentistry is continually changing, with ground-breaking treatments developing based on new materials, techniques, and technologies. Composite materials are a leading example, and the introduction of fiber reinforcement has further increased the possible uses of composites in restorative dentistry. Maintaining arch length during primary, mixed, and early permanent dentition is essential for the development of occlusion. In an effort to prevent future problems, appliances may be placed to retain space resulting from early loss of teeth. In case of primary teeth loss, fixed space maintainers are being used, but these are time consuming to fabricate, and incorporated wires may lead to soft tissue trauma. This clinical case uses fiber-reinforced composite as a space maintainer, thus reducing the time required to complete treatment. In spite of best efforts of practicing dentists, there still remains a large percentage of the population who do not present for treatment, except with pain or other condition. Unfortunately some of those individuals are children, who are not in a position to make the difficult decision to visit the dentist independently. Often by the time they are examined, there is no chance of saving the involved tooth, necessitating extraction and space maintenance. To prevent closure of space and arch length deficiency, appliances may be placed to retain space. Different appliances may be used for space maintenance, such as the removable and fixed space maintainers, but they are difficult and time consuming to construct. Also, the attention span of a child patient is insufficient for this treatment protocol. Considering these difficulties, the clinician could choose the option of a space maintainer, which is less time consuming to fabricate, and for which patient acceptance is optimal.

Dental pulp stem cells from primary and permanent teeth: quality analysis.

OBJECTIVE: The objective of the study was to identify and isolate stem cells from healthy and inflamed dental pulp and characterize their differentiation potential into multiple lineages. STUDY DESIGN: Study was conducted in dental pulp tissues obtained from the children in the age range of 5-14 years. Tissue samples were collected from teeth indicated for pulp therapy and extractions for orthodontic purpose. Samples were processed in the laboratory including cell culture, isolation and differentiation into multiple lineages. The results for the analysis of various cell surface markers used for dental pulp were compared with bone marrow which is considered as a gold standard. RESULTS: There was no statistically significant difference found in the expression of various surface markers between inflamed dental pulp and bone marrow. Healthy pulp from the primary teeth was not sufficient to use as a source for harvesting stem cells moreover the healthy tissue obtained from permanent teeth failed to show any results at all. CONCLUSION: Inflamed pulp discarded during pulp therapy procedures is a potential source for harvesting adult stem cells.

Continued root-end growth and apexification using a calcium hydroxide and iodoform paste (Metapex®): three case reports.

AIM: The aim of these case reports is to present a treatment to promote root-end growth and apexification in nonvital immature permanent teeth in children. METHODS AND MATERIALS: Three cases were presented where the calcium hydroxide and iodoform paste Metapex® was placed in the root canals of immature permanent teeth using disposable plastic tips. The teeth involved were evaluated radiographically at regular intervals for the first 12 months after placement of the paste. At the end of 12 months all the cases showed continued root growth and apical closure (apexification) with no evidence of periapical pathology. Conventional endodontic treatment was then performed. RESULTS: In all three of the clinical cases presented, a combination of calcium hydroxide and iodoform paste (Metapex®) was used and showed promising results in inducing root-end growth and closure after 12 months. CONCLUSION: In these three clinical cases, the calcium hydroxide and iodoform paste Metapex® (Meta Biomed Co. Ltd., South Korea) was found to induce apical closure when assessed radiographically. Over a period of 12 months all the cases showed continued root growth. CLINICAL SIGNIFICANCE: The calcium hydroxide and iodoform paste Metapex® promoted continued root-end growth with apexification in the nonvital immature permanent teeth treated.

Effect of Triphala mouthwash on the caries status.

Nearly 60-70% of the child Indian population suffers from dental caries. Mouth rinsing is the most cost effective method of preventing dental caries. 'Triphala' has been a classic Ayurveda remedy, probably the best known among all Ayurvedic compounds. This study was conducted on 1501 students in the age group of 8-12 years with the aim of determining the effect of Triphala mouthwash on prevention of dental caries (manifest caries) as well as incipient carious lesions, and also comparing the effect of Triphala and chlorhexidine mouthwashes. The incipient caries was recorded at 3, 6, 9 months intervals and manifest caries at 9 months interval. No significant increase in the DMFS scores was found at the end of 9 months. Also, there was no significant increase in the incipient caries score towards the conclusion of the study. It was concluded that there was no significant difference between the Triphala and the chlorhexidine mouthwashes.