Visual interpretation of clinical images among dental students using eye-tracking technology.

BACKGROUND: Tele-consultations are increasingly used for screening and diagnosis. Only a few studies have assessed dental students' visual attention to clinical images. AIM: To (i) determine dental students' gaze behavior, visual fixations, and diagnostic competence while viewing clinical images, and (ii) explore potential opportunities to strengthen the teaching-learning approaches. DESIGN: Tobii Pro Nano-device captured the eye-tracking data for 65 dental undergraduate students in this cross-sectional study. The predetermined areas of interest (AOI) for all five clinical photographs were uploaded onto Tobii software. All participants used a think-aloud protocol with no restrictions to view time. RESULTS: A total of 325 clinical pictures were analyzed, and the average view time was 189.25 ± 76.90 s. Most participants started at the center of the image (three frontal photos), spent a significant share of their view time on prominent findings, did not follow a systematic pattern, and exhibited diagnostic incompetence. Also, most participants followed a "Z" viewing pattern (oscillating movement from left to right) for the remaining two pictures. CONCLUSIONS: Subjects frequently fixated on the prominent AOI, however, failed to make the correct diagnosis. Their view patterns revealed no sequential viewing. Therefore, emphasizing knowledge about common dental abnormalities and focusing on full coverage of clinical pictures can improve dental students' diagnostic competence and view patterns.

Crown dimensions of primary teeth-A systematic review and meta-analysis.

Odontometrics, also known as metric traits, includes mesiodistal, buccolingual dimensions, and crown height. The purpose of this study was to assess pancontinental odontometric variations in the crown dimensions of primary teeth. Ten electronic databases were searched to identify studies that measured crown dimensions of primary teeth, published in English language, without year restriction up to July 2020. Studies included cross-sectional research measuring on casts, subjects, and on radiographs of healthy children. Meta-analysis was performed, and risk of bias was assessed using modified Newcastle-Ottawa Scale. Eighty-seven observational studies were included, with 24,634 participants (9487 males, 11,083 females; 19 studies lacked gender information). Only one study showed a low bias risk, whereas 81 and 5 studies had moderate and high risk, respectively. Sixty-five studies included for meta-analysis revealed heterogeneity in mean mesiodistal dimensions of maxillary first molars from Asia (I2 -99.7%), buccolingual measurements of mandibular first molars from Europe (I2 -99.9%), crown height of mandibular second molars from Africa and Europe (I2 -79.8%). Among mesiodistal and buccolingual dimensions, Australians have larger while Asians have smaller teeth. Pertaining to crown height, very few studies could be found in the literature. This review highlights the variations in crown dimensions of primary teeth among populations.

Glanzmann Thrombasthenia: Use of the Soft Splint with Tranexamic Acid Paste to Reduce Spontaneous Oral Bleeding.

BACKGROUND: Glanzmann thrombasthenia is a rare bleeding disorder due to defects in the glycoprotein Ilb/IIIa complex present on the platelet membrane. The most common mode of treatment for this disorder is platelet transfusion. However, scientific evidence does state that repeated transfusions could lead to auto immunization making transfusions ineffective. AIM AND OBJECTIVE: To describe the use of a novel technique of soft splint with tranexamic acid paste to stop oral bleeding in a patient with Glanzmann thrombasthenia (GT). CASE DESCRIPTION: A 7-year-old female patient with a known history of GT was referred to the pediatric department. The chief complaint of the patient revealed a history of spontaneous bleeding from the oral cavity. The patient required multiple teeth extractions due to severely carious teeth. History revealed that the patient was admitted to the hospital (casualty) three times within 1 month due to a similar complaint leading to hypovolemic shock. Several transfusion procedures were done to stop the spontaneous bleeding. To stop the intraoral bleeding without transfusions, a novel method of using a soft splint with tranexamic acid paste (500 mg tablet crushed and mixed with saline) in the area of spontaneous bleeding was employed with a successful follow-up of 7 months. CONCLUSION: Soft splint with the tranexamic acid paste can serve as an effective method of treatment for patients with spontaneous oral bleeding due to medical conditions like GT. CLINICAL RELEVANCE: This case report highlights the need for awareness among all the healthcare providers about the importance of regular dental visits. The healthcare providers also need to emphasize the same to all patients with medical conditions to avoid such life-threatening situations. HOW TO CITE THIS ARTICLE: Bhavyaa R, Vignesh KC, Muthu MS, et al. Glanzmann Thrombasthenia: Use of the Soft Splint with Tranexamic Acid Paste to Reduce Spontaneous Oral Bleeding. Int J Clin Pediatr Dent 2021;14(4):580-585.

Morphological variations and prevalence of aberrant traits of primary molars.

BACKGROUND: Morphological variations in tooth structure exhibit as metric and non-metric traits which play an important role in dental anthropology. AIM: The purpose of this study was to determine the prevalence of morphometric traits and mean crown dimensions of primary molars in children. SUBJECTS AND METHODS: This cross-sectional study was carried out in 4256 sectional dye casts of caries-free children aged 2.5-4 years from Puducherry. Two calibrated examiners graded the non-metric traits utilising the Arizona State University Dental Anthropological System classification and measured the crown dimensions in primary molars. The results are expressed in the form of numbers and percentages. RESULTS: Of the eight non-metric traits studied, metaconule (30.17%), Cusp of Carabelli (90.6%), and deflecting wrinkle (87.41%) in second primary molars, and distal trigonid crest (93.06%) and parastyle (3.48%) in first primary molars, seemed to have higher prevalence, and the overall crown dimensions were found to be smaller in comparison with those in other populations. CONCLUSION: This study highlights the prevalence of aberrant dental traits in primary molars in a population. The study describes, for the first time, the existence of these traits in first primary molars, adding anthropological significance of primary dentition in various other populations.

Prevalence of the Cusp of Carabelli: a systematic review and meta-analysis.

CONTEXT: The Cusp of Carabelli (CoC) is the most commonly occurring dental morphological trait. OBJECTIVE: To provide a pancontinental overview on the prevalence of the CoC in primary maxillary second molars and permanent maxillary molars. METHODS: An electronic search was conducted on ten databases without year restrictions up to July 2020. All cross-sectional studies published in the English language reporting prevalence estimate of CoC were included. A modified version of the Newcastle-Ottawa scale was used to assess study quality. Meta-analyses were conducted for studies that reported data using Dahlberg and ASUDAS classification across continents. RESULTS: For qualitative synthesis, 142 studies (45,327 participants) were included, of which 130 studies had moderate risk of bias. Random effects meta-analysis was performed for 41 studies. For prevalence of CoC in primary maxillary second molars, the estimate was 72% (2,829 participants). The overall percentage attained for permanent maxillary molars was 59% (16,607 participants) for first molars; 8% (2,277 participants) for second molars; and 10% (89 participants) for third molars. Subgroup analysis revealed the European continent reported the highest prevalence in permanent maxillary first and second molars. CONCLUSION: Primary maxillary second molars recorded highest prevalence of CoC followed by permanent maxillary first, third and second molars. Pancontinental studies with regard to primary maxillary second molars are warranted.

Prevalence of Cusp of Carabelli and its caries susceptibility - an ambidirectional cohort study.

BACKGROUND/AIM: To investigate the susceptibility of Cusp of Carabelli (CoC) to caries in 3- to 4-year-old children. METHODS: The prevalence of CoC was obtained, by two calibrated examiners using 2128 maxillary posterior sectional die models of 1064 caries-free children (that were prepared 8 months back). Four months after recording the CoC, prospective clinical examination of above-mentioned children was carried out by a calibrated third examiner. International Caries Detection and Assessment System was used to record caries of the mesiopalatal surfaces (site of CoC) of the primary maxillary second molars. Data were expressed in numbers and percentages and subjected to chi-square and logistic regression analyses. RESULTS: The prevalence of CoC was 90.6%. The incidence of caries in association with CoC was 10.5%, and this association was statistically significant (0.004), with an odds ratio of 4.7. A statistically significant association was found between positive and negative expression of CoC and caries (0.001), with an odds ratio of 7.7 in positive expression and 4.1 in negative expression. CONCLUSION: The prevalence of CoC was high, with an increased risk for caries with a positive cusp expression. This highlights the need for closer assessment of the mesiopalatal surfaces of primary maxillary second molars during examination.