Efficacy of Glutathione Biomolecule in Reducing the Tooth Discoloration Associated with Silver Diamine Fluoride: A Split-mouth In vivo Study.

Background: The necessity to modify silver diamine fluoride (SDF) to make it esthetically acceptable without affecting its beneficial properties keeps the research in this field pertinent. Aim: This study aims to comparatively evaluate the efficacy of Glutathione (GSH) in reducing tooth discoloration associated with SDF. Materials and Methods: This split-mouth in vivo study was conducted on 20 children aged 3-8 years having a minimum of 3 active carious primary teeth. The three teeth in each patient were randomly divided into Group I - 38% SDF; Group II - 38% SDF followed by application of potassium iodide; and Group III - 38% SDF mixed with 20% GSH. Standardized photographs were taken immediately after application and after 6 months, which were analyzed using Image J software. The carious lesions were clinically classified as active or arrested after 6 months. Results: When mean gray values of three groups were compared postoperative, the highest value (lighter shade) was observed for group II and least (darker shade) for group I, whereas, during the 6-month follow-up, the highest value was seen for group III and least for group I. The color change from preoperative to 6 months' follow-up was compared, and a statistically significant difference was observed between groups I and II (P = 0.003) and groups I and III (P = 0.001). When caries arresting effectiveness was analyzed, there was no significant difference found between any of the groups (P = 1). Conclusion: Mixing 20% GSH with 38% SDF was an effective measure in reducing the tooth discoloration associated with SDF, without affecting caries arresting the efficiency of the latter.

Reliability of the electric pulp tester as an indicator of pulpal anesthesia in primary maxillary posterior teeth to assess the need for supplemental injections: An observational clinical study.

Background: The primary maxillary molars occasionally remain sensitive during operative procedures even post the buccal supraperiosteal injection. This could be due to the widely flared palatal roots receiving accessory innervation from the palatal nerves. Identifying inadequate anesthesia upfront using the electric pulp test (EPT) would give vital information to the clinician on the need of a supplemental palatal injection. Aim: The aim of this study was to assess and evaluate the reliability of the EPT as an indicator of pulpal anesthesia in primary maxillary molars. Methodology: Fifty one primary maxillary molars were subjected to the EPT following a buccal supraperiosteal injection. During the operative procedure, the " Face Legs Activity Cry Consolability" (FLACC) scores were recorded. The outcome of the EPT was correlated with the results of the FLACC score using Pearson's Chi-square test.Results: The EPT results were correlated to the FLACC scores. Five out of the 10 primary maxillary second molars which responded to the EPT scored 0 on the FLACC scale. The remaining 5 teeth scored 1 on the FLACC scale. The P value was 0.056 which was not statistically significant. This infers that the EPT is not a reliable tool to assess the adequacy of pulpal anesthesia in primary maxillary second molars. Conclusion: From the results of the present study, it can be concluded that the EPT is not a reliable tool to be used as an indicator of pulpal anesthesia in primary maxillary molars.

Evaluation of Anxiety Levels in Children While Using Rubber Dam and OptraDam Isolation Techniques.

Aim: The aim of the study was to evaluate the anxiety levels in children while using rubber dam and OptraDam isolation techniques. Materials and methods: This study was a crossover trial conducted on 27 selected 6-12-year-old children. The procedure of placement of either of the isolation techniques was told and demonstrated using audiovisual aid. The sequence of the proceedings on each child (rubber dam or OptraDam) was determined randomly using toss of coin. Second demonstration was carried out 7 days after the first demonstration. The anxiety experienced was recorded using Venham's anxiety scale at two time points-after verbal explanation and after the audiovisual demonstration. The study also objectively assessed the anxiety by measuring the salivary malondialdehyde (MDA) levels of two patients. Results: When mean values of Venham's anxiety scores after verbal explanation and after audiovisual demonstration were compared for each of the two techniques using paired Student's t test, there was statistically significant decrease in the anxiety score following audiovisual demonstration in both the techniques. When the scores between two groups after verbal explanation and after audiovisual demonstration were compared using repeated measures of analysis of variance (ANOVA), the reported anxiety scores were significantly lesser for the OptraDam technique (p = 0.000). Conclusion: Audiovisual demonstration reduced the anxiety of children when compared to verbal explanation for both isolation techniques. OptraDam isolation was found to be less anxiety generating in children compared to rubber dam isolation. Clinical significance: When using modern adhesive techniques, a good isolation of the working field is an important requirement for better prognosis. OptraDam being the latest addition to the rubber dam family, if found to be more children friendly can solve majority of the problems related to isolation in pediatric dentistry. How to cite this article: S Mahima, YM Karuna, Shenoy R, et al. Evaluation of Anxiety Levels in Children while using Rubber Dam and OptraDam Isolation Techniques. Int J Clin Pediatr Dent 2023;16(2):287-291.

Evaluation of pain response in children to the SoftClamp™ as an alternative to the metal rubber dam clamp: A randomized clinical trial.

Background: The use of a rubber dam is more important than ever in today's COVID-19 era to limit cross infections. In children, the placement of the metal clamp to retain the rubber dam is perceived to be painful and often requiring a local anesthetic injection. This dissuades many clinicians from placing the rubber dam. Hence, this study evaluated the pain response of children to a SoftClamp™ compared to the conventional metal clamp. Materials and Methods: This was a randomized controlled, equal allocation ratio, split-mouth clinical trial. Forty-two children aged between 8 and 12 years, having two permanent mandibular molars in need of sealants, were divided into Groups A and B (metal clamp and SoftClamp™, respectively). The pain response was recorded using both an objective and a subjective scale i.e., the Faces Legs Activity Cry Consolability (FLACC) scale and the Wong Baker Faces Pain Rating Scale (WBFPRS). The level of significance was set at 5% (P < 0.05). The pain response recorded from the WBFPRS and the FLACC scale for the metal and the SoftClamp™ were analyzed using the Wilcoxon signed rank test. The difference in pain response between genders and between two age groups (below and above 10 years of age) was analyzed using the Mann-Whitney U-test. Results: The children reported mild discomfort to clamp placement in both the scales. The P values for the FLACC and WBFPRS scores comparing the pain response to the metal and SoftClamp™ were 0.311 and 0.149, respectively. Conclusion: There was no significant difference in the pain response of children to both the clamps. Good rubber dam application practices in children through the use of behavior guidance and a proper topical anesthesia technique may play a far more important role regardless of the clamp used. But the SoftClamp™, with its more child friendly appearance could be a viable alternative to the metal clamp in 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.

Evaluation of Changes in the Occlusion and Occlusal Vertical Dimension in Children Following the Placement of Preformed Metal Crowns Using the Hall Technique.

Objectives: To evaluate the time taken and the mechanism through which the occlusion settles following the placement of a preformed metal crown (PMC) using the Hall technique. The secondary objective was to assess any temporo mandibular joint dysfunction (TMD) resulting from the Hall technique through a questionnaire. Study Design: 44 children fulfilling the inclusion criteria were evaluated for changes in overbite and occlusal vertical dimension (OVD) following the placement of preformed metal crowns (PMCs) using the Hall technique. The overbite and OVD measurements were taken before treatment, immediately post treatment, then at one, two, three and four weeks post treatment. After four weeks, a questionnaire recorded the occurrence of any signs or symptoms of TMD. Results: At the fourth week, the overbite measurement did not show a statistically significant difference (p value= 0.58) compared to baseline values indicating that the occlusion settled by the fourth week. By the third week the OVD values obtained did not show a significant difference compared to the baseline (p value= 0.42) indicating that the OVD had been restored. The questionnaire provided at the end of four weeks showed negative response for signs and symptoms of TMD in all the children. Conclusion: Any changes in occlusion following the placement of a Hall crown settles in four weeks. The OVD settles three weeks post placement implying that extrusion of teeth do not play a role in settling of the occlusion. The children do not develop any signs or symptoms of TMD post a Hall crown.

Assessing the behavior management problems during the first dental visit of preschool children using a doll placement test.

CONTEXT: Assessing dental anxiety as a predictor of the likely behavior of the child in the dental operatory is of paramount importance for a clinician to render quality care. AIM: This study aims to correlate the dental anxiety of preschool children as shown during the doll placement test with that of their behavioral patterns during the first dental visit. SETTINGS AND DESIGN: This cross-sectional study was conducted between the ages of 3-7 years. MATERIALS AND METHODS: During their first dental visit, the background variables were elicited from parent/guardian at the reception desk. Later at the play area, the child was given a set of dolls representing dentist, child, and mother to place them in a model dental office having a dental chair. The child was then taken for the initial oral examination, during which the behavior of the child was rated using Frankl's Behavior Rating Scale. The data collected were analyzed using Chi-square test and binary regression analysis. RESULTS: The observed association between the doll placement pattern and the behavior of the patient during dental treatment was statistically significant (P < 0.001). The binary regression analysis showed that the child's unpleasant previous medical and parent's unpleasant dental experiences had higher odds favoring uncooperative behavior (46.63 and 41.93, respectively). CONCLUSIONS: The child's behavior on the dental chair is associated with the doll placement pattern, which is also influenced by experiences of the child during his/her encounter with the medical doctor and previous dental experiences of their parents.

Comparison of Patient Comfort During the First Stage of Conventional Versus Modified Two-Stage Inferior Alveolar Nerve Blocks in Pediatric Patients.

Our aim was to compare the comfort of pediatric patients during the first stage of the conventional 2-stage inferior alveolar nerve block (IANB) versus the modified 2-stage IANB. This was a parallel group, single-blinded, randomized controlled trial. Pediatric patients meeting the inclusion criteria were randomly allocated to 1 of the 2 groups receiving IANB, group 1 (31 subjects) utilized a conventional 2-stage technique, and group 2 (33 subjects) utilized a modified 2-stage approach. Patient comfort was assessed indirectly by 2 observers using the Face, Legs, Activity, Cry, Consolability (FLACC) scale during the first stage of the injections. FLACC score data between the 2 groups were analyzed using the chi-square test, and interobserver reliability was measured using kappa statistics. During the first stage of the injections, lower FLACC scores of 0 indicating a relaxed/comfortable patient experience were found in 57.6% of group 2 subjects compared with only 25.8% group 1 subjects, which was a statistically significant difference (p-value .013). Interobserver reliability assessed using kappa coefficients (κ = 0.812) indicated excellent agreement. FLACC scores for the pediatric patients during the first stage of the modified 2-stage IANB technique were significantly lower than during the first stage of the conventional 2-stage IANB technique.

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.

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.

Presurgical nasoalveolar molding: A boon to facilitate the surgical repair in infants with cleft lip and palate.

Cleft lip and palate (CLP) is the most common congenital craniofacial anomaly. Rehabilitation of CLP generally requires a team approach. Alveolar and nasal reconstruction for these patients is a challenge for the reconstructive surgeon. Various procedures have been attempted to reduce the cleft gap, so as to obtain esthetic results postsurgically. The presurgical nasoalveolar molding (PNAM) technique, developed by Grayson, is a new approach to presurgical infant orthopedics. PNAM reduces the severity of the initial cleft alveolar and nasal deformity. Thus, it enables the surgeon and the patient to enjoy the benefits associated with repair of a cleft deformity that is minimal in severity. This article presents a brief insight into PNAM with a case series of three different cases (one unilateral and two bilateral) which underwent PNAM treatment and gave an excellent surgical prognosis.

Cavity disinfection in minimally invasive dentistry - comparative evaluation of Aloe vera and propolis: A randomized clinical trial.

CONTEXT: The survival of atraumatic restorative treatment (ART) restorations would probably increase if near total elimination of cariogenic microorganisms could be done in the process of cavity cleaning before going ahead with the restoration. Thus, use of naturally occurring disinfecting agents for achieving this goal could herald a new beginning in the field of contemporary minimum intervention dentistry. AIMS: To evaluate the efficacy of hand instruments in excavating dental caries and comparatively evaluate the roles of Aloe vera and propolis as potential cavity disinfecting agents after minimally invasive hand excavation of dental caries. SETTINGS AND DESIGNS: Experimental, in vivo intergroup split mouth, randomized clinical trial. SUBJECTS AND METHODS: The study included Group I (Control), Group II (A. vera) and Group III (propolis). Ten patients with three teeth each have occlusal/occlusoproximal lesions suitable for ART were selected. Dentinal samples were collected three times from each tooth viz., preexcavation, postexcavation and postdisinfection of the cavities. These dentinal samples were subjected to microbiological analyses for total viable count. STATISTICAL ANALYSIS USED: Repeated measures of analysis of variance (ANOVA) with Bonferroni post-hoc test and one-way ANOVA with Tukey post-hoc test. RESULTS: In all the three groups, significant amount of bacteria were left behind after hand excavation. Group II and Group III, in which cavities were treated with A. vera and propolis extracts respectively, showed a significant reduction in the bacterial counts when compared to control the group. CONCLUSIONS: Hand excavation alone does not completely eliminate bacteria, which may predispose treated teeth to secondary caries. Both propolis and A. vera extracts can be used as potential natural disinfecting agents, thereby embracing the concept of phytotherapy in minimum intervention dentistry.