Effect of sleep on development of early childhood caries: a systematic review.

PURPOSE: To investigate the impact of sleep on the development of early childhood caries (ECC). METHODS: Seven electronic databases and grey literature were searched with various keyword combinations. Two reviewers independently selected studies, extracted data, and assessed the risk of bias using the Newcastle-Ottawa Scale. The studies were included if they evaluated the impact of sleep parameters on the caries experience or severity of ECC in children under 6 years of age. RESULTS: Four cross-sectional studies and two longitudinal studies were included. Children who had irregular bedtimes had a 66-71% higher chance of developing ECC. Children who slept after 11 pm might have a 74-85% higher chance of developing ECC. Children who slept less than 8 h during the night had a 30% increased risk of caries than children who slept more than 11 h. CONCLUSION: Irregular or late bedtime and fewer sleeping hours could be an independent risk factor for ECC. The risk of ECC might be related inversely in a dose-response manner to the number of sleep hours.

Topical Fluoride to Prevent Root Caries: Systematic Review with Network Meta-analysis.

The aim of this systematic review and network meta-analysis was to summarize the direct and indirect clinical evidence on the effectiveness of professionally applied and self-applied topical fluorides in preventing dental root caries. Controlled clinical trials with any follow-up duration were included. MEDLINE, PubMed, Embase, Scopus, and Cochrane Library were searched. Two reviewers independently carried out the selection of studies, data extraction, risk-of-bias assessments, and assessment of the certainty in the evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Fixed effects model and frequentist approach were used in the network meta-analyses. Nine clinical trials involving 4,030 participants were included. Five professionally applied and 7 self-applied topical fluoride agents or combinations were included in the meta-analyses. Compared to control group, 38% silver diamine fluoride solution, 5% sodium fluoride varnish, and 1.2% acidulated phosphate fluoride reduced root caries increment after 2 y (ranging from 0.59 to 0.85 mean decayed or filled root [DF-root]). Fluoride mouth rinse and fluoride toothpaste, used alone or in combination, reduced root caries increment after 1 y (ranging from 0.29 to 1.90 mean DF-root). Among the professionally applied topical fluorides reviewed, an annually applied 38% silver diamine fluoride (SDF) solution combined with oral health education is most likely to be the most effective in preventing dental root caries. Among the reviewed self-applied topical fluoride methods, daily use of a 0.2% sodium fluoride (NaF) mouth rinse is most likely to be the most effective, followed by 1100 ppm to 1500 ppm fluoride toothpaste plus 0.05% NaF mouth rinse, and 1100 ppm to 1500 ppm fluoride toothpaste.

Factors Associated with Dental Root Caries: A Systematic Review.

OBJECTIVES: The objectives of this review were to identify the factors associated with root caries and to describe their relationship with the presence and extent of root caries. METHODS: A search was carried out on the PubMed, Medline, Embase, and Scopus databases for articles published between January 1990 and October 2018. Information was extracted on the factors associated with the presence or extent of decayed or filled root surfaces and/or decayed root surfaces. Factors were sorted into 6 categories: social-demographic background, general health, health behaviors, fluoride exposure, oral health habits, and oral health condition. RESULTS: The quality of the 127 identified relevant papers was assessed, and those of low methodological quality were excluded. Finally, 44 articles reporting on 40 cross-sectional studies were included. The total sample size comprised 78,183 participants from different countries around the world. Positive correlations were detected between root caries and age, gingival recession, and use of tobacco, while negative correlations were found for social position, use of fluoride toothpaste, and oral hygiene status. Mixed findings were reported for association with the number of teeth and dental visit behaviors. CONCLUSION: This systematic review found a number of factors in different categories to be associated with root caries. People who are older, of lower socioeconomic status, or tobacco users and those with more gingival recession and poorer oral hygiene have higher risk of root caries. KNOWLEDGE TRANSFER STATEMENT: This systematic review found a number of factors associated with root caries, including age, social position, exposure to fluoride, and oral hygiene status. This information helps dental public health workers and clinicians identify the groups at high risk of caries and the factors to act on for more effective prevention and management of root caries (e.g., use fluoride toothpaste and improve oral hygiene).

A systematic review and meta-analysis of randomized clinical trials comparing rotary canal instrumentation techniques with manual instrumentation techniques in primary teeth.

BACKGROUND: Use of rotary instruments in the root canals of permanent teeth is well known; however, there are no evidence-based recommendations on the effectiveness of rotary canal instrumentation techniques over manual instrumentation techniques during root canal treatment in primary teeth. AIM: To appraise the current literature on the effectiveness of rotary canal preparation techniques compared to manual techniques during root canal treatment in primary teeth. DATA SOURCES: MEDLINE, Embase, Cochrane Library, Scopus, PubMed and Web of Science (1 January 1991 to 3 January 2019). STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS: Population: Children with primary teeth; Intervention: Rotary canal instrumentation; Control: Manual canal instrumentation; Outcomes: Success rates (clinical and/or radiographic), quality of root filling, instrumentation and root filling time, postoperative pain, cleaning effectiveness. STUDY APPRAISAL AND SYNTHESIS METHODS: Cochrane risk of bias tool 2.0 was used to ascertain the validity across five domains. Risk ratio (RR) for dichotomous variables and weighted mean difference for continuous variables were used as summary measures. The GRADE approach was used to assess the certainty of evidence using GRADE-pro software. RESULTS: A total of 13 trials were selected of 2471 records after screening of the databases. The RR of clinical success in rotary versus manual canal preparation technique was 1.01 (95% CI: 0.91-1.12; P = 0.913) at 6 months. The RR of radiographic success in rotary versus manual techniques was 0.97 (95% CI: 0.74-1.27; P = 0.805) at 6 months. The quality of root filling was not significantly different between the two groups (P = 0.062). The weighted mean difference of instrumentation time and canal filling time was significantly less with rotary techniques (P < 0.001); however, postoperative pain was non-significant across both techniques at 12, 24 and 72 h but significantly less with rotary techniques at 6 h (P < 0.001) and 48 h (P = 0.023). LIMITATIONS: Inclusion of only English literature. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Rotary canal instrumentation had a similar clinical and radiographic success rate, less postoperative pain (at 6 and 48 h), and took less instrumentation time compared to manual instrumentation techniques (moderate level of evidence).

A comparison of decontamination methods of tried-in preformed metal crowns: an in-vivo study.

AIM: To compare the effectiveness of different decontamination methods on tried-in preformed metal crowns (PMCs). METHODS: Sixty unused PMCs and 90 tried-in PMCs from patients were assessed for contamination after culturing for 24 h on liquid media, solid media and differential media for identification of Streptococcus mutans, Staphylococcus aureus, and Escherichia coli. Subsequently, these PMCs were divided equally into the following six groups: autoclave (121 °C, 15 psi for 15 min), 5% sodium hypochlorite (5 min), 5% glutaraldehyde (5 min), 70% isopropyl alcohol (1 min) and normal saline (5 min). The contamination was reassessed, and the Log10 counts were compared to the pre-decontamination levels using one way ANOVA and paired t-test at a significance level of p < 0.05. RESULTS: The mean percentage reduction in colony counts was significantly more in the autoclave group compared to glutaraldehyde or sodium hypochlorite groups, glass bead, isopropyl alcohol, and normal saline in this decreasing order. CONCLUSIONS: PMCs supplied by the manufacturer were found to be sterile and can be used directly on patients. The autoclave was the best method of sterilisation, although it did not eliminate the microbes 100%; followed by 5% glutaraldehyde and 5% sodium hypochlorite.

A cross sectional study to evaluate the oral health status of children with intellectual disabilities in the National Capital Region of India (Delhi-NCR).

BACKGROUND: Children with intellectual disabilities (ID) have usually been reported to have poorer levels of oral hygiene and higher prevalence of dental caries than their compeers. The present study was conducted to assess the status of dental caries and oral hygiene in different categories of institutionalised children with ID (syndromic and non-syndromic) registered in various special schools of Delhi (National Capital Region, India). METHODS: The present cross sectional study was conducted on 269 children [52 with cerebral palsy (CP), 35 with Down syndrome (DS), 30 with autism and 152 with non-syndromic intellectual disability] attending nine special schools who were examined for dental caries [Decayed, Missing and Filled Teeth index for permanent teeth (DMFT); decayed, missing/indicated for extraction, filled index for primary teeth (dmft) and prevalence of caries] and oral hygiene status [Oral Hygiene Index-simplified (OHI-S)]. The levels of disability were classified according to Stanford Binet scale as severe (IQ ≤ 35), moderate (IQ = 36-51) and mild (IQ = 52-67). Statistical analysis was performed using one way analysis of variance and post hoc test to compare the levels between groups at a significance level of P < 0.05. RESULTS: Mean DMFT, dmft and OHI-S indices scores for all the children irrespective of the category and the level of ID were 2.12 ± 1.95, 0.97 ± 1.60 and 2.05 ± 1.07, respectively. As the level of ID increased among these children, the mean DMFT index and OHI-S index increased with no significant effect on dmft. However, children with severe ID had higher OHI-S and DMFT scores than children with mild or moderate ID. The dental caries prevalence was 86.53%, 68.57%, 76% and 86.18% in children with CP, DS, autism and non-syndromic intellectual disability, respectively. CONCLUSIONS: The level of caries in permanent teeth and oral hygiene deteriorated with the increasing severity of ID as indicated by DMFT and OHI-S scores (severe > mild, moderate). However, the level of caries (dmft) was not affected by the level of ID in primary dentition. The prevalence of dental caries was highest among children with CP and least among children with DS.

Delayed replantation of avulsed tooth with 15-hours extra-oral time: 3-year follow-up.

BACKGROUND: Avulsion is one of the most serious injuries of the tooth which is most commonly seen in young children and occurs in the upper front teeth. Immediate transplantation of the avulsed tooth is recommended treatment and results in good prognosis although this may not be always possible. CASE REPORT: The present case highlights the 3-year follow-up of delayed replantation (after 15h) of maxillary central incisor which was avulsed due to trauma. The complications seen in the present case were ankylosis and inflammatory resorption, but clinically the tooth was asymptomatic and maintains the esthetics of the individual signifying the importance of delayed replantation even after prolonged extra-oral time. CLINICAL IMPLICATIONS AND CONCLUSION: Although complications like ankylosis or root resorption may be unavoidable, delayed replantation of avulsed tooth may be a good alternative to prosthesis (implant or fixed partial denture) till the growth is completed due to preservation of the alveolar bone and psychological benefit to the patient. Also efforts should be made to educate and update children, teachers and parents regarding management of avulsed tooth at accident site and also the dentists regarding its management in dental office.

Comparative evaluation of Ferric Sulfate, Electrosurgical and Diode Laser on human primary molars pulpotomy: an "in-vivo" study.

BACKGROUND AND AIMS: Despite modern advances in the prevention of dental caries and increased understanding of the importance of maintaining the natural primary dentition, many teeth are still lost prematurely. This can lead to malocclusion with aesthetic, phonetic and functional problems that may be transient or permanent. Therefore, maintaining the integrity and health of the oral tissues is the primary objective of pulp treatment. Pulpotomy has remained an acceptable and mainstay treatment in preserving the vitality of primary tooth and prolonging its life till the permanent successor erupts. Various materials and techniques are available for pulpotomy on primary molars; all with some advantages and disadvantages. The present study was carried out on 45 primary molars to evaluate and compare the clinical and radiographic success of diode laser, electrosurgical and ferric sulfate pulpotomy over a period of 9 months. Materials (Subjects) and Methods: The forty five primary molars were randomly and equally divided into three treatment groups which were as follows: Group A: 15 primary molars treated with 15.5% Ferric sulfate Group B: 15 primary molars treated with electrosurgical unit and Group C: 15 primary molars treated with diode laser. All teeth in three categories were followed up clinically and radiographically at 1, 3, 6 and 9 months post treatment and the findings were recorded on the prepared proforma RESULTS: Clinically, 86.6% success rate was found in ferric sulfate group whereas 100% success rate was found in electrosurgical and diode laser groups. Radiographically, 80% success rate was found in all the three groups at the end of 9 months with internal resorption being the most common cause of failure after pulpotomy. CONCLUSIONS: Thus, electrosurgery and diode lasers appear to be acceptable alternative to pharmacotherapeutic pulpotomy agents.

Correlation of thyroid functions with severity and outcome of pregnancy.

BACKGROUND: During normal pregnancy, changes in thyroid function are well documented; however, information regarding thyroid function in preeclampsia is scanty. AIM: The present study was planned to study thyroid hormones in mild and severe preeclamptic women and normotensive women and correlate them with outcome of pregnancy. SUBJECT AND METHODS: Thyroid hormones were analyzed in mild (n = 50) and severe (n = 50) cases of preeclamptic women and normotensive women (n = 100). RESULTS: Thyroid-stimulating hormone (TSH) and TT4 levels were higher in mild preeclampsia as compared with severe preeclampsia (P < 0.001 and P < 0.01, respectively). TT3 levels were lower in preeclampsia (more so in severe preeclamptics as compared with normotensive pregnant and non-pregnant women). Preeclamptic with raised TSH levels had significantly higher mean arterial blood pressure and low birth weight (BW). A negative correlation was observed between BW and TSH levels (r = 0.296, P < 0.001) and BW and TT4 levels. A positive correlation was observed between BW and TT3 levels. CONCLUSION: These findings indicate that there is a state of biochemical hypothyroidism that correlates with severity of preeclampsia and influences obstetric outcome in these women. Identification of thyroid hormone in pregnancy might be of help in predicting occurrence of preeclampsia.

Firecracker explosion in the mouth of a 3-year-old child.

Facial soft tissue injuries are commonly associated with majority of pediatric trauma cases. A rare case of soft tissue trauma caused due to explosion of a firecracker intraorally in a 3-year-old child is being presented.

Lipomata of the pharynx.

Two rare cases of lipomata arising from the pharynx are being reported. The tumors were excised and have showed no recurrence.

Unusual foreign body in the neck.

An unusual FB. (broken end of a metallic knief) in the neck is reported. The case is cousidered as unusual because no history of FB entering into the neck during the injury was available and the wound over the FB was healed. In addition, patient was otherwise Asmyptomatic, the reason why the diagnosis was delayed.