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Aim: To investigate the potential effectiveness of "medical clowns" on preoperative, intraoperative, and postoperative anxiety of children undergoing various dental treatments and also its effect on the operator's stress levels in a dental setup. Materials and methods: A total of 170 pediatric patients, aged 4-8 years, indicated for preventive therapy, extractions, restorative, and endodontics were included and divided into two groups [group I-audiovisual (A-V) aids; group II-medical clowns], group of 85 patients each after recording Modified yale preoperative scale. Both pre- and postoperatively, Frankl's behavior score was recorded for each patient. During treatment, the face, legs, activity, cry, consolability (FLACC) pain scale, and dental operator's stress level were recorded. Results: Intervention of medical clowns positively influenced children during dental treatment by increasing their pain threshold. The majority of children showed positive Frankl rating scales after dental treatment. Also, the operator's stress was significantly reduced, which led to enhanced treatment outcomes. Conclusion: Humor yields the power of healing, distracts pediatric patients, reduces their anxiety, and alleviates their pain, conferring the patients with a sense of laughter, creativity, and care.Therefore, medical clowns in pediatric dentistry can prove to be serviceable and valuable as a nonpharmacological approach to behavior management. How to cite this article: Aggarwal P, Mathur S, Chopra R. Assessment of Medical Clowning in Influencing the Anxiety and Behavior Scores of Children Undergoing Various Dental Treatments and the Stress Levels of the Operator. Int J Clin Pediatr Dent 2024;17(1):59-66.

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Moebius syndrome (MBS) is a rare congenital nonprogressive neuromuscular disorder characterized by partial or complete, unilateral or bilateral paralysis of the facial (VII) and abducens (VI) cranial nerves (CNs). In this syndrome bilateral facial palsy may occur with the involvement of VII CN and impaired eye movements can be there because of the involvement of VI CN. It can also be associated with other CN palsies, orofacial anomalies, and limb defects. MBS is diagnosed exclusively on the basis of clinical criteria, although causative genetic patterns are being documented in recent studies. The present case report describes the dental management of a 5-year-old child diagnosed with MBS. The child presented with the abnormal shape of legs, incomplete eye closure during sleep, inability to smile, lingual hypoplasia, microstomia, and hypoplastic teeth among other dental-skeletal abnormalities, and a clinical diagnosis of MBS was made. How to cite this article: Mittal M, Kumar A, Chopra R, et al. Diagnosis and Dental Management of a Child with Moebius Syndrome: A Case Report. Int J Clin Pediatr Dent 2023;16(S-1):S109-S112.

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BACKGROUND: The present study was designed to assess variations in physiological, psychomotor parameters, and analgesic effects at various levels of nitrous oxide-oxygen analgesia in 3-12 years old children. DESIGN: One hundred children aged 3-12 years were assessed for physiological, psychomotor, and analgesic parameters at various concentrations of N2O, i.e., baseline, 20, 40, 50, and 0% (100% O2). Physiological, psychomotor, and analgesic effects were assessed using a pulse oximeter, bender visual-motor Gestalt test, and response to electric pulp tester, respectively. RESULTS: Oxygen saturation (SpO2) showed a significant increase while heart rate (HR) showed a significant reduction at 50% N2O. No significant changes were observed in respiratory rate with a change in N2O levels. Significant reduction in the pain scores was found at the same level of stimulation by an electric pulp tester at 40 and 50% levels. The psychomotor changes were consistently higher at every concentration of nitrous oxide. However, no correlation could be found between various parameters tested. CONCLUSION: N2O caused a significant increase in SpO2 in both the age groups, a decrease in HR, a significant decrease in pain score at 40 and 50% concentration of N2O, and had a significant effect on the psychomotor ability of children. HOW TO CITE THIS ARTICLE: Sharma S, Chopra R, Mathur S, et al. Variations in Physiological, Psychomotor, and Analgesic Parameters during Titration of Nitrous Oxide in 3-12 Years Old Children Managed with Inhalation Sedation. Int J Clin Pediatr Dent 2020;13(6):650-655.

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BACKGROUND: In continuation with the ultraconservative minimal intervention approach for carious lesions treatment, lesion sterilization and tissue repair (LSTR) is a novel concept of using antibacterial drugs to disinfect dentinal, pulpal, and periapical lesions. AIMS: The purpose of this study is to evaluate the clinical, radiographic, and microbiologic success rate of indirect pulp treatment (IPT) using a new technique minimal excavation and LSTR with triple antibiotic paste (TAP), for primary molars. SETTINGS AND DESIGN: This was randomized controlled trial design. MATERIALS AND METHODS: Forty-two healthy cooperative children aged 5-10 years having deep carious lesion in primary molars were randomly assigned to receive either traditional IPT with calcium hydroxide or minimal excavation and LSTR with TAP. Follow-up was done at 6 weeks, 3, 6, and 15-18 months intervals, and treatment success or failure was determined by a combination of clinical, microbiological, and radiographic findings. STATISTICAL ANALYSIS USED: Qualitative data were analyzed using Pearson's Chi-square test. Mann-Whitney U nonparametric test was used for statistically significant differences between the bacterial counts (median values and percent reduction) between the two groups and the Wilcoxon sign rank test for the intragroup evaluation of bacterial counts. RESULTS: LSTR with TAP was found to be as effective as traditional indirect pulp treatment (P < 0.05). CONCLUSIONS: Minimal excavation and LSTR with TAP can be an effective treatment methodology for the management of deep carious lesions in primary molars.

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BACKGROUND: Various strategies for controlling caries focus on disrupting the interaction between risk factors. Of these, fluoride varnish has been shown to reduce the colony-forming (CFU) units and water-insoluble extracellular polysaccharide amount. Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and xylitol-containing fluoride varnishes have recently gained importance as caries-protective fluoride varnishes. AIM: This study aims to assess and compare the reduction in Streptococcus mutans count in biofilm samples after topical application of three different fluoride varnishes and to evaluate the effect of oral prophylaxis prior to fluoride varnish application. MATERIALS AND METHODS: Sixty healthy children with no active caries, in the age group of 2-8 years, were randomly divided into Group A = fluoride varnish containing CPP-ACP; Group B = fluoride varnish containing xylitol; and Group C = fluoride varnish with 0.9% difluorosilane; further, the groups were divided into two subgroups, namely A1, B1, and C1 with prior oral prophylaxis and A2, B2, and C2 without oral prophylaxis. Plaque samples were collected at baseline, 1st month, and 3rd month; cultured; and incubated, and CFU/ml was calculated. RESULTS: Data were compiled, and CFU/ml was analyzed by independent t-test, paired t-test, and one-way ANOVA. There was no statistical difference between the fluoride groups. Furthermore, no statistically significant difference was seen between the subgroups. CONCLUSION: Fluoride varnish containing CPP-ACP showed higher reduction in S. mutans count followed by xylitol-containing fluoride varnish and Fluor Protector®. There was no effect of prior oral prophylaxis on the efficacy of fluoride varnish.

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This study was conducted to compare pain perception of intraligamentary anesthesia (ILA) using a computer-controlled local anesthetic delivery system (CCLADS) versus a conventional intraligamentary injection for extraction of primary molars. A randomized controlled trial was designed where 82 children requiring 102 primary molar extractions were given ILA of 2% lidocaine with 1:80,000 epinephrine with either the conventional method or a CCLADS. Pain during injection and extraction was assessed using the Sound, Eye, Motor (SEM) scale and heart rate recording. Faces Pain Scale-Revised (FPS) scores were self-reported by patients. The Mann-Whitney test was used for evaluation of FPS and SEM scores and Student's t test for evaluation of heart rate readings. Heart rate values during injection were found to be higher, but not statistically significantly higher (p = .077), for conventional injection versus CCLADS; however, heart rate values during extraction were significantly higher for the conventional method (p = .009). Both FPS and SEM values were found to be significantly higher for conventional ILA technique (p < .05). ILA can be an effective alternative means of anesthesia for primary molar extractions, and CCLADS devices can make ILA more effective and less painful.

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OBJECTIVE: Composition of saliva plays an important role in defining the dental caries risk for an individual. The role of trace elements present in saliva on dental caries is still not clear. Thus this study was designed to evaluate the effect of certain salivary trace elements like copper, potassium, fluoride, selenium and lead on the caries experience of children. STUDY DESIGN: 60 subjects in the age group of 3-15 years were selected and divided into two groups, caries active and caries free. 5 ml of unstimulated saliva from each subject was collected and analyzed for the levels of trace elements using Induced Couple Plasma Spectrophotometer (ICP-OES). RESULTS: Copper and Fluoride levels were significantly higher in caries free as compared to caries active individuals whereas Lead was significantly higher in caries active as compared to caries free children (p-value<0.05). Potassium and Selenium though present in appreciable amounts did not show any significant difference between the two groups (p-value>0.05). CONCLUSION: In caries free subjects, copper and fluoride levels were significantly higher while the level of lead was lower as compared to caries-active children. Potassium and selenium did not show any significant differences within the two groups.

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OBJECTIVE: Failure of inferior alveolar nerve block in achieving profound anesthesia of the pulp due to various reasons has led to the introduction of more potent local anesthetic agents like articaine. This study was conducted to compare the efficacy of buccal infiltration with articaine in achieving pulpal anesthesia of primary molars as compared to inferior alveolar nerve block with lignocaine. STUDY DESIGN: 30 patients (4-8 years) with indication of pulp therapy in at least two mandibular primary molars were selected. Patients were randomly assigned to receive nerve block with lignocaine or infiltration with articaine on first appointment and the other solution on second appointment. All the pulpotomies and pulpectomies were performed by a pediatric dentist. Two researchers standing at a distance of 1.5 m recorded the Pain Scores and Sound, Eye, Motor (SEM) scores. After the completion of procedure, the patient was asked to record the Facial Image score and Heft-Parker Visual Analogue Score (HP-VAS). RESULTS: Pain Score recorded at the time of injection showed significantly more movements with block as compared to infiltration (p<0.001). SEM scores at time of pulp extirpation were also higher for block than infiltration (p<0.001). CONCLUSION: Articaine infiltration has the potential to replace inferior alveolar nerve block for primary mandibular molars.

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A supramolecular ensemble having Ag@Cu2O core-shell nanoparticles stabilized by aggregates of a hexaphenylbenzene derivative has been developed which exhibits excellent photocatalytic efficiency in reactions involving preparation of imidazole and benzimidazole derivatives via C-H activation.

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BACKGROUND: Children who have severe early childhood caries (S-ECC) weigh significantly less than caries-free children. The association between S-ECC and weight suggests that its timely treatment at early stages may preserve general health, in addition to preventing pain and infection. OBJECTIVE: This study was conducted to evaluate whether children with untreated S-ECC had lower weight and height as compared with children with low caries and to evaluate whether full mouth rehabilitation of children with S-ECC resulted in the phenomenon of catch-up growth. MATERIALS AND METHODS: The weight and height of children with noncontributory medical histories and S-ECC (3-6 years) were compared with caries-free children, before and 6 months after full mouth dental rehabilitation. RESULTS: Prior to dental rehabilitation, children with S-ECC had significantly less weight and height than their comparison counterparts (p < 0.001). Following therapeutic intervention, the test group children exhibited catch-up growth in relation to weight, as there was no significant difference in the body weight of the test and control groups (p = 0.171). CONCLUSION: Comprehensive full mouth rehabilitation of children with S-ECC results in catch-up growth, thus improving the overall health of the child. How to cite this article: Sachdev J, Bansal K, Chopra R. Effect of Comprehensive Dental Rehabilitation on Growth Parameters in Pediatric Patients with Severe Early Childhood Caries. Int J Clin Pediatr Dent 2016;9(1):15-20.

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PURPOSE: Buffering of anesthetic solutions has been suggested to reduce pain on injection and onset of anesthesia. The purpose of this study was to assess the reduction in pain on injection during inferior alveolar nerve block administration in children. METHODS: A double blind crossover study was designed where 30 six- to 12-year-old patients received two sessions of inferior alveolar nerve block scheduled one week apart. Two percent lidocaine with 1:200,000 epinephrine was given during one appointment, and a buffered solution was given during the other. Pain on injection was assessed using the sound, eye, and motor (SEM) scale, and the time to onset was assessed after gingival probing. The Heft-Parker visual analogue scale (HP-VAS) was self recorded by the patient after administration of local anesthesia. RESULTS: When tested using Mann-Whitney analysis, no significant differences were found between the SEM scores (P=0.71) and HP-VAS scores (P=0.93) for the two solutions used. Student's t test was used to assess the difference in the onset of anesthesia, which was also found to be statistically insignificant (P=0.824). CONCLUSION: Buffered lidocaine did not reduce the pain on injection or time to onset of anesthesia for inferior alveolar nerve block in children.

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Silver nanoparticles (AgNPs) stabilized by aggregates of derivative 4 have been used as catalyst for the construction of synthetically and biologically important [4 + 2] cycloadducts at room temperature.

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AIM: To assess the effect of combining 0.2% chlorhexidine (CHX) mouthwash with xylitol (XYL) chewing gum on Streptococcus mutans and biofilm levels among 8- to 12-year-old children. MATERIALS AND METHODS: Sixty children aged 8 to 12 years were selected with moderate and high salivary S. mutans levels. They were divided into three groups of 20 children each: (1) XYL group where the subjects chewed XYL twice daily; (2) CHX where rinsing was done twice daily; and (3) combination of XYL and CHX group (XYL+CHX) where both the agents were used once daily. The S. mutans colony-forming units (CFUs) were counted by using the mitis salivarius agar plate at the beginning of the study and at 15 days, 1, 2, and 6 months from the start of the study. RESULTS: The XYL+CHX group showed the maximum reduction in both the biofilm and S. mutans scores throughout the study period. CONCLUSION: The XYL+CHX combination reduced both the biofilm and S. mutans score significantly better than either XYL chewing gums or CHX mouthwash used alone. HOW TO CITE THIS ARTICLE: Syed M, Chopra R, Shrivastava V, Sachdev V. Comparative evaluation of 0.2% Chlorhexidine Mouthwash, Xylitol Chewing Gum, and Combination of 0.2% Chlorhexidine Mouthwash and Xylitol Chewing Gum on Salivary Streptococcus mutans and Biofilm Levels in 8- to 12-Year-Old Children. Int J Clin Pediatr Dent 2016;9(4):313-319.

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INTRODUCTION: Dental caries is one of the most common infectious diseases affecting the oral cavity. Among the oral bacteria, mutans streptococci have been implicated as major cariogenic bacteria as they can produce high levels of dental caries causing substances such as lactic acid and extracellular polysaccharides. AIM: The aim of the study was to detect the presence of Streptococcus mutans and Streptococcus sobrinus in dental plaque by using Polymerase Chain Reaction (PCR) method, quantification of these micro-organisms using Modified Sucrose-Bacitracin (SB-20M) agar medium and to correlate their presence in Caries Active (CA) and Caries Free (CF) pre-school children. MATERIALS AND METHODS: Sixty-eight pre-school children, in the age group of 3-5 years were divided equally into 34 CA and 34 CF children. Dental plaque samples were obtained for detection of these microorganisms by PCR method and quantification was done using SB-20M culture medium. The data was analyzed using statistical software SPSS version 16. For statistical analysis, the frequencies and means of Colony Forming Units (CFU) were used with CI = 95%. For bivariate analysis, Fisher exact test was used at 5% level of significance. The comparison of mean of number of CFU of S. mutans and S. sobrinus was made by Mann Whitney U test and Spearman's Rho test at 1% level of significance was used for correlation between dmft and CFU in CA group. RESULTS: The results showed that S. sobrinus was significantly higher in CA group as compared to CF group whereas S. mutans showed no significant difference. On quantification of these micro-organisms, S. sobrinus was present in significantly higher numbers in CA group as compared to CF group. On correlating the CFU/ml of the micro-organisms with the dmft index, both the micro-organisms showed a positive correlation. CONCLUSION: We conclude that S. mutans and S. sobrinus were detected in higher numbers in CA children as compared to CF children. PCR is a sensitive, specific, rapid and an effective method for the detection of oral microorganisms.

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INTRODUCTION: Utility of various dental materials ranging from diagnosis to rehabilitation for the management of oral diseases are not devoid of posing a potential risk of inducing allergic reactions to the patient, technician and dentist. This review aims to develop a systematic approach for the selection and monitoring of dental materials available in the market thereby giving an insight to predict their risk of inducing allergic reactions. MATERIALS AND METHODS: Our data included 71 relevant articles which included 60 case reports, 8 prospective studies and 3 retrospective studies. The source of these articles was Pub Med search done with the following terms: allergies to impression materials, sodium hypochlorite, Ledermix paste, zinc oxide eugenol, formaldehyde, Latex gloves, Methyl methacrylate, fissure sealant, composites, mercury, Nickel-chromium, Titanium, polishing paste and local anaesthesia. All the relevant articles and their references were analysed. The clinical manifestations of allergy to different dental materials based on different case reports were reviewed. RESULTS: After reviewing the literature, we found that the dental material reported to cause most adverse reactions in patients is amalgam and the incidence of oral lichenoid reactions adjacent to amalgam restorations occur more often than other dental materials. CONCLUSION: The most common allergic reactions in dental staff are allergies to latex, acrylates and formaldehyde. While polymethylmethacrylates and latex trigger delayed hypersensitivity reactions, sodium metabisulphite and nickel cause immediate reactions. Over the last few years, due to the rise in number of patients with allergies from different materials, the practicing dentists should have knowledge about documented allergies to known materials and thus avoid such allergic manifestations in the dental clinic.

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PURPOSE: Recent evidence has shown that buccal infiltration with articaine alone can be used to anesthetize dental tissues for various dental procedures. The purpose of this study was to evaluate the efficacy of articaine compared to lidocaine for extraction of primary maxillary molars and assess whether palatal anesthesia could be achieved with buccal infiltration injection but without the need for palatal infiltration. METHODS: One hundred and two children requiring primary maxillary molar extraction were randomly selected to receive buccal infiltration using either articaine or lidocaine. During extraction, The Wong Baker Facial Pain Scale (FPS) was employed for subjective evaluation and Modified Behavior Pain Scale (MBPS) values, heart rate, and blood pressure were recorded for objective evaluation. Effectiveness of anesthesia was checked using subjective symptoms and probing. RESULTS: Palatal anesthesia with buccal infiltration could not be obtained in any of the groups. Statistically significantly higher MBPS pain scale values were seen with lidocaine as compared to articaine. FPS, heart rate, and blood pressure values presented no statistically significant difference in the two groups. CONCLUSIONS: Although buccal infiltration with articaine failed to provide adequate palatal anesthesia, it can still be considered a good alternative to lidocaine for local anesthesia in children.

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AIM: To assess the acceptance and efficacy of aerosolized midazolam through buccal mucosa for conscious sedation. METHODS: Thirty-five children aged 2-6 years with Grade I and II Frankl behavior rating scale were selected for various dental procedures under local anesthesia. Initially behavior-shaping procedures were used and Houpt behavior scoring was recorded. Thereafter, midazolam was administered using a spray through buccal mucosa and scores for acceptance of drug and behavior after sedation were recorded. The data were compiled and a Wilcoxon signed ranks test was used to assess the difference in behavior before and after the sedation. RESULTS: Eighty-three percent of the patients accepted the drug without any complaint. A statistically significant improvement was seen in the Houpt scores before and after drug administration (P < 0.001). CONCLUSIONS: Buccal aerosolized midazolam can be used successfully for pediatric conscious sedation.

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Special and medically compromised patients present a unique population that challenges the dentist's skill and knowledge. Providing oral care to people with cerebral palsy (CP) requires adaptation of the skills we use everyday. In fact, most people with mild or moderate forms of CP can be treated successfully in the general practice setting. This article is to review various dental considerations and management of a CP patient. How to cite this article: Sehrawat N, Marwaha M, Bansal K, Chopra R. Cerebral Palsy: A Dental Update. Int J Clin Pediatr Dent 2014;7(2):109-118.

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BACKGROUND AND AIMS: Oral health is an essential component of health throughout life. Hardly any information is available on the oral health status of children in Gurgaon. Thus, the present study was conducted among 5-year-old and 12-years-old children in schools in rural Gurgaon. MATERIALS AND METHODS: A total of 1003 children were examined of which 619 were in 5 years age group and 384 in 12 years group. The prevalence of dental caries was studied using dentition status and treatment needs index. For dental calculus criteria of Community Periodontal and for dental fluorosis Dean's index was used. RESULTS: In 5 years age group prevalence of dental caries was 68.5%, dental fluorosis was 22.5% and treatment needs were 63.7%. In 12 year age group prevalence of dental caries was 37.5%, dental fluorosis was 76.04%, highest community periodontal index score was 2, seen in 80.2% and overall treatment needs were 44.3%. CONCLUSION: Preventive approaches seem to be a viable alternative to tackle the overwhelming problem of dental caries and other oral diseases. Provision of oral health education in schools and school based preventive programs are important for improvement of this situation.

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INTRODUCTION: Antimicrobial resistance is a growing problem that is likely to have a major negative impact on healthcare in the future. Dentists have a key role in ensuring that antimicrobials are prescribed correctly to reduce the emergence of resistant strains. OBJECTIVE: To audit how appropriately antimicrobials were prescribed in the oral surgery acute dental department of Guy's Hospital in London, when compared to the standards set within the Faculty of General Dental Practice (UK) and Scottish Dental Clinical Effectiveness guidelines on antimicrobial prescribing in dentistry. TARGET: 100% compliance. METHOD: A prospective audit consisting of two cycles (each including 60 patients) was carried out. Between each cycle, there was a two-month intervention period, which included extensive training and education of staff and students. RESULTS: Cycle 1 showed that only 30% of prescriptions were appropriate and only 62% of practitioners were recording a diagnosis. After two months of intervention, cycle 2 was carried out; this showed a significant improvement, with 80% of prescriptions being appropriate and 100% of practitioners recording a diagnosis. The majority of inappropriate prescriptions in both cycles were for acute pulpitis without evidence of systemic involvement. CONCLUSION: This audit has shown that clinical practice for antimicrobial prescribing did not follow the published guidelines. Following targeted interventions, a substantial improvement was made in the prescribing pattern. The target of 100% has not been reached, necessitating further intervention.

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