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Background: Administering anesthesia in dentistry can be distressing for patients, especially those with dental fear and anxiety. Needle pain during local anesthesia is a common concern in intraoral procedures. This study aimed to compare pain perception in 4-6-year-old children following intraoral dental injections with 26- and 31-gauge needles. Methods: Fifty healthy children were divided according to age into Group I (N = 25; 4-5 years) and Group II (N = 25; 5-6 years). Each group was further subdivided according to the needle gauge as follows: Group IA (26 gauge), Group IB (31 gauge), Group IIA (26 gauge), and Group IIB (31 gauge). Using a lottery method, the gauge of the needle to be used at the first visit for local anesthesia administration was selected. Children's reactions to pain were evaluated using a Modified Behavioral Pain Scale. Immediately after administration of local anesthesia, pain perception was evaluated using the Faces pain rating scale. In the subsequent visit, another needle gauge was used to administer local anesthesia, and the previously described evaluations were performed. At the third appointment, the child was shown both syringes and asked to choose one of the syringes they preferred, and the choice was noted. Results: When local anesthesia was administered using a 31-gauge needle, pain perception was similar between the two groups. In group II, the children demonstrated significantly higher arm and leg movements (P = 0.001). However, the difference was significant in group I alone (P < 0.001). Conclusion: Irrespective of age, anesthesia with a 31-gauge needle resulted in significantly lower pain perception than anesthesia with a 26-gauge needle.

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BACKGROUND: The advent of Highly Active Anti-Retroviral Therapy (HAART) does influence the overall oral health care of children. The children undergoing HAART have shown an increase in caries activity owing to sugars in medicines to make them more palatable. AIM: The aim of the study was to assess and compare the Oral Health of Children Living with HIV/AIDS (CLHAs) and Adolescents Living with HIV/AIDS (ALHAs) undergoing HAART and those who are HAART-naïve. METHODS: This study was carried out at different Non-Governmental Organizations (NGO's) across Kerala, India. The study group consisted of 150 HIV-infected children aged 6-18 years. They were divided into two groups. Group 1 comprised of children prior to onset of HAART and Group 2 included children who had been on HAART for more than 3 years (HAART naïve). The assessment of dental caries status and dental plaque status was done. The observations were tabulated and statistically analyzed. RESULTS: On Statistical Analysis, significant difference was noted between the groups with the Group 1(2.26 ± 0.58;p value = .000* ) showing higher scores of dental plaque and a significant difference was also observed with respect to dental caries scores with DMFT and dmft scores higher in Group 2(dmft 2.08 ± 2.85; p value = .001* and DMFT 4.10 ± 1.71;p value = .003*). CONCLUSION: It was concluded that oral hygiene conditions were poor in children with HIV, with dental plaque scores more in HAART-naïve which may be due to their lesser visits and reinforcements regarding oral hygiene from a dentist and dental caries score more in HAART group, this may be attributed to the hidden sugars present in HAART medications to make it more palatable. Early recognition and management of oral conditions are important to improve the quality of life for these children.

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OBJECTIVES: Increased demand for esthetics by parents and children has resulted in the use of tooth-colored restorative materials. Children with chronic respiratory conditions like asthma use inhalers which have shown to affect the surface of restorative materials. Hence, the aim of the present study was to evaluate the effect of antiasthmatic inhalers on color stability and surface roughness of three restorative materials. MATERIALS AND METHODS: Forty samples each of three dental restorative materials: group A: glass ionomer cement (GIC), group B: alkasite restorative material, and group C: composite resins were prepared. Each group was further divided into two subgroups of 20 samples each according to the inhaler used. All the specimens were polished using polishing discs and stored in artificial saliva in order to simulate the oral environment. The baseline color value and surface roughness of all the samples were measured using a spectrophotometer and a profilometer, respectively. Group 1 and group 2 were exposed to 0.31 mg of salbutamol sulfate and 20 mg formoterol fumarate in combination with budesonide, respectively, for every 12 hours, for a period of 15 days following which the samples were evaluated for color changes and surface roughness. STATISTICAL ANALYSIS: The data obtained was subjected to statistical analysis and level of significance was set at p < 0.05. RESULTS: Exposure to both the inhalers caused a change in color and surface roughness in all three restorative materials. There was a significant change in the color of GIC and composite resin (ΔE > 3.3), following exposure to both the inhalers (p < 0.05). The change in color of alkasite restorative material was not significant. A significant increase in the surface roughness of composite resin from 0.56 ± 0.14 to 0.67 ± 0.19 was seen following 15 days' exposure to formoterol in combination with budesonide inhaler (p < 0.05). CONCLUSION: Following exposure, both the inhalers had an equal effect on color and surface roughness of all three restorative materials. Alkasite restorative material showed greater resistance to change in color and surface roughness when exposed to antiasthmatic inhalers, compared to GIC and composite resin. Thus, children who use inhalers and nebulizers should be advised to implement more precautionary oral hygiene measures and periodic dental visits.

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Background: Hearing impairment affects communication and oral hygiene practices. Aim: To determine the effect of dental education and motivation on oral health-related quality of life (OHRQoL) and oral hygiene in children and adolescents with hearing impairment. Materials and methods: Ninety children aged 8-16 years were selected from a special school of hearing impaired. Their OHRQoL was assessed using child oral health impact profile short form (COHIP-SF) at baseline and at 12 months. Oral hygiene was assessed using Silness and Loe plaque index and Loe and Silness gingival index. Oral health education followed by motivational sessions once a month was carried out for 12 months. Data was statistically analyzed using student paired t-test and Karl Pearson correlation test. Level of significance was considered as 5%. Results: COHIP score showed a significant improvement from 39.7 at baseline to 48.0 at 12 months (p < 0.05). A significant reduction was seen in plaque (p = 0.002) and gingival inflammation (p < 0.05) at 6 and 12 months. An inverse relation was seen between the COHIP score and gingival health. Conclusion: OHRQoL of children and adolescents with hearing impairment significantly improved from baseline to 12 months. How to cite this article: Manohar PS, Subramaniam P. Oral Health-related Quality of Life and Oral Hygiene of Children and Adolescents with Hearing Impairment. Int J Clin Pediatr Dent 2022;15(3):311-315.

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Aim: The present in vivo study aims to evaluate and compare the clinical efficacy and survival rate of resin-based composite sealant (Clinpro Sealant, 3M ESPE, Irvine, California, United States of America) with high viscosity glass ionomer (GI) (Equia Forte, GC India, Patancheru, Telangana, India) using atraumatic restorative treatment (ART) sealant protocol in primary molars. Materials and methods: The design of the study was a clinical, prospective split-mouth study. A total of 100 contralateral primary molars were selected and divided into two groups. In group I, children received Equia Forte, and in group II, children received Clinpro Sealant. The follow-up examinations were performed in the 1st and 6th months. Simonsen's criteria were used to check for retention. International Caries Assessment and Detection System II (ICDAS II) criteria were used to check for dental caries. The data obtained were subjected to statistical analysis. Results: At 6 months, there was no statistically significant difference between the groups with regard to retention and caries preventive effect. Conclusions: High-viscosity GI sealants can be applied using the ART protocol and provide an alternative to resin-based sealants. Clinical significance: There is a limited number of studies on the performance of ART sealants in primary molars. Thus, the clinical efficacy and survival rate of resin-based composite sealant (Clinpro Sealant, 3M ESPE, Irvine, California, United States of America) with high viscosity GI (Equia Forte, GC India, Patancheru, Telangana, India) using ART sealant protocol in primary molars were evaluated. The research concluded that high-viscosity GI sealants using ART protocol are effective sealants in primary molars. How to cite this article: Kaverikana K, Vojjala B, Subramaniam P. Comparison of Clinical Efficacy of Glass Ionomer-based Sealant using ART Protocol and Resin-based Sealant on Primary Molars in Children. Int J Clin Pediatr Dent 2022;15(6):724-728.

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Background: Preservation of pulpal vitality is of paramount importance as the vital functioning pulp is capable of initiating a unique reparative capacity. The present study aimed to evaluate and compare four regenerative materials for pulpotomy in primary molars. Materials and Methods: This in vivo study included a total of 120 primary molars from 30 healthy children aged 3-9 years for regenerative pulpotomy procedure. The teeth were then divided by the lottery method (chits with names of materials on it) into four groups so that each child received all four of the regenerative materials; Group 1: Biodentine (BD)™, Group II: Mineral Trioxide Aggregate Plus (MTA Plus™), Group III: Retro MTA (Retro MTA®), and Group IV: Calcium Enriched Mixture (CEM) cement. All the primary molars (1st/2nd molars) were evaluated clinically and radiographically at 6, 12, 18, and 24 months. Data were subjected to the statistical analysis using the Chi-square test. The level of significance was considered as P < 0.05. Results: Clinical evaluation showed 100% success with BD™ and CEM cement; whereas 96.2% success was seen with MTA Plus™ and Retro MTA®. On radiographic evaluation, MTA Plus™ and CEM cement showed 96.2% success, whereas BD™ and Retro MTA® showed 92.59% success rate. Conclusion: All four regenerative materials showed high success in the pulpotomy of primary molars.

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Orofacial granulomatosis (OFG) is an uncommon condition with varying clinical presentation. Gingival enlargement in children could be due to a varied etiology. The present case report is of an adolescent female with initial presentation of generalized gingival enlargement, lip swelling and perioral discoloration without any known etiopathological factors or systemic involvement. Conservative excision of the enlargement was performed and histopathological examination revealed a non caseating granulomatous lesion. Diagnosis of orofacial granulomatosis in context to sarcoidosis was arrived after excluding other granulomatous diseases. Follow up after 18 months showed no recurrence and regression of lip swelling and perioral discoloration. Gingival enlargement can be considered as one of the presenting features of sarcoidosis.

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AIM AND OBJECTIVE: To assess the efficacy of an innovative vibrating device and compare it with the conventional method in reducing discomfort during the administration of local anesthesia. MATERIALS AND METHODS: Forty children in the age-group of 4-8 years requiring local anesthesia for routine dental procedures were allocated to either a control or experimental group, with 20 children in each group. The preoperative assessment of behavior was carried out using the Frankl Behavior Rating Scale. Both groups received local anesthesia using the intraoral conventional approach. However, in the experimental group, a vibrating device was simultaneously placed over the cheek during local anesthesia administration. The SEM (sounds, eyes, motor) scale was used to assess the level of comfort or pain during the administration of local anesthesia. Data were subjected to statistical analysis and the level of significance was considered at 5%. RESULTS: The mean SEM score in the control group was 6.65 ± 21.95 which was significantly higher than 3.80 ± 1.15 in the experimental group (p < 0.001). CONCLUSION: The vibrating device was useful and effective in reducing pain and discomfort during intraoral local anesthesia administration. HOW TO CITE THIS ARTICLE: Subramaniam P, Ghai SK. Efficacy of an Innovative Device in Reducing Discomfort during Local Anesthesia Administration in Children: A Clinical Study. Int J Clin Pediatr Dent 2021;14(3):353-356.

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BACKGROUND AND OBJECTIVES: Role of salivary zinc to dental caries and body weight has not been studied extensively in children. The aim of the present study was to evaluate the relationship between salivary zinc and caries in overweight/obese Indian children. STUDY DESIGN: One hundred and sixty children aged 8-12 years of both genders were divided into two groups of eighty each based on their body mass index into normal weight and overweight/obese. Each child was assessed for their caries experience in primary and permanent dentition. Unstimulated salivary samples were collected from each child to estimate zinc levels by atomic absorption spectrophotometer. Data was subjected to statistical analysis. RESULTS: The mean caries score among the overweight/obese children was 2.2±3.9 and 0.7±1.5 in the primary and permanent dentition respectively compared to the 2.0±2.6 and 0.2±0.5 respectively among normal weight children. Mean salivary zinc levels in overweight/obese children were 0.36±0.27 ppm compared to normal weight children of 0.81±0.46 ppm. CONCLUSION: Overweight/obese children demonstrated significantly lower salivary zinc levels and higher caries experience in permanent dentition. Salivary zinc levels showed a positive but weak association to caries in permanent dentition in both groups. Salivary zinc levels showed a negative non-significant correlation to caries in primary dentition among the children with higher BMI.

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Background: In early childhood due to dental neglect, children suffer from multiple decayed teeth and experience pain, interfering with their daily activities. This study aimed to assess Oral Health Related Quality of Life (OHRQoL) of preschool children in urban and rural Bangalore, and to correlate it with their dental caries status. Study design: Oral health examination of 1545 preschool children, aged 3 to 5 years were selected from urban and rural Bangalore. The parents answered the Oral Health-Related Early Childhood Quality of Life OH-ECQOL proforma on OHRQoL of their children. Results: The mean OHRQoL of urban preschool children was 17.86 and was significantly different from 20.42 of rural preschool children. (p<0.001). The mean deft score was 2.60±2.26 in rural preschool children and it was significantly higher than 1.92±2.05 seen in urban preschool children (p< 0.001). A significant correlation was seen between dental caries (deft) and OHRQoL in urban preschool children (p=0.04). Their OHRQoL was significantly associated with the 'decayed' component.(p=0.03) Multiple regression analysis showed OHRQoL to be significantly associated with dental caries. Conclusion: OHRQoL among preschool children living in urban Bangalore was found to be better than those in rural Bangalore.

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CONTEXT: Enamel erosion is manifested as partial demineralization occurring at the enamel surface leading to increased surface roughness. Diets comprising milk, cereals, and millets are frequently fed to infants and toddlers. These foods are prepared so as to make them soft in texture, palatable, and easy to ingest. AIM: To determine the erosive effect of milk, honey, and porridges made from cereal and millet on primary tooth enamel. SETTINGS AND DESIGN: Exfoliated caries-free primary teeth were collected, and a total of 50 longitudinal sections were prepared. They were equally divided into five groups of 10 samples each. MATERIALS AND METHODS: Each group was incubated in milk, honey, cereal porridge, millet porridge, or saliva for 30 min. Subsequently the samples were washed and incubated at 37°C in saliva for 2 h. This cycle was repeated five times. The samples were gold sputter coated, and surface roughness was measured using optical profilometry. Saliva samples were evaluated for calcium release using dry chemistry method. The pH of foods and titratable acidity were also estimated. STATISTICAL ANALYSIS USED: One way analysis of variance and Tukey's post hoc test. RESULTS: The mean surface roughness value, Ra (µm), obtained with millet porridge was 6.0175 ± 0.54 µm, which was significantly higher than cereal porridge, honey, and milk (P < 0.05). Calcium release in saliva was highest with honey (>14 mg/dL) and it also exhibited the lowest pH (4.33). CONCLUSION: Porridges prepared from millet and brown rice cereals were seen to have an erosive effect on the enamel of primary teeth.

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Aim: This preliminary study aimed to estimate and correlate the relationship between salivary flow rate and levels of salivary triglycerides, cholesterol and total lipids in children with and without early childhood caries. Study design: Ninety children aged 3 - 6 years were divided into three groups of 30 each based on their decayed missing filled tooth (dmft) score, group I (dmft score = 0), group II (dmft score ≥4 and ≤ 9) and group III (dmft scores ≥ 10). Whole unstimulated saliva was collected in a sterile graduated cup over a period of 5 minutes and was quantitatively analyzed for levels of salivary triglycerides, cholesterol and total lipids. Data obtained was subjected to statistical analysis by one way ANOVA, Post-Hoc tukey and Pearson's correlation test. Results: Salivary flow rate was 1.20±0.36, 1.01±0.37 and 0.86±0.31 ml/min in group I, II and III respectively. The mean levels of salivary triglycerides in group I, II and III was 3.57±0.43mg/ml, 6.11±1.70mg/ml and 6.03±1.73 mg/ml, respectively. The mean levels of salivary total lipids were higher in group II and III, ie 22.51±2.87 mg/ml and 22.68±2.54 mg/ml respectively. The mean level of salivary cholesterol was highest in group III (8.03±2.91 mg/ml). Salivary triglycerides and total lipids showed a significant positive correlation with dmft scores of children (p≤ 0.001). Salivary cholesterol also had a positive association with dental caries experience of children but was not significant. There was a negative correlation between salivary flow rate and levels of salivary triglycerides, cholesterol and total lipids. Conclusion: Children with ECC (group II and III) had lower salivary flow rate and higher levels of salivary triglycerides and total lipids compared to caries free children (group I). Levels of salivary cholesterol did not differ between caries free and children with ECC.

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OBJECTIVE: Dental caries is both an infectious and transmissible disease. Maternal transfer of Mutans Streptococci occurs at an early age and is important in the initiation of dental caries in children. The aim of this study was to identify certain strains of Streptococcus mutans in mother-child pairs, of children with early childhood caries. STUDY DESIGN: Sixty mother-child pairs of healthy children aged 18-36 months were selected. Mothers with high levels of Streptococcus mutans in their saliva and only children with ECC were included. Dental plaque samples were collected from mother-child pairs. The plaque samples were stored, transferred to the laboratory and analyzed for Streptococcus mutans strains c, f, e and k, present in mother-child pairs using Real time Polymerase Chain Reaction (PCR) technique. Data obtained was subjected to statistical analysis for level of similarity in Streptococcus mutans strains present in mother-child pairs. RESULTS: A similar distribution of Streptococcus mutans strains c, f and k was identified in 28 mother-child pairs. Streptococcus mutans strain e was seen in 18 pairs. CONCLUSION: Less than 50% of mother-child pairs showed similarity in distribution of Streptococcus mutans strains.

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Background Diabetes mellitus is a metabolic disorder. However, dental caries and periodontal health have not attracted much interest in diabetic patients. This study was carried out to assess the dental caries status and gingival health status in children with type 1 diabetes mellitus (T1DM). Methods The study group consisted of 80 children, aged 6-18 years, with T1DM. The dental caries status was recorded using the World Health Organisation (WHO) criteria. Gingival health was assessed using the Loe and Silness gingival index (GI). Data obtained were subjected to statistical analysis. Results The mean dental caries status for primary (decayed, extracted, filled teeth [deft]) and permanent dentition (decayed, missing, filled teeth [DMFT]) scores in diabetic children were 0.44±1.28 and 1.26±2.49, respectively. The GI scores of diabetic children were 0.33±0.48. GI in the study group significantly correlated with DMFT (p<0.001) and deft (p≤0.05). Conclusions Dental caries in primary dentition was lower in diabetic children but was not statistically significant, whereas dental caries in permanent dentition was significantly higher. The gingival condition of diabetic children was healthy.

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BACKGROUND: Conscious sedation is used in the pediatric dentistry to reduce fear and anxiety in children and promote favorable treatment outcomes. To achieve them, the primary clinical need is for a well-tolerated, effective, and expedient analgesic and sedative agent that is safe to use. AIM: The aim of the present study was to evaluate the efficacy of nitrous oxide-oxygen and triclofos sodium as conscious sedative agents in 5-10-year-old children. METHODOLOGY: Sixty children aged 5-10 years showing anxious, uncooperative, and apprehensive behavior were randomly divided and assigned into two groups (Groups A and B) such that Group A received 40% nitrous oxide-60% oxygen and Group B received triclofos sodium in the dose of 70 mg/kg body weight, given 30 min before the treatment procedure. During the whole course of sedation procedure, the response of the child was assessed using Houpt's behavior rating scale. The acceptance of route of drug administration by the patient and parent was also assessed. Data obtained were statistically evaluated using the Mann-Whitney U-test and Chi-square test. RESULTS: Children sedated with triclofos sodium were significantly more drowsy and disoriented compared to those sedated with nitrous oxide. The overall behavior of children in both the groups was similar. Good parental acceptance was observed for both the routes of administration. Patients accepted the oral route significantly better than inhalation route. CONCLUSION: Both nitrous oxide-oxygen and triclofos sodium were observed to be effective sedative agents, for successful and safe use in 5-10-year-old dental patients. Patients showed a good acceptance of the oral route compared to the inhalation route for sedation.

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OBJECTIVE: This study aimed to evaluate the levels of salivary IgA, amylase, lactoferrin, and lysozyme before and after comprehensive dental treatment in children with early childhood caries. DESIGN: Thirty children aged 36-60 months, with a deft score ≥5, were selected for the study. Before dental treatment, paraffin-stimulated whole saliva was collected in a sterile graduated cup for a period of 5 min. The saliva samples were quantitatively analyzed for levels of IgA, amylase, lactoferrin, and lysozyme using enzyme-linked immunosorbent assay. Comprehensive dental treatment was carried out in all the children including caries preventive procedures. A second sample of saliva was collected at 3 months following completion of dental treatment. Data obtained was subjected to statistical analysis using Student's t-test. RESULTS: The mean levels of salivary IgA was significantly reduced from 59.60 µg/ml to 56.42 µg/ml after dental treatment (P < 0.05). There was a significant reduction in the levels of salivary amylase from 115.78 µg/ml to 113.33 µg/ml (P < 0.001). Following dental treatment, salivary lactoferrin and lysozyme levels were significantly reduced from 3.76 µg/ml and 10.62 µg/ml to 3.44 µg/ml and 10.27 µg/ml, respectively (P < 0.001). CONCLUSIONS: Levels of salivary IgA, amylase, lactoferrin, and lysozyme were reduced significantly at 3 months following comprehensive dental treatment.

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BACKGROUND: Molar incisor hypomineralization (MIH) is a developmental defect. The prevalence of MIH ranges widely from 2.4% to 40.2%. AIM: This study was under taken to determine the prevalence of MIH in 7-9-year-old children of Bengaluru City, India. MATERIALS AND METHODS: A cross-sectional epidemiological study was conducted in a representative sample of 2500 school children aged 7-9 years of Bengaluru, India. Oral examination was carried out by a single trained calibrated examiner under natural daylight. RESULTS: Twelve children (0.48%) were diagnosed with MIH. A total of 68 teeth were observed with MIH. All four first permanent molars were affected in 50% of children. In the molar group, mandibular molars (29.41%) were more frequently affected than maxillary molars (27.94%). CONCLUSION: The prevalence of MIH in 7-9-year-old children of Bengaluru was 0.48%, with no gender predilection.

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AIM: The present SEM study was undertaken to evaluate the effect of root canal instrumentation using both manual and rotary files in the root canals of primary anterior teeth. STUDY DESIGN: Thirty freshly extracted primary maxillary incisors were divided into 3 groups of 10 teeth each. In Group I, root canals were instrumented with rotary NiTi files; in Group II, the root canals were instrumented using manual NiTi K files and; in Group III, manual instrumentation was done with stainless steel K files. Longitudinal sections were prepared and processed for observation under SEM at the coronal, middle and apical thirds. Scoring of smear layer was done according to Hulsmann and the data obtained was subjected to statistical analysis. RESULTS: Rotary files cleaned the coronal and middle thirds of root canals more effectively. Statistically there was no significant difference between the groups. Lowest score of 2.6 in the apical third of root canals was seen with hand NiTi files. CONCLUSION: Rotary instrumentation was as effective as manual instrumentation in removal of smear layer in the root canals of primary anterior teeth.

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Introduction: Marginal seal integrity is important for a successful adhesive dental restoration. Alterations caused by laser irradiation in the enamel and dentin surface can affect the marginal integrity of adhesive restorations. The aim of this study was to evaluate the microleakage of a composite resin restoration in primary teeth following laser irradiation of enamel and dentin. Methods: Forty freshly extracted sound human primary maxillary and mandibular anterior teeth were used in this study. The teeth were randomly divided into two groups (I and II), with 20 teeth in each. In group I, proximal cavities (Class III) were prepared using an airotor hand -piece and diamond bur. The cavities were etched for 15 seconds with 35% phosphoric acid gel, rinsed with water for 15 seconds, air dried and a bonding agent was applied onto the cavity surfaces and light cured for 20 seconds. The cavities were restored with composite resin and light cured for 40 seconds. In group II, proximal (Class III) cavities were prepared using Erbium, Chromium: Yttrium Scandium Gallium Garnet (Er,Cr:YSGG) (Er,Cr:YSGG) (Biolaseiplus, wave length 2.78 µm). The cavity was then rinsed, air dried and without etching, a bonding agent was applied and light cured for 20 seconds. The cavities were restored in the same manner as that of group I. The treated teeth were mounted on acrylic resin blocks and were subjected to a thermocycling regimen. Following, the teeth were immersed in 2% methylene blue for 24 hours. The teeth were sectioned longitudinally in a bucco-lingual direction using a diamond disc at slow speed. The sections of all the groups were examined under a stereomicroscope for micro-leakage. Results: The mean scores for microleakage in group I was 1.95 ± 1.31 and in group II it was 1.4 ± 1.27. There was no significant difference between the two groups (P = 0.882). Conclusion: No significant difference in microleakage was noticed between the composite resin bonded to lased enamel and dentin and the teeth preparedwith conventional method.

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Garrè's sclerosing osteomyelitis is a specific type of chronic osteomyelitis that mainly affects children and young adults and is commonly associated with odontogenic infection. The paper describes an unusual case of Garrè's osteomyelitis in an 11-year-old boy, in whom the condition arose following poor oral hygiene and periodontal problems in relation to permanent mandibular left first molar. Clinically the patient presented with bony hard, nontender swelling and the occlusal radiograph revealed pathognomic feature of "onion skin" appearance.

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