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O manejo clínico em Odontopediatria é individual, podendo variar nas diversas culturas mundiais. O objetivo desta revisão de literatura é reunir as principais diretrizes de diferentes países ao redor do mundo, incluindo o Brasil, visando identificar como em cada lugar o uso das técnicas de comportamento são aplicadas e sua eficiência. Inicialmente, foram selecionados os principais guias nacionais e internacionais, sendo eles retirados da Associação Internacional de Odontopediatria (IAPD) e Associação Americana de Odontopediatria (AAPD), além de artigos de diferentes países e continentes, como Argentina, Brasil, Europa e Ásia, também foram analisados se o protocolo dos principais guias estão condizentes com os protocolos do Departamento de Clínica Infantil da Faculdade de Odontologia de Ribeirão Preto - USP. Os resultados obtidos nos guias para manejo clínico odontológico brasileiro, americano, internacional e os artigos estudados recomendam inicialmente utilizar técnicas menos invasivas, com o intuito proporcionar um atendimento tranquilo e sem criar traumas para a criança, uma vez que muito do comportamento não cooperativo vem de experiências anteriores traumáticas. Entretanto, técnicas avançadas podem ser utilizadas para casos mais desafiadores. Concluímos com o estudo dos guias e artigos, que o cirurgião dentista possui diversas técnicas a serem aplicadas para que o atendimento infantil seja atraumático e restabelecer saúde ao paciente.

Clinical management in Pediatric Dentistry is individual and varies across different cultures around the world. The objective of this literature review is to bring together the main guidelines from different countries around the world, including Brazil, aiming to identify how the use of behavioral techniques are applied and their efficiency in each place. Initially, the main national and international guides were selected, taken from the International Association of Pediatric Dentistry (IAPD) and the American Association of Pediatric Dentistry (AAPD), as well as articles from different countries and continents, such as Argentina, Brazil, Europe and Asia, as well as It was analyzed whether the protocols of the main guides are consistent with the protocols of the Children's Clinic Department of the Faculty of Dentistry of Ribeirão Preto - USP. The results obtained in the guides for Brazilian, American and international dental clinical management and the articles studied recommend initially using less invasive techniques, with the aim of providing calm care and without creating trauma for the child, since much of the uncooperative behavior comes from previous traumatic experiences. However, advanced techniques can be used for more challenging cases. We conclude from studying the guides and articles that the dental surgeon has several techniques to be applied so that child care is atraumatic and restores health to the patient.

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BACKGROUND: The use of cone beam computed tomography (CBCT) for dentomaxillofacial diagnostics in pediatric dentistry is expanding and concerns have been raised about the radiation risks associated with this imaging modality, especially for children. Dentomaxillofacial paediatric imaging: an investigation towards low-dose radiation induced risks (DIMITRA) is a multidisciplinary project focused on optimizing CBCT exposure for children and adolescents. This study aims to clarify the indications behind CBCT scans in children aligned with DIMITRA's recommendations. METHODS: For each CBCT examination, data were collected on patient age at the time of the CBCT examination, gender, reason for request, referring department, CBCT-requested region, and the field of view (FOV) dimension of imaging. The CBCT indications were categorized under six headings according to an adaptation of the DIMITRA project recommendations: impacted teeth, dentoalveolar trauma, orofacial clefts, dental anomalies, bone pathology, syndromes. Indications not categorized in DIMITRA were recorded below the heading "other". RESULTS: The most common indication was the "other" category (34.8%), which included implant, temporomandibular joint dysfunction, orofacial anomalies, foreign object and root canal morphology. The least common indication was "orofacial cleft" (1.9%) and no requests were made for cases related to syndromes. Detection of supernumerary tooth in dental anomalies (68.6%) was the most common CBCT indication, while dentigerous cysts (37.6%) were among the most common CBCT indication in bone pathologies and orofacial anomalies (68.1%) in the other category. The most common size was External Center (15 × 15 cm) (27%) and the least common size was Both Arches/small (8 × 8 cm) (0.4%) when the CBCT FOV was analysed. CONCLUSIONS: Although the option of a smaller FOV size was available, the larger FOV size that included the both jaws were most frequently used. When justifying CBCT requests, patient-specific radiation dose risks should be considered and specific guidelines should be followed.

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Purpose: Children's fear of the injection of local anesthetic agents affects their cooperation in pediatric dentistry. Different techniques are available to decrease the injection pain, including the use of precooling agents or vibrators. The present study investigated the effectiveness of Buzzy (Buzzy MMJ Labs, Atlanta, GA, USA). This device transfers cold and external vibration to the injection site during the inferior alveolar nerve block (IANB) injection. Materials and Methods: The present self-control, randomized, and double-blind clinical trial evaluated 30 children aged 6-12, who had bilateral mandibular permanent or primary carious molar teeth. On one side, the BUZZY was applied before and during the IANB injection, and the other side was considered as control. On both sides, a topical anesthetic gel was applied before injection. The pain severity and children's anxiety were determined using Wong-Baker, face, leg, activity, cry, consolability (FLACC) scales, and the heart rate. Results: The mean age of the participants was 7.18 ± 1.5 years, with 12 girls and 18 boys. The Wong-Baker scale and FLACC scale did not show any statistically significant difference between BUZZY and control (p value = 0.9 and 0.15, respectively). In addition, BUZZY tool did not significantly decrease pain and anxiety during injection, assessed through the heart rate difference (p=0.38). Conclusion: Under the limitations of the present study, a combination of precooling and vibration using the BUZZY device did not decrease pain and anxiety in children during the IANB injection.

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Advancements in 3D printing technology are providing a new direction in pediatric dentistry by offering innovative solutions to traditional challenges. The remarkable expansion of 3D printing necessitates a comprehensive examination of its status and applications in the dental field, particularly in the pediatric dentistry. This review provides a comprehensive exploration of the applications of 3D printing in pediatric dental practices by drawing from a systematic search across databases, including PubMed/MEDLINE, Scopus, Web of Science, Scielo and the Cochrane Library. The search strategy employed a combination of keywords: "Digital dentistry and 3D printing", "3D printing technology in dentistry", "3D printing in pediatric dentistry" and "3D printing in pediatric dental procedures". The review encompasses a wide array of studies, including original research, cross-sectional analyses, case reports and reviews. A detailed overview is presented in regard to the use of 3D printing for master and educational models, space maintainers, prosthetic restorations, surgical guide, splint design and fracture treatment, fluoride application, autogenous dental transplantation, anterior teeth restoration, and pediatric endodontics and regenerative treatments. This review shows that 3D printing improves clinical outcomes through personalized and precise treatment options and enhances dental students' educational landscape. Areas lacking extensive research were also identified, which warrent further investigation to optimize the integration of 3D printing in pediatric dentistry. By mapping out the current landscape and future directions, the aim of this paper is to support pediatric dentists in recognizing the broad implications of 3D printing for improving patient care and advancing dental education.

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There is evidence that antibiotics are sometimes prescribed inappropriately by dental practitioners, which can lead to undesirable outcomes. This study aimed to assess the impact of a clinical audit on antibiotic prescribing practices at Taibah University Dental Hospital in Madina, Saudi Arabia. The study retrospectively analyzed antibiotic-prescribing data for pediatric patients by dental interns and faculty members over a period of 8-months. The data collected revealed that inappropriate antibiotic prescription was prevalent initially, with a total of 119 antibiotic-prescriptions issued. After implementing an action plan that included the use of guidelines and educational sessions, a second cycle of the audit was conducted over a 4-month period. During the second cycle, the number of antibiotic prescriptions significantly decreased to 58, indicating a reduction of 48%. Across both cycles, amoxicillin emerged as the most frequently prescribed antibiotic, closely followed by Augmentin. Notably, pulpal diseases and peri-radical complications were consistently ranked as the conditions with the highest number of antibiotic prescriptions in both study periods. The results suggest that the clinical audit, along with the implementation of guidelines and educational sessions, had a positive impact on antibiotic prescribing practices at Taibah University Dental Hospital, leading to a significant reduction in inappropriate antibiotic prescriptions.

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OBJECTIVES: This study assesses the needs and feasibility of conducting a produce prescription (produce Rx) program in a pediatric dental clinic setting serving low-income patients. METHODS: We conducted a cross-sectional quantitative survey examining several household characteristics including demographics, benefits received, fruit and vegetable intake patterns, food security, feasibility of a produce Rx program, and respondents' answers to questions based on social cognitive theory constructs. The survey was administered at the University of Nebraska Medical Center (UNMC) pediatric dental clinic, a pediatric dental residency clinical training site. One hundred adult respondents with low income completed a 36-item questionnaire during their child's dental appointment. RESULTS: Almost half of respondents reported experiencing food insecurity (45%). Respondents who were food insecure experienced higher levels of nutrition insecurity (p = 0.012), less confidence in choosing fruits and vegetables (FVs) (p = 0.026), difficulty in purchasing FVs in their neighborhood (p = 0.012), and more concern that FVs cost too much (p < 0.001) when compared to respondents who were food secure. Notwithstanding the barriers they face, almost all respondents reported that they eat FVs because of health benefits (95%) and to set a good example for their family (91%). Additionally, most respondents expressed an interest in produce Rx programs (80%) and nutrition education activities (81%). CONCLUSIONS: This study demonstrated the potential for produce Rx program uptake in a pediatric dental clinic setting through positive caregiver-reported need and interest. Future studies should explore how produce Rx programs can be adapted most effectively in this novel setting.

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BACKGROUND: Systematic reviews (SRs) represent the most robust source of evidence for informing decision-making. While there are rigorous protocols for properly conducting SRs, sometimes the methodological biases in the primary studies are accounted for in the conclusions of the SRs. OBJECTIVE: This study aimed to map the evidence regarding the management of caries lesions in primary teeth. METHODS: Two reviewers conducted a systematic search up to March 2024 in electronic data-bases. Any SR concerning the management of caries lesions in primary teeth was considered eli-gible. RESULTS: About 162 SRs were included. Among these, 80 focused on restorative treatments, 64 on endodontic treatments, and 18 on non-invasive treatments. Only 42.6% presented a study registra-tion protocol. The majority (67.9%) performed a meta-analysis, while a minority exclusively car-ried out qualitative data analysis. Despite 92.6% of the SRs evaluating the methodological quality or risk of bias of the primary studies using some tool, only 24% assessed the certainty of evidence using the GRADE approach, resulting in classifications ranging from very low to moderate. CONCLUSION: There is a limited adherence to study registration protocols, indicating a need for improvements in this practice. Additionally, among the few SRs that used the GRADE approach, the majority demonstrated levels of very low to moderate certainty.

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Background Dental fear and anxiety are significant issues among pediatric patients, often complicating dental treatments. Various tools measure these emotional responses, including subjective scales such as the Visual Facial Anxiety Scale (VFAS) and Children Fear Scale (CFS), and objective scales such as Venham's Anxiety Scale (VAS) and Frankl Behavior Rating Scale (FBRS). This study explores the association between these measures in children subjected to brainwave entrainment (BWE) therapy. This study aimed to evaluate the association between subjective and objective fear and anxiety measures in pediatric dental patients within both the brainwave entrainment (BWE) intervention group and control group. Methods This randomized controlled trial included pediatric participants aged seven to 12 years reporting to the department for dental treatment. Participants were randomized into two following groups: an experimental group receiving BWE therapy and a control group receiving traditional behavioral management. Fear and anxiety levels were measured using subjective and objective scales before and after the intervention. Data were analyzed using Spearman's correlation to examine the associations between these scales, with statistical significance set at p<0.05. Results Post-intervention analysis revealed significant correlations between subjective and objective measures of fear and anxiety in both groups. In the BWE group (N=126), there was a moderate positive correlation between the VFAS and VAS (rho=0.540, p<0.001) and a strong negative correlation between the CFS and FBRS (rho=-0.666, p<0.001). The control group (N=126) showed stronger correlations, rho=0.778 for anxiety scales and rho=-0.817 for fear and behavior scales (p<0.001). Combined data analysis from both groups (N=252) confirmed strong correlations. Conclusion This study found a significant association between subjective and objective measures of fear and anxiety in pediatric dental patients within both the brainwave entrainment (BWE) intervention group and control group. Thereby proving that self-reporting behavioral scales are useful for quickly assessing anxiety in pediatric dental settings.

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INTRODUCTION: Malnutrition in children is epidemic in developing countries. Several health issues and consequences are believed to develop due to this phenomenon. Children's oral health is also affected by malnutrition. The main aspects of oral health status are caries experience, the existence of cariogenic bacteria, and salivary immunoglobulin A.

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Neonates with cleft palate exhibit a malformed maxillary arch since birth. Newborns with various types of clefts exhibit multiple issues, primarily associated with their feeding habits. Feeding these children is crucial, as evidence indicates that newborns with this congenital deformity exhibit a slower growth rate compared to those without this condition. To mitigate these challenges, the conventional line of treatment for these children is obturator therapy to facilitate sucking or feeding followed by various surgical procedures. The following case report describes a 2-day-old girl, who reported with her parents to the Department of Pediatric Dentistry, to seek treatment for congenital cleft present in her palate as it was interfering with her feeding habits. A feeding appliance was made with a direct technique to help the parents improve feeding habits. It also regulates milk flow by sealing the area separating the oral and nasal cavities. This feeding appliance is placed over the child's hard palate, creating a contact point that facilitates milk expression from the mother's mammary gland and making it easier for the neonate to compress the nipple. It shortens the time needed for feeding, eases feeding, and lessens nasal regurgitation.

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PURPOSE: To assess the impact of transformations in pediatric dental clinics following reopening during the COVID-19 pandemic on pediatric dentistry procedures performed by dental students. METHODS: Data were collected from electronic clinical records of Integrated Dental Clinical disciplines (I, II, III, and IV) from 2018 to 2023. The procedures were categorized into phases: prevention/stabilization, restorative/definitive, and maintenance. The data were analyzed descriptively and by t-test considering the pre-pandemic and pandemic periods (α = 5%). RESULTS: During the pandemic, Integrated Dental Clinics I and III saw increased prevention/stabilization procedures percentages (92.4% and 74.3%) compared to pre-pandemic (84.9% and 70%), while Integrated Dental Clinic II and IV saw a decline (76.6% and 66.1%) compared to pre-pandemic (79.1% and 67.9%). Restorative/definitive procedures decreased in Integrated Dental Clinic I and III (5.5% and 20.3%) from pre-pandemic period (10% and 24.1%) but increased in Integrated Dental Clinic II and IV (18.3% and 26.2%) from pre-pandemic (15.3% and 25%). Maintenance procedures decreased in Integrated Dental Clinic I, II, and III (2.1%, 5%, and 5.4%) compared to pre-pandemic (5.1%, 5.6%, and 6%), except for Integrated Dental Clinic IV, which saw an increase (7.8% from 7.2%). Despite the percentage changes, no significant differences were found between the periods analyzed (p > 0.05). However, when considering the total procedures across all disciplines and phases, there was a significant decrease during the pandemic in phases 1 and 3 (p < 0.05). CONCLUSION: Despite the changes in pediatric dentistry procedures, the transformations within the dental clinic suggest tangible benefits for the teaching-learning process and safe patient care.

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An eruption bulge is a swelling or an enlargement below the gumline due to the eruption of a tooth. Radiographic images would also illustrate the fact that there may be the presence of a successor tooth (unerupted or unimpacted) under the bulge of the gingiva. Teething refers to the sequence of growth and appearance of the primary as well as permanent teeth within the oral region that varies according to age. A tooth eruption bulge is a lump that occurs due to the eruption of the teeth in the gum tissue. The appearance of the bulge varies according to the amount of fluid or blood present in this engorged organ. It is important to focus on the fact that the dentist will always be able to notice any changes and solve the issue when it comes to the check-ups, which should take place on a regular basis. Parents need to be aware of the possible adverse effects of trauma on primary incisors on the eruption as well as the health of its permanent successors. They need to watch and tell about any oral changes or conditions their child may have, like pain, color change, and swelling as this may tell of something negative to their dentition. Such a condition can only be managed using a multi-disciplinary team that includes a pedodontist, an orthodontist, and in severe cases an oral surgeon who will have to deal with the long-term sequelae of dental trauma. This is why it is necessary to educate them on these matters because then they can be proactive.

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Background: The heart of childhood nurtures an array of immature emotions. Through this rollercoaster of childhood emotions, from tears to laughter, it is the sole responsibility of a pediatric dentist to help the children navigate through their emotions with their empathetic actions. Whenever a child is anxious or fearful in the dental chair, the child may put forth his emotion through crying or taking up a flight response. Dental caries is a disease that is aggravated when a child refuses to cooperate with dental treatment. The tiny holes in the tooth, when unfilled, may lead to bigger problems, which in turn may lead to tooth loss in future. It is the comprehensive responsibility of the pediatric dentist to support health and emotional development and provide a complete, fulfilling oral rehabilitation to the child patient. Aims and objectives: The purpose of this study was to determine the anxiety levels of pediatric patients visiting the dental Outpatient Department at a Dental College and Hospital in Kavalkinaru. This study unveils a novel technique wherein birds were used in the form of CHRIS'S Birds Assisted Therapy to reduce anxiety in pediatric dental patients. Results: Results showed that intervention with birds through CHRIS'S Birds Assisted Therapy significantly reduced the anxiety levels in children. Conclusion: Thus, CHRIS'S Birds Assisted Therapy is shown to be a promising method of anxiety control, a key to a successful pediatric dental practice. How to cite this article: Joybell C, Kumar K. Evaluating the Effectiveness of CHRIS'S Birds Assisted Therapy on Dental Anxiety among Pediatric Patients: A Pilot Study. Int J Clin Pediatr Dent 2024;17(S-1):S84-S94.

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Background: This randomized clinical trial (RCT) investigated whether hypnosis would lead to favorable outcomes in reducing anxiety, enhancing cooperation, and improving physiological responses in school-aged children undergoing tooth extraction compared to nitrous oxide/oxygen (N2O/O2) and conventional behavior guidance (CBG). Methods: Sixty-six school-aged children (mean age: 7.87 ± 1.18 years) who needed one posterior primary tooth extraction were included. Children with low-to-moderate anxiety were randomly divided into three groups (n = 22 each): hypnosis, N2O/O2, and CBG. Anxiety levels during and after anesthetic injection and tooth extraction were assessed using the Venham Clinical Anxiety Scale (VCAS) and the Venham Picture Test (VPT). Changes in heart rate (HR) and oxygen saturation (SpO2) were monitored. Children's cooperation levels were measured using the Venham Clinical Cooperation Scale (VCCS). Results: The VPT scores were significantly higher in the CBG group than in the N2O/O2 and hypnosis groups (p < 0.001). The VCAS scores in the N2O/O2 group were lower than those in the CBG group (p < 0.05) and were comparable to those in the hypnosis group. The VCCS scores were significantly higher in the CBG group than in the N2O/O2 and hypnosis groups (p < 0.05). HR changes in the N2O/O2 group were significantly lower than in the hypnosis and CBG groups (p < 0.05). No significant difference in pain was observed between the groups the day after the intervention. Conclusion: N2O/O2 inhalation and hypnosis are effective in reducing self-reported and observed anxiety and improving cooperation levels in pediatric patients during dental extraction. Moreover, the frequency of reported pain was lower in the hypnosis group compared to the other groups.

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PURPOSE: The present systematic review aims to summarize the current evidence regarding various treatment modalities and their results when dealing with hypersensitivity in teeth with Molar-Incisor Hypomineralization (MIH). METHODS: Systematic searches were conducted in PubMed and Scopus using the search terms "MIH AND Hypersensitivity AND treatment." Studies involving children aged 6-18 years diagnosed with MIH and exhibiting hypersensitivity were considered for inclusion. The outcomes examined included clinical, behavioral, and psychosocial treatment options for reducing hypersensitivity. A meta-analysis was performed for six of the included articles, and the I2 value was calculated to determine heterogeneity. RESULTS: A total of eight articles met the inclusion criteria for this review, with six eligible for the meta-analysis. Various treatment modalities, such as dental mousse, sealing, laser therapy, and crown therapy, demonstrated significant reductions in hypersensitivity individually (p < 0.05). CONCLUSION: The treatment methods that offer the most effective reduction in hypersensitivity are sealing with resin composite or glass ionomer cement for mild cases of MIH, while crown therapy is more effective for severe cases of MIH. However, the small number of participants and short follow-up times limit the strength of these conclusions.

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The objective of this article is to report the clinical case and 4-year follow-up of a 5-year-old child with multiple dental anomalies, emphasizing the importance of early diagnosis and use of combined pediatric surgery and orthodontic approaches. A 5-year-old boy, accompanied by his mother, sought dental care for dental caries and tooth pain. Clinical and radiographic examinations revealed active caries, a supernumerary primary tooth in the region of the mandibular right second premolar, and severe ankylosis of the primary mandibular right second molar. The treatment plan involved extraction of the supernumerary tooth as well as sectioning and extraction of the ankylosed molar. When the patient was 6 years old, the permanent mandibular right first molar showed signs of an altered eruptive process, and orthodontic treatment was initiated. A unilateral band-and-loop space maintainer with coil springs designed to move the permanent first molar was placed on the primary first molar. A new panoramic radiograph, obtained when the patient was aged 7 years, suggested the presence of an odontoma in the apical region of the primary maxillary right canine. Surgical removal and histopathologic examination of the lesion confirmed that it was a developing odontoma. After surgery, due to occlusal anomalies that included transverse maxillary deficiency, deep overbite, and midline deviation, the patient underwent rapid maxillary expansion therapy with a Haas-type appliance. When the patient was 8 years old, orthodontic treatment continued with a removable palatal Hawley expander and a orthodontic mandibular lingual arch. Currently, at the age of 9 years, the child is still undergoing fixed orthodontic treatment after surgical exposure of the impacted permanent maxillary right canine and bonding of an orthodontic attachment to enable traction. A multidisciplinary approach to the management of dental anomalies promotes a favorable prognosis and ensures comprehensive treatment of young patients.

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BACKGROUND: In dental extractions, particularly when local anesthesia is used, it usually offers analgesic relief for a few hours. However, pain can become a notable concern in the immediate postoperative period due to the trauma experienced by both soft and hard oral tissues. OBJECTIVES: This systematic review aimed to evaluate the most effective strategies for managing postoperative pain in primary tooth extractions. METHODS: Two examiners conducted a search across five electronic databases: MEDLINE (via PubMed), Embase, Scopus, Web of Science, CENTRAL, and OpenGray. Studies were included if they met the following criteria after reviewing their titles and abstracts: they involved children and evaluated pain management following primary tooth extraction. Subsequently, articles that described extractions performed under any form of sedation, were not conducted under local anesthesia, in an outpatient setting, and in children aged 0 to 12 years, or were not randomized controlled trials, were excluded. RESULTS: The search yielded 374 relevant articles, of which 9 were included. Among these, 5 utilized preoperative medications as a pain management strategy, one evaluated low-level laser therapy (LLLT) postoperatively, one assessed calendula drops postoperatively, and another explored virtual reality during the procedure and arnica in solution both pre and postoperatively. CONCLUSION: Among all the strategies evaluated, the strategy involving analgesics administered 30 minutes before tooth extractions was supported by better-designed studies. However, there is a high risk of bias.

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Childhood caries is a public health problem with a significant burden on the community. The specialist dental workforce cannot adequately manage all treatment needs in children. Therefore, the general dental community remains critical in delivering care to children. The purpose of this study was to investigate the self-rated confidence of general practitioners in treating children. A cross-sectional survey was designed that involved general dentists in various primary care centers in Jordan. Participants were asked to complete a questionnaire about their experience and self-perceived level of confidence in performing various procedures in children using the Likert scale. Descriptive statistics, t-tests and one-way analysis of variance (ANOVA) were used for data analysis. A total of 150 general dentists completed the questionnaire. The overall confidence score was high (3/4). Most respondents (86.7%) reported high confidence in providing prophylaxis and preventive treatment. The lowest level of confidence was reported for dental trauma and interceptive orthodontics. No statistically significant gender disparity was found except for the management of dental trauma in which males were significantly more confident than females. Regarding years of experience, confidence levels in dental trauma management were significantly higher among dentists with 5-10 years of experience compared to the recently graduated and the longest qualified dentists (p = 0.008). Similarly, for interceptive orthodontics, participants with 5-10 years of practice were significantly more confident compared to dentists in the other groups (p = 0.021). One-third of participants (30.1%) were not willing to treat children and considered them disruptive to their practice. Overall, This study revealed low levels of confidence in dental trauma management and interceptive orthodontics in children. Modification of dental curricula to increase clinical exposure should positively reflect on future levels of confidence. Strategies should be implemented to encourage general dentists to treat children to ensure equitable access for all.

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OBJECTIVE: This study aimed to assess the different pathways between predictor factors such as zygosity, atypical swallowing, mouth breathing, breastfeeding and bottle feeding related to anterior open bite (AOB) in twins. METHODS: The study was conducted in monozygotic (MZ) and dizygotic (DZ) twin children aged 3-15 years. AOB, atypical swallowing, mouth breathing, feeding type, duration of bottle use, and mouth opening status during sleep were recorded during oral examination. Partial least squares structural equation model (PLS-SEM) and sobel tests were performed to assess the total and indirect effects among the variables on AOB. RESULTS: A total of 404 children (29.2% MZ;70.8% DZ) participated in this study. The effect of zygosity on mouth breathing in the PLS-SEM model was statistically significant. Conversely, it was determined that mouth breathing effected that atypical swallowing (p = 0.001). Atypical swallowing triggered AOB (p = 0.001). The atypical swallowing has a mediation effect between AOB and mouth breathing (p = 0.020). Mouth breathing causes atypical swallowing and therefore indirectly increases the likelihood of AOB. While breastfeeding decreases AOB incidence (p = 0.023), bottle feeding increases AOB incidence (p = 0.046). The sobel tests show that the fully mediator variable feature of mouth breathing is statistically significant in the negative relation between zygosity and atypical swallowing. CONCLUSION: The PLS-SEM model showed that mouth breathing triggers atypical swallowing and atypical swallowing triggers AOB. As a result of this chain of relationships, an indirect effect of zygosity on AOB was observed. According to sobel tests, zygosity has an indirect effect on atypical swallowing through mouth breathing, while mouth breathing has a positive indirect effect on AOB through atypical swallowing. CLINICAL RELEVANCE: This study identified the relationships between different factors and the presence of AOB. The findings of this study demonstrate in detail the relationships between AOB and zygosity, atypical swallowing, mouth breathing, breastfeeding and bottle feeding. Brestfeeding has a reducing effect on the frequency of AOB. Among the nutritional forms, breastfeeding ensures the proper development of the stomatognathic system by working the oro-facial muscles.

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Background: The crown is considered the most effective restoration for the management of dental caries. It reproduces the morphology and contour of the damaged coronal portion of the tooth while maintaining its function. The esthetic needs of children and the demands of parents bring advancement in dentistry toward a new era of esthetic crowns. In this era of esthetic crowns, the newly introduced preformed BioFlx crown seems to be an effective esthetic treatment option. Case description: In the present case series, full coverage restoration for the management of carious and pulp therapy-treated primary molars was done by esthetic and flexible BioFlx crown (Kids-e-Dental, LLP, Mumbai, India). Over a 6 months period, the crowns have demonstrated good retention and esthetic results. Conclusion: Dealing with the esthetic needs of children and managing primary molars using BioFlx crowns would be practical and successful. Clinical significance: The treatment described in the case series is a new advancement in pediatric dentistry with promising esthetic alternatives. How to cite this article: Goswami M, Jangra B, Chauhan N, et al. Esthetics in Pediatric Dentistry-BioFlx Crowns: Case Series. Int J Clin Pediatr Dent 2024;17(3):357-361.