Aim and objective: This study aims to compare the retentive strength of different adhesive cements used for band cementation of fixed space maintainer by comparing the shear peel bond strength and mode of failure for each adhesive material using three different adhesive cements. Materials and methods: Eighty intact extracted teeth were used to assess the shear peel bond strength. Preformed bands were adapted to each tooth. Three cements compared in this in vitro study are glass ionomer cement [Ketac Cem radiopaque (3M ESPE)], resin-modified glass ionomer cement [RelyX luting 2(3M ESPE)], and self-adhesive resin cement [RelyX U200 (3M ESPE)]. The teeth were randomly divided to four groups of 20 samples each. All samples were stored at 37°C for 24 hours before testing. All specimens were tested in a tensile mode using a universal testing machine to determine shear peel bond. After debonding procedure, each specimen was visually assessed at the site of cement. Results: The results of our study showed that the greatest resistance to decementation was shown by self-adhesive resin cement (256.85 N) followed by resin-modified GIC (165.40 N) and GIC (127.40 N) (p < 0.001). Self-adhesive resin cement has the greatest shear peel bond strength (2.36 MPa) followed by resin-modified GIC (1.53 MPa), conventional GIC (1.22 MPa), and bands without cementation (0.29 MPa) (p < 0.001). In terms of adhesive remnant index (ARI) scores, it was seen that the decementation of bands of both conventional GIC and self-adhesive resin cements occurred at the band/enamel interface. However, resin-modified GIC showed varied results in the ARI scores. Conclusion: The findings of our study suggest that self-adhesive resin cements can be used for cementation of bands of fixed space maintainers. However, further research with short-term and long-term data is required to evaluate the ability of these cements for its application in vivo.

Aim: To compare the efficacy of lignocaine and benzocaine when applied as a topical anesthetic before intraoral local anesthetic administration in children. Materials and methods: Forty-four patients aged between 4 years and 10 years indicated for pulp therapy of primary teeth under inferior alveolar nerve block were selected for this study. The participants were randomly allocated into two groups of 22 each. Group I (lignocaine gel) and group II (benzocaine gel) were applied before inferior alveolar nerve block. The pain scale was assessed by a trained examiner using the visual analog scale (VAS) and sound eye motor scale. Results: Lignocaine when used as a topical anesthetic agent showed lower mean scores under both the pain scales when compared with benzocaine but the results were statistically insignificant. Conclusion: Lignocaine and benzocaine are equally effective when applied as a topical anesthetic agent. But lignocaine was more preferred in taste when compared with benzocaine.

Aim and objective: The objective of this study was to evaluate and compare the antimicrobial efficacy of low-fluoride and fluoride-free dentifrices against Streptococcus mutans. Materials and methods: The antimicrobial efficacy of four commercially available low-fluoride child formula dentifrices and four fluoride-free dentifrices against S. mutans was determined using the agar diffusion test. Fifty microliters of various dilutions (1:1, 1:2, 1:4) of each dentifrice were inoculated on the assigned plates under aseptic conditions. Saline was taken as negative control and 0.2% chlorhexidine was considered as a positive control. The plates were incubated at 37°C for 24 hours and the zone of inhibition around the wells was measured. Results: All the tested low-fluoride dentifrices showed varying degrees of antimicrobial activity against S. mutans with F2 (Pediflor®) and F4 (Cheerio™) showing greater zones of inhibition when compared to F1 (Colgate®kids) and F3 (Kidodent). When the mean zones of inhibition produced by non-fluoridated dentifrices were compared with that of fluoridated dentifrices, no statistically significant difference was noted between NF1, NF3, NF4, and F2, F4. The antibacterial activity of F1 and F3 was significantly lower when compared to others. However, no antibacterial activity was noted with NF2. Conclusion: Both low-fluoride and fluoride-free formulations tested in the study exhibited antimicrobial activity against S. mutans. In very young children where the risk of fluorosis is of concern, fluoride-free formulations can be considered as safe alternatives to fluoride formulations. Clinical significance: Several dentifrices, both fluoride-free and low-fluoride formulations, are being aggressively marketed for young children. Though these toothpastes are being very commonly used by young parents for their infants and toddlers, there is very little published literature available on their antimicrobial activity and this study focuses on addressing this.

Aim and objective: Mouth breathing is one of the most common deleterious habits prevalent in children which leads to various skeletal and dental malocclusions. Due to the close relationship between nasal and nasopharyngeal cavity volume and maxilla, transverse maxillary deficiency causes reduced nasal and nasopharyngeal cavity volume leading to mouth breathing. Therefore, knowledge of average nasal and nasopharyngeal cavity volume is essential to accurately diagnose mouth breathing and to evaluate underlying causative factors. Materials and methods: Cone-beam computed tomographic scans of 60 children were taken and nasal cavity and nasopharyngeal volumes were calculated using Planmeca Romexis 5.2.0.R software. Average volumes were computed using predetermined landmarks and compared among gender. Results: The nasal cavity and nasopharyngeal volume showed significant differences among the gender (p value < 0.001 and 0.018, respectively). Conclusion and clinical significance: Knowledge of the average nasal and nasopharyngeal cavity volumes can be a useful diagnostic aid for mouth breathing patients and also assess the causative factors and treatment outcomes in these patients.

Purpose: The current in vitro study was conducted to assess the remineralization potential of CPP-ACP and a customized dentifrice (tricalcium-phosphate) on artificial carious lesions using DIAGNOdent. Materials and methods: Fifty-one extracted premolars that satisfied the inclusion criteria were painted using acid-resistant nail varnish. A window of 4 × 4 mm was exposed on the center of the buccal surface of each tooth. After 20 minutes of drying, the baseline reading of enamel specimens was assessed using DIAGNOdent. The teeth were then immersed in a bath of demineralizing solution. An incubation period of 96 hours at 37°C resulted in artificial caries-like lesions on the specimen. Readings of the specimen within the window after demineralization were recorded using DIAGNOdent for all the samples. The specimens were divided into three groups randomly [group I—casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), group II—customized dentifrice, group III—artificial saliva]. Samples were subjected to the daily treatment regimen for a period of 30 days. The samples were evaluated for remineralization by laser fluorescent device (DIAGNOdent) on the 15th and 30th day, respectively. Results: The statistical analysis was done using the Friedman test, Kruskal–Wallis test, Wilcoxon sign rank test, and Mann–Whitney test. The results showed that both CPP-ACP and customized dentifrice showed almost similar remineralization potential but CPP-ACP showed significant remineralization (p < 0.001). Conclusion: The DIAGNOdent observation conclusively proves that CPP-ACP and customized dentifrice remineralizes the demineralized tooth samples in vitro with CPP-ACP showing significant remineralization.

Aim and objective: Apical extrusion of debris and cleaning efficacy in primary root canal treatment has not been well elucidated by using specialized pediatric rotary endodontic files. The purpose of this study is to compare the amount of apically extruded debris and cleaning efficacy during the preparation of primary molar root canals using Pro AF Baby Gold and Kedo-S pediatric rotary files. Materials and methods: Twenty extracted primary molar teeth were assigned randomly to two groups (n = 10 teeth for each group), injected with Indian Ink and instrumented using Kedo-S and Pro AF Baby Gold pediatric rotary files, respectively. The apically extruded debris was collected and dried in pre-weighed using Eppendorf tubes. The dry weight was calculated by subtracting the preoperative weight from the postoperative weight. The cleaning efficacy was evaluated after the diaphanization process. Statistics: Data were analyzed statistically using the independent sample t-test. Results: The amount of apically extruded debris was significantly less for the Pro AF Baby rotary files group compared to the Kedo-S rotary files group (p < 0.05). Cleaning efficacy was significantly better with Pro AF Baby Gold when compared to Kedo-S rotary files in the apical region of the tooth. Conclusion: All instruments caused apically extruded debris in primary teeth. Pro AF baby Gold files can be used with less apical extrusion of debris. Cleaning efficacy was shown to be better with the Pro AF Baby Gold pediatric rotary endodontic file.

Background: A pulpectomy is regarded as the choice modality of treatment for necrotic teeth. The use of hand files, though popular traditionally as a gold standard, may be challenging due to increased chairside time. Postoperative pain is one of the most common complications of pulpectomy and may be unpleasant for a child/pedodontist. Rotary files were found to reduce instrumentation time, reduce apical extrusion, and in turn reduce pain but there is a lack of studies in primary teeth particularly for pediatric and reciprocating file systems. The increased number of options available today makes it a dilemma for the operator to choose a suitable file system. Aim and objective: The study aimed to evaluate and compare the instrumentation time, postoperative pain, and effect on child's behavior among three groups, i.e., hand K-flex files (group I), pediatric rotary files (group II), and reciprocating files (group III). Materials and methods: A total of 75 primary molar teeth after meeting inclusion criteria were randomly allocated into three groups. During the procedure, step-wise instrumentation time was recorded using a stopwatch. The child's behavior pre- and postoperatively was assessed by an evaluator. The postoperative pain (up to 1 week) was assessed by a questionnaire. Results: The mean age of children taken for the study was 6.03 ± 1.2 years with 46 males and 29 females. The mean biomechanical preparation time was observed to be significantly shorter in the pediatric rotary and reciprocating file groups vs hand K-flex files (p < 0.001**). The postoperative pain after 6 hours had a mean value of 0.88 + 0.9 for the hand K-flex file group which was significantly higher than both rotary file groups (p < 0.05*). The pre- and postoperative behavior revealed no significant difference. Conclusion: The clinical performance of pediatric and reciprocating files was superior, but the choice of file system did not significantly alter behavior.

Aim and objective: To compare the arresting caries effectiveness of two different silver nanoparticle (AgNP) concentrations of nano-silver fluoride (NSF), namely 400 and 600 ppm. The hypothesis is that in posterior primary teeth with occlusal and approximal active dentin carious lesions, NSF 600's effectiveness will be higher than that of the NSF 400 solution over a 6-month follow-up period. Materials and methods: This was a double-blind randomized clinical trial (RCT) conducted in the city of Recife, Brazil. A total of 337 children aged 5–7 years who attended the University of Pernambuco Dental School's clinics were examined. A single-blinded investigator conducted the examinations and treatment of the children. After baseline examination and recording of the dmft index, children were allocated to one of two study groups (NSF 600—intervention and NSF 400—positive control). In both groups, each tooth received two drops of NSF and treatments were performed only once in 6 months. The follow-up examinations were visual and tactile, performed in 30, 90, and 180 days to determine the activity of caries. The carious lesions that were not arrested in 30 days were recorded and referred for restorative treatment. Results: The NSF 600 showed higher rate of success in arresting caries (72.7%, p = 0.025) compared with NSF 400 (56.5%). Conclusion: The higher rate of success of NSF 600 can be explained by the higher concentration of AgNPs. Clinical significance: Nano-silver fluoride has emerged as an excellent alternative to silver diamine fluoride (SDF), as it adds a high antibacterial effect to better esthetic results. Treatment is simple, non-invasive, and incurs low cost. It is ideal for use in community-based programs to increase the access to dental care without staining teeth black like other silver products.

Introduction: Pediatric dentists, while treating diabetic patients, have a major concern about the occurrence of hypo- or hyperglycemia complications. So far, no dental care protocol is elaborated to help practitioners in creating a safe environment for their patients. This study aims to evaluate the blood glucose level (BGL) fluctuation in type 1 diabetic children according to the type of the delivered treatment and its duration, to outline guidance for predicting the occurrence of a hypo- or hyperglycemia complication. Materials and methods: A cross-sectional approach was conducted on 70 balanced diabetic children aged between 7 years and 12 years old (32 females and 38 males) in the Department of Pediatric Dentistry at the Lebanese University in Beirut. Only the patients having a BGL between 70 mg/dL and 300 mg/dL could undergo dental treatment. The gender, the duration of the dental session (≤30 or >30 minutes), the BGLs at the baseline and the end of the session were noted. The types of the performed dental treatment were classified as simple, and unpleasant acts. Results: For the female group, only eight sessions lasted ≤30 minutes. The results of simple and unpleasant interventions >30 minutes showed that BGLs before and after treatment were almost identical (p > 0.05). In the male group, for the simple acts >30 minutes, the BGL showed a significant fluctuation (p = 0.02). Conclusion: Dentists must be aware of signs of discomfort in balanced type 1 diabetic children to avoid severe complications. This study highlights a new range of BGLs (70–300 mg/dL) that allows safe dental treatment.

Background: In the last few decades, the non-restorative treatment approach had been labeled by different names. The term non-restorative cavity control (NRCC) was recently established in 2016. The study aimed to evaluate the knowledge, attitude, and practice behavior about this technique among pediatric dental postgraduate students in India. Materials and methods: An 18-item questionnaire was prepared from the previously established literature. The sample size was calculated as 234 responses based on the pilot study. The questionnaires were sent to 1,200 participants through the registered email address and WhatsApp as a Google form link. The online responses were received for a period of 4 weeks from July to August of 2020. The data from the responses were collected and descriptive analysis was done using a Microsoft Excel sheet (Version 2016). Results: A total of 380 responses were received and 35 duplicate responses were eliminated. Among the 345 respondents, 61 (17.7%) were males and 284 (82.3%) were females. The average age of the participants is 27.43 years. About 78.6% (n = 271), 17.1% (n = 59), and 4.3% (n = 15) of the participants were third-year, second-year, and first-year postgraduate students, respectively. The responses were received from 21 out of 24 states’ colleges which were conducting pediatric dental postgraduate course. About 271 (76.8%) participants knew this technique with a maximum positive attitude and fewer practice behavior. Conclusion: The knowledge and attitude about NRCC were good among the pediatric dental postgraduate students but implementing that in practice was relatively less.

Introduction: The success of orofacial myotherapy in children is dependent on patient compliance to treatment protocols recommended by practitioners, such as reporting for regular follow-ups to the clinic, wear of appliances, and practice of orofacial myotherapy exercises at home. Due to the availability of limited literature on the same, this mixed methods study focused on studying the perception of Indian dental practitioners toward pediatric patient compliance to orofacial myotherapy treatment protocols. Materials and methods: A self-administered, digital questionnaire was emailed to members of the Foundation of Orofacial Myotherapy. Participants were asked to rate the pediatric patient compliance in their practice on a 5-point Likert scale ranging from Very Compliant to Not Compliant at all. Parameters assessed included patient attendance for clinical follow-ups, regular appliance wear, and the daily practice of exercises at home. Qualitative data were collected based on the participant's answers to open-ended questions on compliance barriers faced by them in practice. Results: 39.5% of practitioners rated their patients to be compliant toward clinical follow-ups, while 27.9% of practitioners reported patients to be compliant to home schedule. Barriers to patient compliance reported by practitioners were lack of motivation of parent and child, absence of parental supervision, hectic patient schedule, peer pressure, and difficulty in performing exercises and wearing appliances. Conclusion: Patient compliance to orofacial myotherapy treatment protocols remains a problem area for dental practitioners. There is a need to conduct future studies to explore behavioral interventions which can help practitioners overcome the barriers to patient compliance reported in this study. Clinical significance: The results of this study can help practitioners who are already practicing orofacial myotherapy or plan to do so in future, to identify problem areas in their own practice, in the context of pediatric patient compliance toward orofacial myotherapy treatment protocols and the potential measures that can be implemented by them to overcome the same.

Background and aim: The therapeutic procedures used in the treatment of caries do not always eliminate all the microorganisms. Persisting cariogenic bacteria can cause recurrent caries and failure of restoration. Incorporation of an antimicrobial agent in the restorative material may be of paramount significance. The purpose of this study was to evaluate and compare the antibacterial effect of glass ionomer cement (GIC) containing CHX and miswak extract on Streptococcus mutans and Streptococcus sobrinus in ECC children using polymerase chain reaction (PCR). Materials and methods: Forty-five children with ECC in the age-group 3–6 years were selected. The children were randomly allocated into three groups. Supragingival plaque samples (S1) were collected from sound buccal or labial surfaces of primary teeth. Cavity preparation was done and the teeth were restored according to the group to which the child had been allotted. The second plaque sample (S2) was collected 1 month and the final sample after 3 months of restoring all the decayed teeth. All the samples were sent for PCR analysis. Results: Intergroup analysis was done using Kruskal–Wallis test followed by Mann–Whitney post hoc test showed statistically significant difference in S. mutans and S. sobrinus count between group I (CHX) and group III (control) and group II (miswak) and group III (control) but no statistically significant difference between group I (CHX) and group II (miswak) in S. mutans and S. sobrinus count. Conclusion: 1% chlorhexidine digluconate and aqueous extract of miswak are equally effective against S. mutans and S. sobrinus. Miswak can be used as an alternative herbal antimicrobial that can be incorporated in anhydrous GIC.

Context: A very small quantity of trace elements will be present in saliva. Salivary composition influences caries inhibition and promotion based on the different organic, inorganic, and trace elements. Aim and objective: To evaluate the levels of copper in saliva in children with caries-active and caries-free group and to associate copper levels of saliva with hemoglobin (Hb) levels of blood. Materials and methods: Sixty subjects between the ages of 6 and 14 years were divided into group I—caries-free and group II—caries-active. The caries-active group was further subdivided into group IIa (deft/DMFT < 3) and group IIb (deft/DMFT > 3). To maintain the uniformity of salivary composition, unstimulated saliva (5 mL) was collected in noontime before food from all the participants. The copper levels were estimated by atomic absorption spectrophotometry. Hemoglobin levels in the blood and their relation with copper levels in saliva were estimated. Statistical analysis: The results thus obtained were analyzed by t-test and Karl Pearson's correlation coefficient. It was considered significant if the “p” value is 0.05 or less. Results: Copper levels were higher in group II showing statistically highly significant results compared with that of group I with p ≤ 0.00001. The results were no significant with respect to Hb scores among the groups. Conclusion: A definite positive correlation is seen with dental caries and levels of copper in saliva. Hence, the amount of copper in saliva can be considered as a caries risk assessment tool.

Purpose: Assessment of children's behavior in the dental setting and its correlation with thumb print and lip print. Materials and methods: The behavior pattern, lip print pattern, and thumb print pattern of 518 children aged 5–12 years were recorded in their first dental visit. The behavior pattern, lip print pattern, and thumb print pattern were determined using Frankl's Behavior Rating Scale, Tsuchihashi's classification, and Cummin's classification, respectively. The data were tabulated according to the classified criteria and statistically analyzed. Results: It was observed that positive and definitely positive Frankl Behavior was associated with the children bearing an arch pattern of thumb print, whereas their lip pattern had no association with their behavior pattern, particularly in dental sittings. Conclusion: Thumb print pattern can aid as a behavior marker before a child's first dental appointment and this can prove beneficial for both the child and the clinician in providing a high quality of dental care and modify behavior for future dental appointments.

Aim and objective: To evaluate the antimicrobial efficacy of triple antibiotic paste and propolis extracts as an intracanal medicament in young permanent teeth. Materials and methods: A total of 30 single-rooted non-vital young permanent teeth with open apex were selected randomly from the children aged between 7 years and 14 years with no systemic complications. Group I—triple antibiotic paste and group II be propolis allocating 15 teeth in each group. After access opening, the first sample (S1) was collected by inserting paper point into the root canal, the second sample (S2) was collected immediately after irrigation, and the third sample (S3) was collected after post-intracanal medication after 3–4 weeks. Samples were sent for microbiological analysis to assess the bacterial count, and for the obtained data, statistical analysis was done. Results: The mean colony count among the triple antibiotic paste group was 1906.75. After access opening, which was reduced to 315.12 after irrigation, and after 3–4 weeks, it was 817.25. There was a significant difference between sample 1, sample 2, and sample 3 (p value = 0.008). The mean colony count among the propolis group was 1427.87 after access opening, which was reduced to 436.00 after irrigation, and after 3–4 weeks, it has reduced to 252.37. There was a significant difference between sample 1, sample 2, and sample 3 (p value = 0.032). Intergroup comparison between the groups showed no statistical difference between the samples. Conclusion: Propolis exhibited similar antimicrobial efficacy, which is comparable to triple antibiotic paste. So, propolis can be utilized as an intracanal medicament in young permanent teeth with an open apex. Clinical significance: Propolis is a naturally occurring flavonoid-rich resinous product with antibacterial, antifungal, antiviral, immunomodulatory, and antioxidant effects. It is safe without any drug allergies and bacterial sensitivity and is a promising alternative to triple antibiotic paste for disinfecting non-vital young permanent teeth.

Background: Managing a child's anxiety is most critical for the success of treatment in the pediatric dental setup. Present trend advocates the use of non-aversive behavior management techniques. Aim and objective: To compare and evaluate the efficacy of aromatherapy using orange essential oil with that of music distraction in the management of anxious pediatric dental patients. Design: One hundred and fifty children of the age 6–8 years were divided into three groups of 50 each and performed restorative treatment under aromatherapy, with music distraction, without aromatherapy, or music distraction, respectively. Venham's picture test and facial image scale (FIS), pulse rate, respiratory rate, and oxygen saturation were recorded before and after the procedure. Results: Compared with controls, both the aromatherapy group and music distraction group showed significant posttreatment change in anxiety levels with respect to Venham's picture test and FIS, along with the reduction in pulse rate and respiratory rate. When compared between music distraction and aromatherapy, it did not yield statistical significance, though music distraction showed better results compared to aromatherapy. Conclusion: Both music distraction and aromatherapy using orange essential oil are effective in anxiety management of which music distraction presents a comparatively better result. Either these non-invasive techniques alone or a combination of both may be employed in the dental setup of pediatric dentists for molding cooperative patients.

Aim and objective: To evaluate the adhesive bond strength, and sustained release of fluoride in chitosan (CH)-infused RMGIC. Materials and methods: Twenty caries-free human permanent premolar teeth, extracted for orthodontic purposes, were cleaned and stored in thymol solution. The crown of each tooth was cut into two halves and RMGIC (n = 10) and CH-infused RMGIC (n = 10) was placed between the two halves of the crown. The tooth was then stored in 10 mL of artificial saliva for a period of 30 days. The fluoride levels of the saliva were checked on the 15th- and the 30th-day using ion chromatography. The adhesive bond strength was checked on the 30th day using a universal testing machine. Results: This study has shown that the bond strength of RMGIC was not affected by the inclusion of CH in it. Whereas, the sustained fluoride release of CH-modified RMGIC indicated that the fluoride release of CH-RMGIC was 8.47% >RMGIC at the end of 15 days, and, 39.68% >RMGIC at the end of 30 days. Conclusion: The inclusion of CH in RMGIC does not alter its bond strength, while it does cause a greater release of fluoride. Clinical significance: In progression with these results, the inclusion of CH in RMGIC could provide desirable properties like mechanical reinforcement effects and catalytic effects on the fluoride release and growth factors.

Background: The chemomechanical method of caries removal is a modality that is non-invasive, cost-effective, and if some caries preventive measures could be added to them, then it might render the remaining dentin more resistant to future caries attacks also. Thereby, this study is conducted to evaluate the in vivo aspect of newly developed “one man army material—Apacaries gel”. Aim and objective: To evaluate and compare the antimicrobial efficacy, efficiency, and pain perception of a chemomechanical caries removal agent (Apacaries gel) with a conventional method. Design: Twenty children (aged 6–12 years) with bilateral occlusal caries making a sample size of 40 were included in the study. Group I: caries removal using rotary instruments and Group II: caries removal using Apacaries gel (n = 20 each). Caries removal time and pain perception were measured using a stopwatch and Wong–Baker Pain Scale. Dentin samples of both groups were taken before and after caries removal for microbiological analysis. Statistical analysis used: The data were statistically analyzed using the Student's t-test to compare the two groups. Results: There was a non-significant difference in bacterial count while a significant difference was seen in time consumption and pain perception in both methods of caries removal. Conclusion: Chemomechanical caries removal (Apacaries gel) can be an effective clinical alternative treatment for caries removal in children. Key messages: It is the only in vivo study on “Apacaries gel—a one man army” which eliciting the unique property of prevention of dental caries.

Background and objectives: The efficiency of mechanical plaque control in children not only depends on the type of oral aids they use but also on the instructions, training, and motivation given to them. To compare the efficiency of different methods of personal supervision of toothbrushing in reducing the dental plaque levels in 7–9-year-old schoolchildren. Materials and methods: A parallel designed double-blinded randomized study was conducted in a private school in Jeddah, Saudi Arabia from September 2018 to December 2018. The children were allocated randomly into two groups based on the type of supervision given. Plaque scores examination was carried out at four intervals as baseline, 7th day, 14th day, and 90th day. Results: Plaque scores reduced after 7 days in all groups, even though there was no statistically significant difference observed. At the final examination of plaque scores (90th day), there was a highly statistically significant reduction observed in group I and II compared to group III where the reduction was less evident. Conclusion: Supervision of toothbrushing in the correct way was effective in reducing the plaque scores. Our study benefited both parents and children in understanding the correct method of brushing and the importance of plaque control.

Aim and objective: This study aimed to determine the prevalence of missing first permanent molars (FPMs) in the 7–29-year-old selected population of Al Ahsa, Saudi Arabia. Materials and methods: This study retrospectively analyzed 398 panoramic radiographs of patients aged from 7 to 29 years old for missing FPM. Patients were divided into two age-groups: 7–15 and 16–29 years old. Study variables including gender, age, missing FPM, dental arch, and right or left sides of the arch were recorded. The data were statistically analyzed using Chi-square tests. Results: Of the total study sample, 23.1% of patients had only one missing FPM, 13.3% of patients had two, and 2.8% of them had three missing FPM teeth. No patient had four missing FPM teeth. A total of 60.8% (242) radiographs in the overall sample did not show any missing teeth. The mandibular FPMs (35.2%) were found missing more frequently than their maxillary counterparts (17.4%) and the left mandibular quadrant showed a higher rate of missing FPM (21.9%). No statistically significant association was seen between the missing FPM and the gender or age-group (p > 0.05). Conclusion: The high prevalence rates of missing FPM in the study population warrants attention. Further prospective studies are needed to comprehensively evaluate the effect of early loss of the FPM on space changes in the arch and subsequent reduction in complex orthodontic treatment needs.

Introduction: Dental caries is the most widespread disease affecting children worldwide. The reason for this increased prevalence is the use of more processed foods and beverages with the addition of refined sugars. General health affects oral health and its maintenance is of great importance. Lifestyle modifications and habits are formed at an early age therefore health education plays an important role in educating them about the prevention of problems related to oral health. Hence, the aim of this study was to assess and compare the effectiveness of conventional method, game-based and storybook-based oral health education on the oral hygiene status among 7–12-year-old schoolchildren. Purpose: To assess and compare the effectiveness of conventional method, game-based and storybook-based oral health education on the oral hygiene status among 7–12-year-old schoolchildren. Materials and methods: A total of 300 children aged 7–12 years were divided into 3 groups. Each group had 100 children which were randomly assigned to each of the three groups. In group I, oral health education with the help of conventional method using educative posters was given to children once daily for a week. In group II, oral health education was imparted to children through play method (i.e., snakes and ladders game combined with flash cards) followed by group III, in which children were given education through self-made storybooks. The oral hygiene of all the children was estimated through Oral Hygiene Index-Simplified Debris (DI-S) score at day 1 and after 3 months after intervention. Results: In group III, storybooks showed maximum reduction in debris score which was found to be highly statistically significant followed by game based (group II) and conventional method (group I) of oral health education. Conclusion: The reduction in debris score was seen maximum in group III (storybooks). Hence, the use of storybooks should be encouraged for educating children regarding basic oral health concepts. Clinical significance: There is important need to understand differences in the mental cognitive ability of the children at different ages and the need to develop different intervention programs for different age-groups. Rationalizing reading can be an intelligent initiative toward the development of good oral habits and transforming the outlook of oral healthcare system in years to come.

Background: To evaluate the association of sex, type of institution, and satisfaction of educational activities with dental students’ knowledge of International Caries Detection and Assessment System (ICDAS) and International Caries Classification and Management System (ICCMS) in young children. Materials and methods: This was a cross-sectional study involving final-year dental students from all accredited dental institutions across Malaysia. A self-constructed questionnaire was given through an identified personal contact from each school. The students’ responses on the association of sex and institution type with the satisfaction of education activities and ICDAS and ICCMS knowledge were tested using the independent t-test. The relationship between satisfaction of educational activities and knowledge of ICDAS and ICCMS among dental students was evaluated using Spearman's correlation analysis. Statistical significance was set at p < 0.05. Results: A total of 440 responses were obtained. Out of this, 312 (70.9%) were female and 126 (28.6%) were male respondents, and 2 with unknown sex. There were 231 responses (52.5%) from the private institution and 209 responses (47.5%) from the government institution. Males had a higher level of satisfaction toward the education activities. No significant difference was observed between the knowledge of ICCMS and ICDAS and sex or institution type. Conclusion: Male dental students felt more satisfied with pediatric lectures conducted during preclinical years and were more prepared to treat patients independently upon graduation. Sex and type of institution did not play a role in the knowledge and dental students were more knowledgeable in ICDAS compared to ICCMS.

Aims and objectives: • To estimate the prevalence of dental fear and anxiety (DFA) among school-going children in Al Ahsa. • To identify the factors that trigger DFA in the dental office. Materials and methods: A cross-sectional questionnaire-based study was conducted. Eight hundred and sixteen, 7–12-year-old children studying in government and private schools spread across the city of Al-Ahsa, Saudi Arabia, participated in the study. A self-reported questionnaire with 15 close-ended questions pertaining to DFA in logical order was distributed to all the participants. Each question had three options as responses with images. The children were asked to choose the option that best fitted their response. Results and Conclusion: The prevalence of DFA among boys and girls was found to be 50.4 and 71.28%, respectively. The majority of the boys studying in government schools reported DFA when informed about the treatment in advance, while most of those studying in private schools reported DFA at the sight of the dental chair and dental injections, while walking into the clinic, in the waiting room, when informed about the treatment in advance and their tooth being drilled. On the contrary, the responses were very similar among girls irrespective of their school. Most of the boys and girls did not experience any DFA when their parents were allowed to accompany them. Hence, a tailor-made approach for the management of the child in the dental office is warranted. Clinical significance: A tailor-made approach for the management of DFA in the dental office plays a significant role in successful treatment.

The emergence of the novel 2019 coronavirus disease (COVID-19) pandemic has led to a significant challenge to healthcare professionals. Among all the healthcare providers, dental clinical setup is exposed to the generation of potentially hazardous aerosols which could be a point of cross-contamination. Dentists catering to pediatric patients need to take special precautions, as they have milder symptoms or could be asymptomatic and hence potential vectors for the transfer of infection. One needs to change the perspective to manage the oral health of children as a child's oral health presents specific problems that could be time-bound and hence need to be treated accordingly. These problems can be managed on one hand by preventive methods, and on the other by implementing specific protocols relating to the conditions that represent an emergency, or those situations that fall into the category of elective dental procedures. This article highlights the routes of transmission in a dental practice and focuses on the categorization of treatment for children based on treatment needs. It proposes a restructuring of the treatment protocol and hence shifting to minimal invasive or non-aerosol-generating procedures (AGP). These techniques are also proposed to be used even after the end of the current emergency period to minimize the aerosol splatter. Clinical significance: The article highlights the protocol that needs to be followed after treatment categorization during and after COVID-19 pandemic.

Aim and objective: The respective review article is to provide an overview of the various exercises in orofacial myofunctional therapy (OMT) as a treatment modality for tongue thrust habit. Tongue thrust is the persistence of an infantile swallow pattern during late childhood. This leads to breathing and speech difficulties, open bite, and protruded teeth. During formative years, most children successfully transition from an infantile to a mature swallowing pattern. However, a few develop a retained infantile swallow and tongue thrust habit which could be due to abnormal habit like thumb sucking or an underlying cause like enlarged adenoids. Adverse effects of these habits can be avoided by early detection and intervention in a growing child. Tongue thrust can be treated in different ways with early diagnosis, removal of underlying causes, correcting tongue posture, and breaking of habit with the use of orthodontic appliances. This review article is focused on the various OMT techniques employed for the correction of tongue thrust. There are several exercises in OMT which can help a child with tongue thrust. These can be performed at home under the supervision of the child's parents. Orofacial myofunctional therapy has provided a dramatic and positive influence on patients treated for tongue thrust. The joy of eating, speaking, and correct breathing can be regained along with confidence, self-esteem, and improved quality of life. Clinically, OMT plays a positive role by not only improving swallow but also the posture of tongue, improper muscle function, and reduces relapse of previous orthodontic treatments.

Purpose: The purpose of this study was to evaluate the prevalence of temporomandibular disorders (TMDs) in schoolchildren. Materials and methods: In this study a questionnaire taken as part of RDC/TMD of the samples on TMD symptoms. The samples were school students, who were of the age range 15–17 years old (n = 396), 200 are males and 196 are females. All from eight randomly selected schools. They were asked to answer the questionnaire in their classrooms. Results: The prevalence of periauricular pain was 29.0%. More males were affected by TMD than females and most of the affected students were of ages 16 and 17 years old. Severe depression occurs in 69.6% of the affected students with periauricular pain. Periauricular pain resulted in low disability low-intensity pain (grade I) in 64.9%. Conclusion: Based on the results obtained it can be concluded that: (1) Data obtained from the questionnaire identified a nearly lower percentage of TMD in schoolchildren than most of the studies published in the literature; (2) Comparing with females, males with TMD had a higher disability, depression, and non-specific symptoms with and without pain. Clinical significance: Temporomandibular disorder in adolescents is relatively high, in addition, the accompanying pain and depression that is high to worsen the condition.

Tooth loss due to trauma often triggers residual alveolar resorption to a greater degree in the sagittal direction leading to atrophy. However, in a pediatric patient, if this defect is left untreated, it can cause further atrophy leading to collapse of the arch. In the maxillary anterior area, this is also of esthetic concern. Hence, it is viable to reconstruct the alveolar defects and restore the alveolar anatomy with superior quality of bone while the patient is still in growing phase to avoid any structural and dental malformation, as well as to provide a more novel treatment like dental implant at a later stage when growth ceases. Modes for successfully augmenting the bone are diverse. Among these, barrier membrane with guided bone regeneration, distraction osteogenesis, and bone block graft is ubiquitous. The current case report deals with the management of horizontal atrophic anterior maxillary region using autologous block bone graft harvested from mandibular symphysis, to augment the alveolar ridge and aid in esthetic and functional restoration of alveolar anatomy by restoring the defect with the bone of superior quality as well as preparing the site for receiving implant prosthesis in future when growth ceases.

Background: Early loss of anterior primary teeth occurs mainly due to dental caries and trauma and may cause functional changes and negatively impact children's quality of life and social interaction. Aim and objective: This article reports two cases in which pediatric patients with different dental losses were rehabilitated with esthetic functional fixed space maintainers with tube-bar system. Cases description: In the first case, a 3-year-old boy with a missing upper central incisor due to dental trauma was rehabilitated with an esthetic functional fixed space maintainer with tube-bar system. In the second case, a 5-year-old boy lost three upper incisors, also due to dental trauma. He was likewise rehabilitated with an esthetic functional fixed space maintainer with tube-bar system. Conclusion: The rehabilitation of early losses of anterior primary teeth by fixed esthetic functional space maintainers with tube-bar system proved to be a favorable treatment option regardless of the age of the patient or the number of missing teeth. Clinical significance: Early loss of anterior primary teeth may have a major impact on the pediatric patient and is still a challenge in clinical practice. This article presents an effective and inexpensive alternative to this clinical situation.

Aim and objective: To give dental practitioners an insight into the unusual presentation of focal infantile hemangioma on the alveolar ridge showing immunoreactivity to glucose transporter-1 (GLT1). We also recommend the importance of using standardized terminologies to describe the type of hemangioma. Background: One of the most commonly seen and misdiagnosed vascular tumors of the skin and soft tissues of the head and neck region in children are infantile hemangiomas. Infantile hemangiomas developing at extracutaneous locations such as the oral cavity are rare, especially without cutaneous involvement. Case description: A 9-month-old infant girl presented to the Pediatric Dental Department with a swelling over the maxillary alveolar ridge. The solitary exophytic mass appeared after birth and gradually enlarged in size with episodes of bleeding during feeding. Clinical examination revealed a reddish-pink pedunculated mass that bled profusely on palpation. The lesion was excised by electrocautery and was found to be express glucose transporter-1 confirming the diagnosis of infantile hemangioma. The patient was followed up for 1 year and showed no recurrence. Conclusion: Hemangiomas are usually misinterpreted to be pyogenic granulomas, vascular malformation, reactive granulation tissue, or congenital granular cell tumor. This report highlights the use of glucose transporter-1 when there is suspicion of hemangioma for immunohistochemical distinction from other histologically similar vascular lesions of the oral cavity. Clinical significance: Dental surgeons treating vascular lesions of the oral cavity should advocate for surgical management techniques that also produce hemostasis due to the risk of intraoperative bleeding.

West syndrome is a rare, severe form of epilepsy with onset in infancy and early childhood. It combines episodes of epileptic spasms that occur in a cluster, an abnormal pattern of interictal electroencephalogram termed as hypsarrhythmia and neuropsychomotor delay. The syndrome mainly results from brain dysfunction in the prenatal, perinatal, or postnatal period and focal lesions early in life may secondarily affect other sites in the brain presenting with some degree of developmental delay and mental retardation. The oral manifestations vary to a large extent presenting as generalized tooth wear, gingival enlargement, multiple white spot lesions, and a high-arched palate. This case report highlights the importance of early diagnosis, various clinical features, and management in a pediatric patient with West syndrome.

The inflammatory follicular cysts are cystic lesions associated with non-erupted permanent teeth and involve devitalized deciduous teeth. Products resulting from the necrotic pulp of deciduous teeth stimulate crown hood growth of successor permanent tooth radiographically shown as a unilocular, radiolucent area, associated with an impacted permanent crown. Treatment based on cyst decompression and maintenance of the deciduous tooth is a conservative approach to space maintenance. This case report describes the diagnosis, treatment, and post-surgery follow-up after 5 years of an extensive inflammatory follicular cyst in the mandible, in the region of tooth 75, with marsupialization being the method of treatment and emphasizing the importance of clinical and radiographic follow-up.

Aim: Skeletal class III malocclusion are the most challenging orthodontic problem to treat. Diagnosis and treatment in early stage was important to boost self-esteem of patient. Our aim was to correct skeletal relationship and anterior crossbite to enhance the growth of maxilla. Background: Class III malocclusion can be due to retrognathic maxilla, prognathic mandible or combination. Complexity of class III malocclusion depends upon abnormal growth pattern of maxilla and mandible. Maxilla growth ceases around 8–10 years and mandible continue till 16 years. Early intervention boosts self-esteem of the patient. Case description: This case presents with clinical feature of retrognathic maxilla at the age of six years. The patient had concave profile with incompetent lips. The mentolabial sulcus was normal and obtuse nasolabial angle with high clinical Frankfurt mandibular angle (FMA). There was reverse overjet of 1 mm. Cephalometric analysis showed a class III skeletal pattern with retrognathic maxilla and orthognathic mandible with increase in lower facial height and increases in gonial angle. The rapid maxillary expansion (RME) with reverse pull face mask was planned. The expansion screw was activated to loosen the circumaxillary suture. Conclusion: After active treatment anterior crossbite was corrected. The patient sagittal discrepancy was improved. Early mixed dentition period is the best time to begin class III treatment. Clinical significance: Early treatment with maxillary protraction and palatal expansion can correct most anterior–posterior skeletal discrepancy.