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   Table of Contents - Current issue
Coverpage
October-December 2019
Volume 37 | Issue 4
Page Nos. 315-416

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EDITORIAL  

Artificial intelligence - The next frontier in pediatric dentistry p. 315
M Sudhindra Baliga
DOI:10.4103/JISPPD.JISPPD_319_19  PMID:31710003
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REVIEW ARTICLE Top

Empathy among dental students: A systematic review of literature p. 316
Ridhi Narang, Litik Mittal, Sonali Saha, Vikram Pal Aggarwal, Poonam Sood, Shyam Mehra
DOI:10.4103/JISPPD.JISPPD_72_19  PMID:31710004
Background: Empathy is just as relevant within dentistry, although research is limited in this field and very less is available in the current literature. The demonstration of empathy by dentists has been correlated with decreased dental fear. The authors systematically reviewed the literature to investigate empathy levels among dental students. Methods: A systematic review of the literature was undertaken concerning dental students' empathy, published from November 2016 to June 2018, using manual methods and the PubMed, PMC, PsycINFO, and other databases. Articles not in English and not concerned with dentistry were excluded, and intervention studies intended to enhance empathy, opinion articles, and reviews or reports of nonoriginal research were excluded. Eligible studies were those published from January 1, 2005, to May 31, 2017, in English language. A total of 34 full-text articles were obtained and assessed. Of these 34 papers, only seven publications were considered to have met the inclusion criteria and were directly related to the aim of literature search. Results: Only seven articles that provided data and evidence describing empathy among dental students were included. Four studies reported that the difference in mean empathy level across the year of study was statistically significant (P < 0.05), and one reported that there was no significant difference in empathy scores between the year levels of study. Three articles reported that males had higher mean empathy score than females, whereas vice versa was found in the remaining four articles. Conclusion: This article demonstrates that there is only a limited evidence to provide the understanding of empathy among dental students. The results indicated that as patient exposure increases, the empathy level decreases among dental students. Furthermore, it is observed that education in behavioral sciences may be effective in increasing self-reported empathy, and further training may be necessary to maintain high levels.
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ORIGINAL ARTICLES-OBSERVATIONAL STUDIES Top

Knowledge, attitude, and practice regarding standardized treatment protocol for pulp therapy in deciduous dentition among general dental practitioners of Vadodara, Gujarat, India p. 327
Seema Bargale, Shital Kiran Davangere Padmanabh, Pratik Bipinkumar Kariya, Swara Shah, Bhavna Dave
DOI:10.4103/JISPPD.JISPPD_186_19  PMID:31710005
Introduction: Dental caries is the most prevailing disease not only affecting permanent dentition, but also involving deciduous dentition. Deciduous teeth are considered a best space maintainer and preserve arch integrity for eruption of succedaneous permanent teeth. General dental practitioners (GDPs) seem to be less interventionist in their investigation and treatment planning and many times, the treatment done remains incomplete either due to the lack of knowledge of the dentist or due to noncooperation of the child and/or parents. Purpose: The aim of this study was to assess the knowledge, attitude, and practice among GDPs of Vadodara city regarding standardized treatment protocol (STP) for pulp therapy in deciduous dentition. Materials and Methods: This questionnaire-based, cross-sectional study was conducted to assess the knowledge, attitude, and practice regarding standardized treatment options available for pulp therapy in deciduous dentition. The distribution of the self-made questionnaire pro forma was done in person to all the GDPs after obtaining their prior appointments. The GDPs were grouped on the basis of qualification and total clinical experience in years. The questionnaire consisted of 11 questions. The data were collected, and descriptive statistical analysis was performed. The Chi-square test was used to assess the knowledge, attitude, and practice among different groups of GDPs. Results: A statistically significant difference was observed in knowledge regarding STP for pulp therapy in deciduous dentition among both the groups, which is based on the qualification and on the year of clinical experience. Conclusion: Qualification and years of clinical practice among GDPs affect the knowledge and treatment regarding pulp therapy in deciduous dentition. Most of the GDPs lack knowledge about the STP for pulp therapy in deciduous dentition.
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Validation of the Hindi version of the early childhood oral health impact scale among 3–5-year-old preschool children in Rohtak city, Haryana p. 333
Mamta Ghanghas, BC Manjunath, Adarsh Kumar, Radhey Shyam, Ritu Phogat, Vikram Panghal
DOI:10.4103/JISPPD.JISPPD_128_18  PMID:31710006
Background: The early childhood oral health impact scale (ECOHIS) has been developed for assessing oral health-related quality of life (OHRQoL) in the preschool children and translated and validated in different languages to conform to their cultures. This tool has not been validated in Hindi for use among Indian preschool children till now. Hence, the present study was undertaken to assess the validity of the Hindi version of the ECOHIS among 3–5-year-old preschool children in Rohtak city, Haryana. Materials and Methods: The Hindi version of the ECOHIS was developed through standardized forward–backward linguistic translation method. It was tested for validity and reliability among 469 parents and their children after obtaining informed consent. Construct validity of the measure was assessed by correlating ECOHIS score to dental caries experience (deft). For internal consistency, Cronbach's alpha was determined. A subsample of the parents repeated the ratings of the measure to enable test–retest reliability assessments. Results: Construct validity was r = 0.298. Reliability of the questionnaire was 0.873 (Cronbach's alpha), and test–retest reliability as assessed by intraclass correlation value was 0.91. Conclusions: The Hindi version of the ECOHIS is a valid instrument for assessing OHRQoL in preschool children.
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A cross-sectional study to assess the prevalence of early childhood caries and associated risk factors in preschool children in district Mandi, Himachal Pradesh p. 339
K Sharma, KK Gupta, A Gaur, AK Sharma, V Pathania, VB Thakur
DOI:10.4103/JISPPD.JISPPD_95_18  PMID:31710007
Aim: The aim of this cross-sectional study is to investigate the prevalence and related risk factors of early childhood caries (ECC) in preschool children of district Mandi, Himachal Pradesh, India. Materials and Methods: A total sample of 2859 children aged between 2 and 6 years were selected from various parts of district Mandi. The status of dental caries and decayed missing and filled teeth (DMFT) score was recorded. Results: ECC increased significantly with age. Boys had significantly higher caries prevalence and mean DMFT score as compared to girls. Children who belonged to low socioeconomic group showed higher caries prevalence and mean DMFT score. Children aged 3–6 years who brushed their teeth twice daily had the least prevalence of dental caries as well as DMFT score when compared to children with one time and no brushing. Conclusion: The early identification of poor oral hygiene and improper feeding habits should be considered in preventive health promotion in low socioeconomic communities of district Mandi, Himachal Pradesh.
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The prevalence of dental anxiety and fear among 4–13-year-old Nepalese children p. 345
Nitin Khanduri, Namrata Singhal, Malay Mitra
DOI:10.4103/JISPPD.JISPPD_108_19  PMID:31710008
Aim: The aim of the study was to assess the prevalence of dental fear and anxiety among children aged 4–13 years using three fear scales, i.e., facial image scale (FIS), Nepalese version of Children's Fear Survey Schedule–Dental Subscale (CFSS-DS), and Modified Child Dental Anxiety Scale (MCDAS). Materials and Methods: The study was conducted on 300 children (4–13 years) who visited the Department of Pedodontics and Preventive Dentistry. The fear and anxiety levels were measured using three fear measurement scales, i.e., FIS, Nepalese version of CFSS-DS, and MCDAS. The dental behavior observed was rated according to the Frankl's Behavior Rating Scale (FBRS). Results: The prevalence of dental fear according to FIS was 11.9% as evident from children having FIS 4 and 5 scores. Dental fear with CFSS-DS ≥38 was identified in 49 children (21 [12.5%] male and 28 [21.21%] female). In assessment of the behavior of children in the clinics through FBRS, it was observed that the maximum number of respondents (70.6%) showed Frankl's rating 3, i.e., positive. Conclusion: The Nepalese versions of the CFSS-DS and the MCDAS are both reliable and valid scales for evaluating dental anxiety and fear in young children. Assessing dental anxiety and fear is useful, as behavior management can be designed accordingly for child patients.
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Assessment of parental attitude toward different behavior management techniques used in pediatric dentistry p. 350
Sneha Pramod Desai, Preetam P Shah, Shweta S Jajoo, Patil S Smita
DOI:10.4103/JISPPD.JISPPD_138_18  PMID:31710009
Background: The goal of any good dental treatment is to provide a quality dental care to the patient. This may not be possible if the patient is unwilling to cooperate or unable to do so due to their age or related factors. In such children, behavior management techniques are very helpful. With changing times, there have been changes in the law and the outlook of parents and society toward dental treatment. This influences the various behavior management methods used by pediatric dentists. Objectives: This study was conducted to assess the attitudes of parents of children of different pediatric age groups towards:
  • Behavior management techniques used by pediatric dentists
  • The effect of maternal anxiety on the child's behavior in clinic
  • Pharmacological behavior management techniques
  • The effect of parental presence in the operatory on the child's behavior.
Materials and Methods: Three hundred parents were evaluated and divided into three groups comprising 100 each on the basis of their children's age, Group A: 2–5 years, Group B: 6–9 years, and Group C: 10–13 years, which were further divided into two subgroups, on the basis of the child's gender, with each subgroup having parents of 50 male and 50 female children each. For example, Group A1: 50 parents of 2–5-year-old boys, Group A2: 50 parents of 2–5-year-old girls. Results: ANOVA test showed different hierarchies of acceptance for the techniques in all the groups. In all the three groups, tell show do, positive reinforcement, and live modeling were the most accepted techniques. However, statistically significant difference between the groups was not observed for the three techniques. The least accepted techniques for all the groups were hand over mouth technique and voice control technique. Conclusion: Parents were more receptive of those techniques which were visually more acceptable involving a communicative management, such as tell show do, positive reinforcement, and live modeling.
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ORIGINAL ARTICLES - CLINICAL RESEARCH Top

Assessment of mother's ability in caries diagnosis, utilizing the smartphone photographic method p. 360
Sonal Kale, Pradnya Kakodkar, Sahana Hegde Shetiya
DOI:10.4103/JISPPD.JISPPD_349_18  PMID:31710010
Background: Smartphone is proved to be reliable in teledentistry model. The aim of the study was to assess the mother's ability in caries diagnosis, utilizing the smartphone-based photographic method. Hypothesis: Mothers have the ability for caries diagnosis utilizing the smartphone photographic method. Methods: A cohort of 100 mothers was given health education regarding dental caries diagnosis. Then, their children from the preschools were screened by the dentist for dental caries using visual examination, followed by clicking intraoral photographs using Motorola 3G phone. The photographs were sent through WhatsApp to respective mothers, and they were asked to diagnose their child's dental status. Accuracy and reliability measures of mother's diagnosis were estimated by calculating the sensitivity, specificity, predictive values, and kappa value. Results: The calculated value for sensitivity was 88.3%, specificity was 98.3%, positive predictive value was 92%, negative predictive value was 97%, and accuracy was 96%. There was a strong agreement between mother's and dentist's diagnosis (kappa value of 0.87). Conclusion: Following the dental health education, it can be concluded that mothers are in a better position to diagnose their child's dental status through smartphone-based photographs.
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Effect of sesame oil, ozonated sesame oil, and chlorhexidine mouthwash on oral health status of adolescents: A randomized controlled pilot trial p. 365
V Chitra Vadhana, Asokan Sharath, PR Geethapriya, V Vijayasankari
DOI:10.4103/JISPPD.JISPPD_244_19  PMID:31710011
Context: Oil pulling procedure involves swishing of oil in the mouth for various oral health benefits. Aim: The aim of the study was to evaluate the effectiveness of sesame oil (SO), ozonated SO (OSO), and chlorhexidine (CHX) mouthwash on the oral health status of adolescents. Study Settings and Design: Parallel multi-arm double-blinded randomized trial was done in a Government higher secondary school. Materials and Methods: A total of 75 adolescents aged 12–14 years with decay-missing-filled index ≤3 were randomly assigned to three groups (n = 25): Group I (SO), Group II (OSO), and Group III (CHX mouthwash). Baseline (T1) Debris Index (DI-S), Calculus Index (CI-S), Oral Hygiene Index-Simplified (OHI-S), Plaque Index (PI), and salivary Streptococcus mutans count were recorded. All the groups were subjected to intervention with the respective mouth rinses for 15 days. The index scores and the salivary S. mutans count were reassessed after 15 days (T2) and 1 month (T3), and the results were statistically analyzed. Statistical Analysis: The statistical analysis was done using IBM SPSS Statistics for Windows. The statistical significance was set at P ≤ 0.05. Kolmogorov–Smirnov and Shapiro–Wilk test were used to test the normality of the data. The Friedman test and Wilcoxon-signed rank test were carried out for intragroup comparison. Kruskal–Wallis and Mann–Whitney U-test were employed to analyze inter-group comparison. Results: All the groups showed statistically significant reduction in DI-S, CI-S, OHI-S, PI, and S. mutans count after 15 days. Conclusion: Oil pulling therapy using SO and OSO showed a significant improvement in oral hygiene.
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Retention of pit and fissure sealant versus flowable composite: An in vivo one-year comparative evaluation p. 372
Charanjeet Singh, Kamalpreet Kaur, Kavisha Kapoor
DOI:10.4103/JISPPD.JISPPD_122_19  PMID:31710012
Introduction: Pits and fissures are extremely vulnerable to the development of caries. Resin-based materials for sealing pits and fissures (pit and fissure sealants and flowable composites) are helpful in caries control by physical barrier formation, which prevents metabolic exchange between fissure microorganisms and oral environment. Retention is one of the most important prerequisites for pit and fissure sealants. Debris and pellicle might not be removed by conventional prophylaxis and etching; therefore, air abrasion (AB) for fissure preparation has been advocated for sealant retention. This in vivo study was aimed to compare the retention of resin-based pit and fissure sealant to flowable resin composition occlusal pits and fissures of all first permanent molars with and without air-abrasion over a 12-month follow-up. Materials and Methods: A randomized controlled clinical trial was done after obtaining ethical committee approval and informed and written consent. Thirty children with the age of 6–9 years, with all four caries-free first permanent molars without any hypoplasia/fracture but with pits and fissures prone to caries were included in this study. The four first molars were divided into the following four groups: Group A (tooth 16; sealant + AB), B (tooth 46; composite + AB), C (tooth 36; sealant), and D (tooth 26; composite). Assessments were made at 3, 6, 9, and 12 months for partial or total loss of sealant and caries according to Modified Simonsen's Criteria. Results and Conclusions: Flowable composite was relatively better retained than sealant at 12 months' follow-up although results were statistically insignificant. AB followed by acid etching brought superior retention than acid etching. Mandibular teeth have shown relatively superior retention. Future studies should aim at investigating better techniques and materials for sealing pit and fissures.
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Comparative evaluation of antimicrobial effectiveness of probiotic milk and fluoride mouthrinse on salivary Streptococcus mutans counts and plaque scores in children – An in vivo experimental study p. 378
Raju Umaji Patil, Persis P Dastoor, Maitreyee P Unde
DOI:10.4103/JISPPD.JISPPD_45_19  PMID:31710013
Aim: The aim of the study was to compare the effectiveness of probiotic milk and fluoride mouthwash on salivary Streptococcus mutans (SM) counts and plaque index (PI) scores in children. Materials and Methods: Thirty children of 8–13 years with zero decayed, missing, and filled teeth (dmft)/DMFT were randomly divided into two equal groups of 15 each; baseline saliva samples were collected, and plaque scores were recorded. Group A received probiotic milk and Group B received fluoride mouthwash for 7 days, and then, saliva samples were collected for colony counting, and plaque scores were recorded on the 8th day. Study Design: This was a double-blind experimental in vivo study and randomized sample selection. Results: The results showed that there was statistically significant reduction in both salivary SM counts and plaque scores in both the groups after 7 days period. Intergroup comparison showed that there was no statistically significant difference between the two groups (i.e., both groups are equally effective in caries reduction). Conclusion: Probiotic milk was as effective as fluoride mouthwash in reducing SM counts and PI scores.
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Effectiveness of an integrated perinatal oral health assessment and promotion program on the knowledge in Indian pregnant women p. 383
Kalpana Bansal, Om P Kharbanda, JB Sharma, Mamta Sood, Harsh Priya, Alka Kriplani
DOI:10.4103/JISPPD.JISPPD_201_19  PMID:31710014
Background: Oral health during pregnancy plays a crucial role in the overall health and well-being of pregnant women. Evidence shows that most young children acquire cariogenic organisms from their mothers. Poor maternal knowledge about oral diseases combined with inappropriate feeding can lead to severe caries among young children. The aim of study was to assess the oral health status of pregnant women and to evaluate the gain in their knowledge after educational session in an antenatal setting. Materials and Methods: It is a pre- and post-intervention study carried out on the pregnant women (n = 198) attending an antenatal clinic in a tertiary care hospital. A specially designed semi-structured 14-point questionnaire was used to assess the pre- and post-knowledge and attitude to the oral health. Each participant was educated for self and infant oral care with the help of a specially prepared colored printed booklet. Kruskal–Wallis test was used to explore the associations between the age, education and socioeconomic class and knowledge; Wilcoxon signed-rank test was used to compare pre- and post-knowledge score. Results: Median preoral health knowledge–attitude score was found to be 4 (0–8) and was found to be associated with the level of education (P = 0.014) and socioeconomic class (0.019). There was a significant improvement in the median postknowledge score to 7 (2–10) (P < 0.001) following oral health educational session in all categories. Conclusions: An integrated preventive oral health checkup and educational program to pregnant women can benefit the dental health of the women and children. Prenatal care workers can be involved to disseminate the oral health awareness to pregnant women during antenatal visits.
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Evaluation of a mixture of zinc oxide–10% sodium fluoride as novel root canal filling material: A pilot study!! p. 392
Himani Goel, Shivani Mathur, Vinod Sachdev
DOI:10.4103/JISPPD.JISPPD_124_18  PMID:31710015
Background: To establish mixture of zinc oxide and 10% sodium fluoride as a novel root canal obturating material for primary teeth. Aim: This study aims to evaluate clinical and radiographic success of a mixture of zinc oxide and 10% sodium fluoride as root canal obturating material. Settings and Design: This pilot study was conducted among 30 primary molars indicated for pulpectomy. Methods: Thirty grossly decayed primary molars of children aged 4–9 years were selected with signs or symptoms of irreversibly inflamed or degenerative pulp tissue. Single sitting pulpectomy was carried out in all the teeth with a mixture of zinc oxide powder with 10% sodium fluoride, and they were subsequently restored with preformed crown. Teeth were assessed clinically and radiographically at 3-, 6-, 9-, and 12-month intervals. Statistical Analysis: Data were analyzed using SPSS Software Version 20.0 (IBM SPSS Statistics, Chicago, IL, USA) and statistical significance was determined by Chi-square test; level of significance was set at P < 0.05. Results: Overall clinical and radiographic success rate of combination of zinc oxide and sodium fluoride was 92.9% and 85.7%, respectively, at the end of 12 months. Furthermore, resorption rate of material matched resorption of tooth root. Excess filling material was also observed to resorb at the end of 3 months. Conclusion: These results suggest that combination of zinc oxide and sodium fluoride can be considered as suitable alternative root canal obturating materials for primary teeth with low cost to achieve acceptable therapeutic results.
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Biological approach in repair of partially inflamed dental pulp using second-generation platelet-rich fibrin and mineral trioxide aggregate as a pulp medicament in primary molars p. 399
Maria Manhas, Sudhir Mittal, AK Sharma, KK Gupta, V Pathania, V Thakur
DOI:10.4103/JISPPD.JISPPD_133_19  PMID:31710016
Aim: The purpose of this study was to evaluate and compare clinically and radiographically PRF, MTA and Ca(OH)2 as a pulp dressing material in primary molars. Material and Methods: The study was conducted on 30 children between 6-9 years of age. Pulpotomy was performed using MTA(Gp I), PRF + MTA(Gp II) and PRF +Ca(OH)2(Group III). The teeth were evaluated clinically and radiographically after 1,3 and 6 months and were subjected to statistics analysis. Results: After 6 months follow-up the overall success rate was found to be highest in Gp I with success rate of 97% followed by Gp II 95% and Gp III 78.3%. The results were found to be statistically insignificant (P ≤ 0.05). Conclusion: All materials used in the present study were equally effective as the success rates are statistically insignificant.
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CASE REPORTS Top

Does the position of a bottle during infant feeding influence the jaw's postural position? p. 405
Hua Zhu, Bree Zhang, RG Rosivack
DOI:10.4103/JISPPD.JISPPD_91_18  PMID:31710017
Early correction of anterior crossbite in the primary dentition can encourage proper growth and development of the maxilla and mandible, reducing the need for future orthodontic therapy. Correction is typically initiated after the age of 3 when a fixed or removable appliance can be fabricated and worn. This case study describes an instance of exceptionally early intervention without the use of an appliance. A bottle-fed 10-month-old boy presented with anterior crossbite, and a contributing factor may have been the position of the bottle's nipple during feeding. Correction of the anterior crossbite was achieved in 5 months by changing the bottle position to a counterbalancing angle. Although this technique warrants further investigation, it has the potential to reduce the need for and length of future procedures.
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Interceptive management of ectopically erupting central incisor - A case report p. 409
Brinda Suhas Godhi, Raghavendra Shanbhog, HP Chanchala
DOI:10.4103/JISPPD.JISPPD_193_19  PMID:31710018
Radicular cysts are considered to be rare in the primary dentition comprising 0.5%–3.3% of the total number of radicular cysts in both primary and permanent dentition. Ectopic eruption is an eruption disturbance with the prevalence of 5.6% with majority being permanent central incisors. Etiology for eruption disturbance commonly includes odontoma, cysts, supernumerary teeth, and crown-root malformation. Ectopic eruption of permanent incisor due to radicular cyst associated with traumatized primary incisor is a very rare clinical entity that requires timely interception. The present case illustrates the clinical feature and multi-disciplinary management of ectopic eruption of permanent central incisor in a 9-year-old girl child.
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Auriculotemporal nerve syndrome (Frey's syndrome): A literature review and case report p. 414
Roy Petel
DOI:10.4103/JISPPD.JISPPD_285_18  PMID:31710019
Frey's syndrome in children is rare and often erroneously attributed to food allergy. A description of a case of Frey's syndrome in a child and a review of the literature is provided. Awareness of this condition is important for the pediatric dentist to avoid unnecessary medical procedures and provide reassurance to the dental team in the setting of this benign condition.
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