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Journal of Indian Society of Pedodontics and Preventive Dentistry Official publication of Indian Society of Pedodontics and Preventive Dentistry
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   Table of Contents - Current issue
Coverpage
July-September 2022
Volume 40 | Issue 3
Page Nos. 217-346

Online since Tuesday, October 18, 2022

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EDITORIAL  

Get your habits right! Highly accessed article p. 217
Sharath Asokan
DOI:10.4103/jisppd.jisppd_393_22  
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SYSTEMATIC REVIEW Top

Effect of immunoglobulin Y formulations on oral microorganisms in human subjects - A systematic review and meta-analysis of clinical trials p. 219
Ashwin M Jawdekar, Vatsala Srivastava, Urvashi Tank, Laresh Naresh Mistry
DOI:10.4103/jisppd.jisppd_226_22  
Background: Passive immunization using egg yolk-based antibodies has been tested against oral microorganisms. Our study assessed the effect of immunoglobulin Y (IgY) formulations on Streptococcus mutans, Porphyromonas gingivalis, and Candida albicans in human subjects. Highlights: VS and UT independently searched articles using keyword combinations in four search engines; studies in English were selected. Either parallel-arm or split-mouth randomized controlled trials on healthy human subjects were considered. Ten studies remained in the selection; six studies compared the effect of IgY formulations on S. mutans, three on P. gingivalis, and one on C. albicans. Five studies (422 subjects) compared the effect of IgY formulations on S. mutans. When fixed-effect model (FEM) was applied, the risk ratio (RR) (confidence interval [CI]) was found to be 7.81 (6.00, 10.18). Three studies (167 subjects) compared the effect of IgY formulations on P. gingivalis. When FEM was applied, the RR (CI) was found to be 0.06 (−0.03, 0.15) in relation to reduction in probing depth. When FEM was applied, for percentage reduction in bleeding on probing (BOP), the RR (CI) was 1.99 (1.64, 2.41). Only one study (26 subjects) was available of IgY formulation and C. albicans; hence meta-analysis was not performed.The search was extended using Google Scholar, Semantic Scholar, cross-references and by contacting authors and researchers in the field which further yielded five articles. . Conclusions: IgY formulations were effective in the reduction of S. mutans. They were not effective on P. gingivalis in relation to probing depth but were effective in relation to reduction in BOP. No harms were reported. Evidence is of low quality due to high heterogeneity. The ROB was moderate and publication bias was low.
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Nanosilver fluoride as a caries arresting agent in children: A systematic review and meta- analysis Highly accessed article p. 230
Shikha Choubey, Amol Patil, Abhinav L Talekar, Dheeraj Kalra
DOI:10.4103/jisppd.jisppd_224_22  
Background: Dental caries is one of the most common concerns in oral health of children. Arresting these lesions is a treatment which is gaining momentum as against conventional restorative approaches. Aim: The aim is to evaluate the efficacy of nanosilver fluoride (NSF) as a caries arresting agent in primary teeth or first permanent molars in children. Design: The protocol for the systematic review has been registered with PROSPERO database (CRD42020162386). Several databases, such as PubMed®/MEDLINE, Web of Science™, Scopus®, Google Scholar, LILACS, Cochrane Library, ProQuest, and BBO, were searched for randomized controlled trials (RCTs) which evaluated the arrestment of caries, in primary teeth and first permanent molars in children, with a minimum follow-up of 6 months. The Risk of Bias tool by Cochrane reviews system software, Revman 5.4.1, was used for quality assessment of the included RCTs. The quality evaluation was done using the GRADE approach. Heterogeneity was assessed using Cochrane's Q and I2 statistics. Results: Five studies were included for qualitative and quantitative analysis. The Risk Ratio for NSF versus active control group was assessed to be 1.09 (0.93-1.28) with 95% Confidence Interval and for placebo control was 0.49 (0.35-0.67). Conclusion: NSF shows promise as a caries arrestment agent when applied in primary teeth. PROSPERO Registration: This review was registered with the PROSPERO database (CRD42020162386)
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Short- and long-term dental arch spatial changes following premature loss of primary molars: A systematic review p. 239
Janvi Manish Gandhi, Deepa Gurunathan
DOI:10.4103/jisppd.jisppd_230_22  
Aim: The aim of this study was to evaluate the dental arch spatial changes in maxillary and mandibular arches after premature loss of primary molars. Introduction: Primary teeth must be maintained during the change from primary to mixed and then permanent dentition, to preserve and maintain the dental arch. When this normal process is disturbed, usually due to severe decay requiring extraction before normal exfoliation, it can result in migration of adjacent teeth toward the missing space resulting in decreased arch length and malocclusion in the permanent dentition. Materials and Methods: A comprehensive search was conducted using electronic databases such as PubMed Central, Cochrane Database of Systematic Reviews, Google Scholar, LILACS, and ScienceDirect. The title and abstract were screened to find relevant articles, which were then reviewed in full to see if they were worthy of inclusion. All longitudinal and observational studies that looked at space changes after the loss of primary first or second molars were included. Quality assessment of the studies was done based on the Newcastle-Ottawa scale as all the included studies were non-randomized studies. Results: Four thousand five hundred and seventy-eight articles were identified by screening electronic database and assessed for eligibility, 12 full-text articles were assessed, and 4 full-text articles were excluded as they did not match the inclusion criteria. Thus, eight articles were included in this systematic review. Short term and long term space changes and loss of maxillary and mandibular molars were studied individually. In the short term changes, the distal migration of the primary cuspid towards the missing space within 1 month was attributable to early space changes after premature loss of the mandibular first molar, and the greatest space loss was recorded in the first 3 months after premature loss. After the premature loss of the maxillary first molar, immediate space loss of 1mm was documented due to distal migration of the primary canine. Studies found that space loss was caused by the distal migration of primary canines in the case of mandibular primary first molar loss, and that space loss was larger in the mandibular arch after premature loss of second primary molars. Conclusion: The greatest repercussions occurred during the first 3 months after the deciduous molars were extracted, and a space maintainer was recommended in the majority of cases, mainly when there is premature loss of mandibular second primary molar as it leads to mesial displacement of the first permanent molar.
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ORIGINAL ARTICLES - CLINICAL RESEARCH Top

Enhancing special care dentistry with sensory-adapted dental environment: A comparative study p. 246
Simin Kittur, N Basappa, OS Raju, Saraswathi V Naik, Amitha M Shagale
DOI:10.4103/jisppd.jisppd_199_22  
Aim: To compare and evaluate the effect of sensory-adapted dental environment (SADE) and regular dental environment in reducing anxiety levels in children with intellectual disabilities. Materials and Methods: This study was carried out in children with mild intellectual disabilities aged 8–13 years. The developmental screening test was utilized in screening and including these children with IQ scores between 52 and 67, and after random allocation, children were subjected to oral prophylaxis in the SADE and regular dental environment. Anxiety levels were assessed at baseline, 5 min, and at the end of the procedure using Venham's anxiety rating scale, pulse rate, and blood pressure values. Results: The data were coded and analyzed using software SPSS (IBM version 22.0) for statistical analysis. Comparison between the groups was done using independent t-test and repeated measured ANOVA for objective assessment of intergroup and intragroup anxiety levels, respectively, and using Mann–Whitney U-test and Friedman's test for subjective assessment of intergroup and intragroup anxiety levels, respectively. Conclusion: These findings suggest that SADE significantly decreased anxiety levels and cooperative behavior in children with mild intellectual disability and can be used as an alternative behavior management technique in effectively handling children with intellectual disability.
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Effectiveness of self-designed dental storybook as behavior modification technique in 5 – 7 year-old children: A randomized controlled study p. 253
Anshula Deshpande, Aishwarya Jain, Yash Shah, Vidhi Jaiswal, Medha Wadhwa
DOI:10.4103/jisppd.jisppd_237_22  
Background: Dental anxiety is one of the key factors that prevent children from obtaining dental treatment and raises anxiety levels in children. The first dental visit is usually fearful for the child and contributes to managing the child patient in a dental operatory. A pediatric dentist's role is to perform effective treatment using various nonpharmacological behavior management techniques. Aims: The aim of the study was to evaluate and compare the effect of self-designed dental storybook on behavior and pulse rate before and after dental procedures in 57-year-old children. Settings and Design: The study was a prospective, randomized, controlled trial. Materials and Methods: The study was conducted on 380 aged 57 years. Children were randomly allocated into two groups, namely, Group A − Behavior modification using a self-designed dental storybook and Group B – Behavior modification without storybook. Research was carried out in two dental visits (screening, examination, and preventive and restorative treatment) wherein, before and after intervention, pulse rate, Facial Image Scale (FIS), and Venham Scale (VS) were recorded. Descriptive statistical analyses followed by the paired t-test and Wilcoxon signed-rank test were applied and tabulated using the SPSS software version 23.0. Results: There was a significant difference observed in the interventional group as compared to the control group for pulse rate, FIS, and VS. Conclusion: Self-designed dental storybook as an adjuvant was found to be promising behavior modification technique for 57-year-old children.
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Modifications of behavior management strategies pre- and post-covid-19 scenario: A survey among pediatric dentists p. 260
Mili Meghpara, Nikhil Marwah, Yashi Sharma, Archana Paliwal, Shubham Godhani
DOI:10.4103/jisppd.jisppd_213_22  
Background: COVID-19 presented a unique scenario among children, specifically all over the world. The children had decrease outdoors activities and learning times, increased use of electronic gadgets and changes in sleep patterns. These altered behavior patterns of children directly influenced their behavior in the dental operatory. This coupled with the stringent protocols of COVID-19, made the behavior management of children a tedious task. However, as they say that necessity is the mother of all inventions, the pediatric dentist took this time to evaluate newer methods of behavior management and modified old strategies with newer modifications. Aim: The main aim of this study was to observe the modifications in behavior management strategies among pediatric dentists in the post-COVID-19 era while managing the child in dental operatory. Materials and Methods: Four hundred pediatric dentists were mailed a questionnaire consisting of 24 open and closed-ended questions consisting of personal data, professional information, and questions regarding various behavior management techniques used by them in pre- and post-COVID-19 era. Data obtained were subjected to statistical analysis using SPSS version 26.0, IBM, and a comparison of frequencies of categories of variables with groups was made using Chi-Square test and McNemar test. Results: The results showed that there were statistically highly significant changes in behavior management strategies pre- and post-COVID-19 scenario with P < 0.01. Conclusion: Conventional techniques like Tell-Show-Do were popular in both pre- and post-COVID-19 times with minor modifications in approach, but conscious sedation and distraction techniques were evaluated to have gained more popularity in the post-COVID-19 times along with exploration of new novel techniques.
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Comparison of craniofacial morphology characteristics along with dental caries status and salivary properties of operated cleft lip and palate patients with noncleft patients p. 265
Lipsikha Talukdar, Sonali Saha, Kavita Dhinsa, Amit Rai, Vandana Tiwari, Himanshu Trivedi
DOI:10.4103/jisppd.jisppd_278_22  
Background: Cleft lip and palate patients undergo many primary reconstructive surgical procedures which could lead to various changes in the facial morphology with growth. The most common diagnosis is unilateral cleft lip and palate (UCLP) and such patients are more prone to dental caries. Aims: This study aimed to evaluate and compare the lateral cephalometric landmarks, dental caries status, and salivary properties of surgically repaired UCLP children aged 6–15 years with lateral cephalometric landmarks, dental caries status, and salivary properties of noncleft children of the same age group. Materials and Methods: Twelve noncleft patients and 12 surgically repaired UCLP patients were chosen, and cephalometric analysis, salivary analysis, and dental caries status were recorded for both the groups. The data were then compared for both the groups. Statistical Analysis: It was analyzed using the Statistical Package for the Social Sciences (SPSS) version 21. The level of statistical significance was set at 0.05. Results: In surgical repair ULCP children, their was increased prevalance of dental caries along with decrease level of salivary calcium, Phosphorus,flow rate. Also, their was increased level of alkaline phosphatase, total protein level with acidic pH alongwith retruded maxillary complex with Class III malocclusion. Conclusion: Various primary reconstructive surgeries in UCLP children lead to maxillary retrusion with an increased prevalence of dental caries in these patients due to the maintenance of poor oral hygiene.
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Comparison of dental caries experience and salivary parameters among children with Down syndrome and healthy controls in Chennai, Tamil Nadu p. 274
Sujatha Anandan, Nagesh Lakshminarayan, Karibasappa Gundabaktharu Nagappa
DOI:10.4103/jisppd.jisppd_296_21  
Background: Although there have been numerous studies on dental caries in children with Down syndrome, the reports are conflicting. Studies on salivary chemical composition of children with Down syndrome are limited. Aim: The study aims to evaluate and compare the dental caries experience, salivary flow rate, pH, buffering capacity, and concentration of sodium, potassium, calcium, phosphorus, total proteins, and sialic acid in children with Down syndrome and healthy controls. Settings and Design: This was a cross-sectional study. Materials and Methods: Forty subjects with Down syndrome aged 5–18 years fulfilling the eligibility criteria from six special schools were selected by snowball sampling. Sixty healthy controls from six neighborhood schools fulfilling the eligibility criteria were selected by simple random sampling by matching the age, gender, and socioeconomic status. Sociodemographic data, oral hygiene practices, diet history and dental caries experience were recorded. About 6 mL of stimulated whole saliva was collected. Salivary flow rate, salivary pH, buffering capacity, and the concentration of sodium, potassium, calcium, phosphorus, total proteins, and sialic acid were determined. Results: There was no significant difference in the mean proportional caries rate between the study and control group (P = 0.90). Salivary pH (P = 0.00) and salivary sodium concentration (P = 0.02) were significantly low in the study group than the control group. Salivary buffering capacity was significantly higher in the study group than the control group (P = 0.001). Conclusions: Dental caries experience of children with Down syndrome was similar to the healthy controls. School health programs could be implemented in special schools to improve oral and general health of special children.
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Evaluation and comparison of silorane resin composite to glass ionomer in occluso-proximal restorations of primary molars: A randomized controlled trial p. 281
Viral P Maru, Purva Kulkarni, Rewant Chauhan, Salil S Bapat
DOI:10.4103/jisppd.jisppd_377_22  
Objective: In general, proximal restorations of primary molars fracture, so it is vital to study the new materials that could solve this problem. Hence, the present trial assessed the success of occluso-proximal atraumatic restorative treatment (ART) restorations using silorane and glass ionomer cement (GIC) in carious primary molars for a period of 2 years. Materials and Methods: One hundred and ninety-two children between the age group of 4 and 9 years were randomly allocated to GIC or silorane. In the clinical set up, they were treated by a pediatric dentist, and their restorations were evaluated at 3, 6, 12, 18, and 24 months. The primary outcome was the survival of restoration, which was analyzed using the Kaplan–Meier and superior Cox regression models. As a sensitivity analysis, intention-to-treat (ITT) was executed. Sex, age, molar, jaw, cavity volume, and caries incidence were the independent variables. Results: The restoration survival after 24 months for GIC and silorane was 82.75% and 88.88%, respectively, whereas ITT analysis showed a success of 84.37% and 89.58% for GIC and silorane, respectively. Conclusion: With regard to longevity, there was no statistically significant difference between silorane and GIC in primary molar occlusoproximal ART restorations.
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Clinical evaluation of bioactive resin-modified glass ionomer and giomer in restoring primary molars: A randomized, parallel-group, and split-mouth controlled clinical study p. 288
UdayaKumar Deepika, Prasanna Kumar Sahoo, Jayanta Kumar Dash, Ratna Renu Baliarsingh, Prayas Ray, Gaurav Sharma
DOI:10.4103/jisppd.jisppd_139_22  
Aim: This study aims to evaluate and compare the clinical performance of two restorative materials – bioactive resin-modified glass ionomer (ACTIVA BioACTIVE restorative) and giomer hybrid composite (Beautifil Flow Plus) in restoring class I carious primary molars. Materials and Methods: The split-mouth randomized controlled study was conducted on 100 primary molars from 50 children (28 – males, 22 – females) from 50 children in age range of 5-9 years (Mean-7.29±1.34) with at least two occlusal carious lesions on either maxillary or mandibular primary molars. Each child had both the control and the experimental teeth restored with respective restorative materials, Group I (Control, n = 50) → Giomer, Group II (Experimental, n = 50) → Bioactive resin-modified glass ionomer. The restorations were evaluated by two independent investigators using modified United State Public Health Service criteria at immediate postoperative, 6 months, and 12 months. The Chi-square test was used for the statistical analysis after collecting the data. Results: At the 12-month follow-up, 33 children (66 teeth) reported with an attrition rate of 33%. The color match between the groups was not statistically significant at all intervals. The marginal discoloration, marginal integrity, anatomic form, and retention had no significant difference at 6 months. But at 12 months, there was a statistically significant difference between the groups with p value of 0.04,<0.001,<0.02 and <0.001 respectively. respectively. At 12 months, there was no postoperative sensitivity in both groups. Conclusion: Bioactive resin-modified glass ionomer with enhanced properties can be used as an effective restorative material, especially in children with excessive salivation.
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Comparative evaluation of intracanal cryotherapy and curcumin as a final irrigant in reducing post endodontic pain in primary teeth p. 297
Nimisha Kumari, Harsimran Kaur, Rishika Choudhary, Ramakrishna Yeluri
DOI:10.4103/jisppd.jisppd_216_22  
Aim: The aim of this study was to evaluate the intracanal effectiveness of cryotherapy, curcumin irrigant, and normal saline as a final irrigant in reducing postendodontic pain in primary teeth. Materials and Methods: A total of 120 teeth between the ages of 4 and 7 years requiring pulpectomy in primary teeth were included in the study. The teeth were randomly assigned to one of the three treatment groups: intracanal cryotherapy using 2.5°C cold saline, curcumin irrigant, or normal saline. Following completion of chemomechanical preparation, final irrigation with 2.5°C cold saline, curcumin irrigant, and normal saline solution at room temperature were employed in the groups. Participants were asked to rate the severity of their postoperative pain on the Visual Analog Scale before, immediate postoperative after wearing of local anesthetic effect, and 24 h after the procedure. The results were analyzed statistically. Results: The differences in reduction of postendodontic pain between the three irrigating regimens were statistically not significant. Cryotherapy utilizing 2.5°C cold saline or curcumin irrigant can be used instead of normal saline as a final irrigant in pulpectomy of primary teeth. Conclusions: Cryotherapy can be a straightforward, cost-effective, and nontoxic treatment option for the management of postendodontic pain. Curcumin irrigant with its anti-inflammatory properties is also a better alternative as a final irrigant for reducing postoperative pain in primary teeth.
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A comparative study of conventional and Hall techniques of crown placement using finite element stress analysis p. 302
Pawan Pramodrao Herkar, A Anantharaj, P Praveen, Prathibha Rani Shankarappa, R Sudhir
DOI:10.4103/jisppd.jisppd_173_22  
Background: Hall technique of crown placement causes the changes in vertical occlusal dimension; the mode of settlement of which needs to be explored. Aim: To assess and compare the changing patterns of stress distribution following placement of stainless steel crowns on primary teeth by Hall and conventional techniques using a finite element model analysis. Materials and Methods: The clinical crown heights of primary molars restored with Hall and conventional techniques and opposing teeth in contact, vertical dimension changes in the primary canine area were measured using intraoral digital scan. T-scan was used to measure the changes in bite force while the finite element analysis was used to assess deformative changes on the 2nd, 5th, 10th, and 15th days. Results: The Hall technique of crown placement caused more stress distribution in the tooth supporting tissues that settled in 2 weeks as compared with conventional technique of crown placement in which settlement occurred in 2 days. Conclusion: The settling of vertical occlusal dimension as well as stress distribution in Hall technique probably takes place by intrusion of crowned tooth and opposing teeth in contact.
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Prevalence of gingival recession and associated etiological factors among the school children p. 311
Sonia Sudeepthi Seemakurthy, Sailavanya Nuvvula, Sreekanth Kumar Mallineni, Sivakumar Nuvvula
DOI:10.4103/jisppd.jisppd_176_21  
Objective: The objective of this study is to assess the prevalence of gingival recession (GR) and associated etiological factors among school children. Methodology: The study sample consisted of 2095 children from the Nellore region divided into three groups of age ranges from primary dentition (<7 years), mixed dentition (7–12 years), and permanent dentition (>12 years) respectively, attending the department of pediatric and preventive dentistry and the school dental health programs organized by the department. The clinical examination involved measuring GR using William's periodontal probe and evaluating associated etiological factors. Data were statistically analyzed using the Chi-square test. Results: The GR among the study population was 7.9% (n = 165). Among them, males were 46% and females were 54% (P > 0.05). The GR was more in children in the 7–12 years age group (75%), followed by <7 years (21%) and >12 years (4%) age groups. The associated factors include malocclusion (69%), deleterious habits (5%), and anomalies (26%). Anomalies showed an association with GR (P < 0.05) compared to malocclusion and deleteriousness habits (P > 0.05). Conclusion: The prevalence of GR is 7.9%, and GR is more prevalent in males and the 7–12 years age group. GR is associated with transient malocclusion, deleterious habits, and anomalies.
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Malayalam language translation and validation of oral health-related early childhood quality of life tool (OH-ECQoL) p. 317
Faizal C Peedikayil, Soni Kottayi, T Subbalekshmi
DOI:10.4103/jisppd.jisppd_177_22  
Objective: The objective of this study was to adapt the Oral Health-related Early Childhood Quality of Life (OH-ECQoL) tool for the Malayalam-speaking community and investigate its validity and reliability. Methodology: Malayalam language version of OH-ECQoL was derived through a forward–backward translation and tested for content validity. A convenient sample (n = 300) was recruited by including children with and without early childhood caries (ECC). Parents of these children completed the derived Malayalam OH-ECQoL measure. The properties of translated OH-ECQoL were evaluated by determining its validity and reliability using concurrent validity, construct validity, discriminant validity, internal consistency, and test–retest reliability. Results: OH-ECQoL scores varied with ECC and caries-free groups (P < 0.001), supporting the ability to distinguish between patient groups. Discriminant validity tests show that children with ECC have greater median scores and interquartile range (21 ± 8) compared to children without ECC (14 ± 2). Concurrent validity was observed to be 0.72 and 0.71, respectively, for child section (P < 0.001). Convergent validity demonstrates a strong positive correlation between child impact and family impact with a Spearman's correlation coefficient significant of 0.73 (P ≤ 0.01). Cronbach's alpha for the child impact section and family impact section showed good internal consistency at 0.92 and 0.83, respectively. Test–retest reliability at 0.87 shows good reliability. Conclusions: The Malayalam version of the OH-ECQoL tool demonstrated acceptable validity and reliability. The study also shows that ECC presents a negative impact on the QoL of preschool children and their parents.
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ORIGINAL ARTICLES - LABORATORY RESEARCH Top

Effect of non-thermal atmospheric pressure plasma and ErCr:YSGG LASER activation of three fluoride varnishes on surface re-mineralization of enamel: A SEM-EDX analysis p. 324
Shreya Arun Bapat, ND Shashikiran, Sachin Gugawad, Namrata Gaonkar, Swapnil Taur, Savita Hadakar, Pradnya Chaudhari
DOI:10.4103/jisppd.jisppd_113_22  
Background: Dental remineralization is the process of transporting minerals from the surrounding environment (i.e., saliva and biofilm) into partially demineralized tooth structures. Remineralization can be induced by professional therapies such as fluoride-based treatments that have the highest level of supporting evidence. High-intensity LASER and nonthermal atmospheric pressure plasma therapy have been known to increase the resistance of enamel to demineralization by surface modification. Aim: The aim of the study was to evaluate and compare the surface remineralization of enamel using ErCr:YSGG LASER and nonthermal atmospheric pressure plasma (NTP) activation with three different fluoride varnishes. Methodology: Sixty-eight extracted premolars were used which were sectioned mesiodistally to obtain 135 specimens and artificial caries were induced on the experimental surface. They were then randomly divided into three groups (n = 45): MI Varnish (GC Japan), Vanish Varnish (3M ESPE), and Embrace Varnish (Pulpdent). After varnish application, these groups were further divided into three subgroups based on the activation therapy used. Fifteen samples from each group were treated with ErCr:YSGG LASER, 15 samples with NTP, and 15 samples were the control that did not undergo activation. After 9 days of pH cycling, the mean ion concentration of the surface calcium and phosphate ions was recorded using FEG-SEM and EDX analysis. The data were statistically analyzed. Results: One-way ANOVA and post hoc Tukey test accepting P < 0.05 were performed for comparisons between all analyses groups. Vanish Varnish showed a higher Ca/P ratio in LASER, NTP, and control subgroups, followed by MI Varnish and Embrace Varnish. ErCr:YSGG LASER therapy showed an improved Ca/P ratio in all varnishes than NTP therapy and control. Conclusion: ErCr:YSGG LASER therapy showed positive effects toward improving the Ca/P, followed by NTP therapy as compared to control in all three varnishes indicating their role in enhancing the effects of remineralization. Vanish Varnish showed a higher Ca/P ratio indicating better remineralization post activation.
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Evaluation of three different remineralizing agents on artificially demineralized enamel lesions: Using scanning electron microscopy-energy dispersive X-ray and magic-angle spinning nuclear magnetic resonance - An in vitro study p. 330
Divya Vijay Mehta, Shakuntala B Siddaiah
DOI:10.4103/jisppd.jisppd_282_22  
Aim: Demineralization can be arrested or reversed when remineralization agents are applied to incipient carious or noncavitated carious lesions. A large number of therapeutic agents, including nonfluoridated products, have been developed to promote enamel remineralization. This study aims to evaluate the efficacy of different remineralizing agents on artificially demineralized enamel lesions. Materials and Methods: The present in vitro study was conducted on 75 sound premolars divided into three groups of normal, demineralized (n = 15 each), and remineralized teeth (n = 45). The remineralized teeth were further subdivided into three groups (n = 15) as remineralized with 2% sodium fluoride (NaF), 2% NaF, and Psoralea corylifolia (bakuchi) and white mineral trioxide aggregate. Specimens of each group were treated with the above-mentioned remineralizing agents and then subjected to Vickers hardness number (VHN), scanning electron microscopy–energy dispersive X-ray (SEM-EDX), and magic-angle spinning nuclear magnetic resonance (MAS-NMR) for further evaluation. Results: The test results showed significantly the highest VHN and the emission peak of elements under the EDX test, such as calcium, phosphorous, oxygen, and fluorine with remineralized with NaF + bakuchi. MAS-NMR spectra showed fluorine and phosphorous peak in a group with NaF + bakuchi indicative of the increase in remineralization. NaF + bakuchi showed effective results in VHN, SEM-EDX, and MAS-NMR with no antagonist interaction. Conclusion: Thus, P. Corylifolia presents an advantage in enhancing remineralization and inhibiting demineralization for early carious lesions and can be used as a herbal extract for effective reduction in pathogenic bacteria.
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Comparative assessment of the efficacy of low concentration bleaching agents using quantitative light induced fluorescence in removing stains: An In vitro study p. 338
Aiswarya Balakrishnan, Nandlal Bhojraj, Raghavendra Shanbhog, KP Ashwini
DOI:10.4103/jisppd.jisppd_303_22  
Background: Tooth discoloration has become a common esthetic problem in recent years. Removal of stains by bleaching is well-documented. Low concentration home bleaching products are available in market in different forms and concentrations. Aim: The aim of this study is to evaluate and compare the efficacy of low concentration commercially available home bleaching products (whitening strip, gel, and mouthwash) in removing stains and whitening the tooth using clinical and digital methods. Materials and Methods: Sixty permanent enamel samples mounted in an acrylic block were artificially stained and randomly divided into four groups. Negative control, 15 % Carbamide peroxide gel group, 2% Hydrogen 16 peroxide mouthwash group and 6% Hydrogen peroxide strip group respectively. The samples were bleached with respective agents according to the manufacturer's instructions. The efficacy on 7th and 14th day was evaluated clinically (SGU change), photographically (ΔE), and using quantitative light-induced fluorescence (ΔF). The data were analyzed using paired t-test and analysis of variance. Results: Postbleaching, 6% hydrogen peroxide strips and 15% carbamide peroxide gel showed maximum improvement (ΔΔF – 15.73 and 11.89, ΔE – 19.8 and 18.9, respectively) when compared to 2% hydrogen peroxide mouthwash and negative control group (ΔΔF – 9.68 and 6.59, ΔE – 15.04 and 9.44, respectively). The difference was statistically significant (P = 0.001). Conclusion: 6% hydrogen peroxide strips and 15% carbamide peroxide gel showed maximum improvement in stain removal and tooth whitening however, the strips showed better efficacy than the gel. Strips have the added advantage of lesser contact period, less salivary dilution, and no gingival contact. Therefore, strips can be a better alternative for gels and mouthwashes.
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