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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
January-March 2022
Volume 40 | Issue 1
Page Nos. 1-101

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Gratitude – Moral memory of mankind! Highly accessed article p. 1
Sharath Asokan
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Sports-related facial trauma in the Indian population - A systematic review Highly accessed article p. 3
S Shreya, Shridhar Damodar Baliga, Sulakshana Shridhar Baliga
Background: Sports injuries are a growing concern which requires immediate attention. Dental injuries are the most common type of orofacial injuries sustained during sports activities. Objectives: This study aims to review the prevalence of sports-related facial trauma in India, to identify the most common types of oro-facial injury incurred due to sports, and to assess the level of awareness regarding preventive measures used in sports. Methodology: The present review was performed in accordance with preferred reporting items for systematic reviews and meta-analyses guidelines. All articles published from 2005 to 2019 on sports-related facial trauma were analyzed. PubMed, Google Scholar, and Cochrane reviews databases were searched using primary keywords. Results: A total of 24 articles published in the period of 2005–2019 were included. The prevalence of sports-related facial trauma was found to be the highest in the study conducted by Selva et al., in 2018, at a rate of 75%, whereas it was found to be minimal in the study conducted by Bali et al. in 2013. While the awareness of mouthguards was reported the highest in a study conducted by Ramagoni et al., in 2007. Conclusion: This study shows that there is a definite need to improve the awareness as well as the usage of protective gear, from the level of schooling, where children are introduced to sports. Prevention of sports-related facial trauma is essential to avoid the serious and lifelong consequences which could be the aftermath of such injuries.
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Apical extrusion of debris with root canal instrumentation in primary teeth: A systematic review Highly accessed article p. 9
Drishti Kaushal, Srinivas Gosla Reddy, Krishna Prasad Biswas, Ashutosh Dixit, Rebecca Chowdhry, Ashi Chug
Aim: This study aimed to systematically review available literature of in vitro studies on apical extrusion of debris through rotary instrumentation in comparison to manual instrumentation in pediatric endodontics, and also to perform a comparison between various rotary instrumentation systems for assessment of debris extrusion. Materials and Methods: A comprehensive search was conducted on PubMed, Medline, Cochrane Library, Embase, Scopus, and Google Scholar without any language restriction and year of publication. A planned search strategy was made for PubMed and applied to other databases. After full-text reading, 7 articles were selected for quantitative synthesis. Modified CONSORT checklist of items for reporting in vitro studies of dental materials was used for quality assessment of included studies. Results: Root canal preparation with rotary instrumentation led to lesser apical debris extrusion than manual instrumentation. Self-adjusting file system was associated with the least debris extrusion among all included studies, followed by ProTaper Next, Kedo-S, ProTaper, K3, Mtwo, Revo-S, and Wave One. Conclusion: More apical debris extrusion was seen with manual instrumentation than rotary instrumentation. Furtrhermore, variance in debris extrusion was seen with different rotary file systems.
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Estimating the effectiveness of lollipops containing xylitol and erythritol on salivary pH in 3–6 years olds: A randomized controlled trial p. 19
Sakshi Jain, Shivani Mathur
Background: Prevention of dental caries is important for nutrition and health of the child. Sucrose being considered an arch criminal, various substitutes are recommended. Xylitol is an artificial sweetener which cannot be metabolized by bacteria. Thus, it seems to be a promising method in prevention of dental caries. Materials and Methods: Fifty children between the age of 3–6 years were randomly divided into two groups; Group 1: Control group (without lollipops) and Group 2: Experimental group (with sugar substitute lollipops). The saliva sample was collected at four different time intervals, and pH of saliva was determined using universal pH indicator. Results: There was a significant drop in the pH after drinking sweetened beverages in both the groups, but there was a significant rise in pH after having xylitol + erythritol lollipops which almost returned to baseline after 15 min. Conclusion: Lollipops containing xylitol and erythritol can be used in small children and it has potential to increase salivary pH, thus not allowing the pH to fall below the critical value.
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In vivo evaluation of clinical performance of Cention N and glass ionomer cement in proximal restorations of primary molars p. 23
Divya Arora, Mansi Jain, HP Suma Sogi, Prinka Shahi, Ishita Gupta, Meera Sandhu
Introduction: Restoring a proximal lesion in primary tooth has met with many challenges which has led to evolution of many materials. An alternative to Glass Ionomer Cements which has fluoride releasing capacity, offers good bond strength and is esthetic have been long looked for. Aim: This study aimed to compare the clinical performance of GIC and Cention N in proximal restorations of primary molars. Materials and Methodology: A prospective study was conducted on 154 primary molars in patients aged between 5 and 8 years using a split-mouth design. Patients were divided into two groups. Control group restored with GIC and study group received Cention N. Both groups were assessed at baseline 3, 6 and 9 months according to Ryge criteria and data was statistically analysed using Fisher's Exact. Results: Statistically significant difference was found between GIC and Cention N restorations for color match at baseline and color stability at 3 months (P < 0.001), while the other parameters did not show any significant difference among the two restorative materials. Conclusion: Cention N can be used as a suitable alternative to GIC for restoring Class II restorations in primary molars.
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Quantification of sugar intake and mineralization of teeth in 13–15-year-old subjects – A pilot study p. 30
Sona Gajanan Therathil, Prasad V V. Kakarla
Background: Dental caries begins with the initiation of demineralization which is a reversible process. Diet, especially intake of sugar, is an important aetiological factor for demineralization of enamel which eventually leads to caries. Aim: This study aims to understand the quantitative relationship between sugar consumption and mineralization by finding out the change in mineralization of teeth as a result of the change in the sugar score. Settings and Design: This interventional study was done among 119 teeth of 19 subjects who were between the ages of 13–15 years in Hubli city. Materials and Methods: Sugar score was calculated from a 5-day diet history of the subjects and a DIAGNOdent pen was used to indicate the mineralization value of the teeth before the intervention. Diet counseling was given as an intervention after which sugar score and DIAGNOdent scores were measured again after 14 days and compared with the baseline values. Statistical Analysis: Descriptive statistics and a linear regression analysis was done to determine the relationship between the variables. Results: Sugar score and DIAGNOdent score after 14 days were found to have reduced significantly by 41.6% and 20.3% respectively from the baseline values. The Linear Regression indicated that a reduction of sugar score by 5 resulted in a decrease of DIAGNOdent score by 0.16. Conclusion: The findings of the present study suggest that the modification of sugar consumption brought about a significant improvement in the mineralization of the demineralized teeth thus making diet counseling an effective preventive strategy for caries prevention.
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A clinical and radiographic comparative evaluation of custom-made zirconia crowns using CAD-CAM and stainless steel crowns in primary molars p. 34
Deepika Prabhu, A Anantharaj, P Praveen, S Prathibha Rani, R Sudhir
Background and Aim of Study: Early childhood caries is a multifactorial disease process affecting children below 71 months of age and continues to be a global health problem. Stainless steel crowns (SSCs) are widely used and are very popular in pediatric dentistry due to its superiority and durability when compared with multisurface amalgam restorations. However, one of the major disadvantages with these crowns is the poor esthetics. Parents often request for a more esthetic alternative to the SSC. Zirconia crowns are one of the tooth-colored full crown restorations currently available for use in primary teeth. These are available as both preformed and custom-made crowns and show excellent esthetics. However, these require extensive tooth preparation with a subgingival finish lines, which would cause gingival trauma and bleeding during the preparation. The present study uses intraoral scanners for making the custom-made zirconia crowns, which will avoid the conventional impressions. Currently, there are no studies available in pediatric dentistry regarding CAD-CAM crowns. Hence, there is a need for the study. Aim: The aim of this study is to clinically evaluate the performance of preformed SSCs and custom-made zirconia crowns in primary molars. To elicit parental and patient satisfaction with respect to preformed SSCs and custom made zirconia crowns and to radiographically compare the interproximal bone height for 1 year. Methods: The patients were selected with purposive sampling. The tooth of interest was prepared according to the crown it would receive. The upper and the lower arch of the tooth receiving custom-made zirconia crown was scanned using an intraoral scanner. The crowns were cemented using Type 1 glass ionomer cement (GIC) (SSC) and resin modified GIC (custom-made zirconia crown). After the crown placement, the patient and the parent's satisfaction was scaled regarding the time taken, comfort, cost of crown, appearance of crown, etc., using a 5-point Likert scale. A baseline radiograph was taken after crown placement. The patient was recalled every 3 months till 1 year for evaluation (loss of retention, loss of proximal contact, gingival inflammation, opposing tooth wear, and marginal integrity). At the end of 1 year, radiographs were taken to check the interproximal bone. Results: After 1 year evaluation of custom-made zirconia crowns and preformed SSCs in primary molars, it was shown that both SSC and zirconia crowns showed good gingival scores but zirconia crown was better than SSC in improving the gingival health. SSCs showed better results with respect to the opposing tooth wear and marginal adaptability. Parents as well as patients preferred a tooth-colored crown as a treatment option. Conclusion: Custom-made zirconia crowns are comparable to the preformed SSCs and they show better gingival scores and excellent color match.
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Estimation of dental age using Willems method and comparing it with Demirjian's method in 7–14-year-old children of Uttarakhand p. 43
Keerti Chandail, Varinder Goyal, Mehak Kaul, Satyam Dutt, Tishya Koul, Burhan Altaf Misgar
Age is one of the essential factors, which plays an important role in every aspect of life. Age is estimated on the basis of chronological age, bone age, dental age, mental age and others. This study represents the objective of an ideal age estimation technique to arrive at an age as close to the chronological age as possible. Aim: The aim of this comparative study was to estimate the dental age using Willems method by assessing the developmental stages of left seven permanent mandibular teeth in 7–14 years of age groups with the help of digital orthopantomogram and comparing it with Demirjian's method to conclude which method was more appropriate and better in Indian population of Uttarakhand region. Materials and Methods: A total of 100 digital orthopantomogram films of patients in the age group of 7-14 years was collected over the study period of 3 years from July 2014 to January 2017 and was equally distributed by convenience sampling. Group I included 50 boys and Group II included 50 girls aging 7–14 years of age (as permanent 7 teeth in the 3rd quadrant were to be assessed and scored according to the Demirjian's table, the 7–14 age group was selected). The date of birth of the subject was documented against their allocated identification number. Dental age according to Willem's method was calculated using Willem's table and Demirjian and Goldstein's table scores were used to calculate dental age by Demirjian's method. Results: Willems method was more accurate and better than Demirjian's method as it showed less mean percentage error, i.e., 0.34% as compared to 15.94% obtained from Demirjian's method in Group II and 2.19% as compared to 8.05% obtained from Demirjian's method in Group I. Conclusion: The results suggested that Willems method of dental age estimation was an effective method of age estimation and was better and more accurate than Demirjian's method.
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Correlation and comparative evaluation of nasal index and nasal cavity volume in nasal and mouth breathers: A preliminary cone-beam computed tomographic study p. 48
Ritesh Kalaskar, Shruti Balasubramanian, Ashita Kalaskar
Introduction: Mouth breathing is one of the most deleterious oral habits with a prevalence of 4%–6% among children. Due to the wide range of comorbidities associated with mouth breathing, early diagnosis and prompt treatment is indispensable. At present, there are very few objective methods available for the diagnosis of mouth breathing. The present study was planned to evaluate a possible correlation between nasal index (NI) and nasal cavity volume (NCV) among nasal and mouth breathers (MB). In addition, the average NCV of nasal and MB was also computed. The foresight of this research was to establish the significance of NI as an objective diagnostic tool for mouth breathing. Methods: This cross-sectional study was conducted among 8–11-year-old children. The NI was determined using a digital Vernier caliper and NCV was calculated using dolphin imaging Results: There was a significant difference in NCV and nasal width (NW) in both groups, but no difference was seen in nasal height and NI. There was no statistically significant correlation between NCV and other parameters in both groups. Conclusion: The present study was a baseline analysis in this line. Even though this study did not reveal any significant correlation between both parameters, future studies are recommended to explore a plausible correlation.
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Development and validation of a novel Middle childhood oral health impact scale (MCOHIS) p. 55
Sharath Asokan, PR Geetha Priya, Sudhandra Viswanath, Shyam Sivasamy, S Nambi Natchiyar
Purpose: The study was planned to develop and validate a novel middle childhood oral health impact scale (MCOHIS) for 6- to 9-year-old children in India. Methodology: A cross-sectional study design was employed to develop and validate MCOHIS in the sequential phases. A panel of ten pediatric dentists evaluated a pool of 36 items corresponding to the oral health-related quality of life (OHRQoL) of children. MCOHIS with 20 items under five domains was formulated and content validation was done. Cohen's kappa statistics was employed to measure the concordance between the child's self-report and the caregiver's proxy report. Concurrent validation was done among 130 participants from 13 districts of Tamil Nadu state, India. Discriminant validity was checked among another sample of 60 participants. Internal consistency and test-retest reliability of MCOHIS were assessed using Cronbach's alpha and Kappa statistics respectively. Results: MCOHIS had adequate content validation with Scale Level Content Validity Index / Average score of 0.94 for relevance. There was a statistically significant inter-rater reliability observed between the child's self-report and caregivers' proxy report in all items with a moderate to substantial agreement. Concurrent validation showed a statistically significant positive correlation with a Rho value of 0.712. There was a statistically significant difference noted in overall discriminant validity (P < 0.001). Acceptable internal consistency reliability was observed with Cronbach's alpha value of 0.75. Test-retest reliability showed a high stability coefficient of 0.98. Conclusions: MCOHIS was found to be a valid and reliable age-specific tool for assessing the OHRQoL of Indian children aged 6–9 years.
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Effect of silver diamine fluoride, potassium iodide, and glutathione on micro-shear bond strength of glass ionomer cement to caries affected dentine p. 62
Deepthy Priya, Rupali Karale, BR Prashanth, Aparna Raj, KN Vathsala Heggade
Background: Silver diamine fluoride (SDF, 38%) is an efficient topical fluoride used to arrest dental caries though it causes black staining of both teeth and restoration. The application of potassium iodide (KI) after SDF reduces the stain, but the color change is only temporary. An alternative method suggested is by mixing glutathione (GSH) with SDF, which preserves the silver ions of SDF within the solution. Hence, the purpose of this in vitro study was to evaluate the microshear bond strength (μSBS) of glass ionomer cement (GIC) to caries affected dentin (CAD) pretreated with SDF/KI/GSH. Materials and Methods: Thirty dentine slices of 2 mm thickness from human permanent upper premolars were demineralized using pH cycling method to mimic CAD. They were allocated to three groups of 10 each and treated with SDF, SDF-KI (SDF followed by KI), SDF + GSH (SDF mixed with GSH), respectively. Specimens were bonded with GICs. The μSBS was assessed using a universal testing machine and the data obtained were analyzed using one-way ANOVA and Tukey's post hoc test. Results: The μSBS (mean ± standard deviation) values for groups SDF, SDF-KI, and SDF + GSH were 4.81 ± 2.026, 5.78 ± 1.809, 8.18 ± 2.828 megapascal respectively. Group 3 showed significantly better bond strength compared to groups 1 and 2. In group 2, the addition of KI showed better bond strength when compared to group 1, but the difference was not statistically significant. Conclusion: Pretreatment of teeth with GSH along with SDF application showed significantly better bond strength of GIC to CAD compared to SDF and SDF-KI.
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A comparative evaluation of gingival microleakage and internal voids in Class II composite restoration with two different lining techniques: An in vitro study p. 67
Rachana Shishodia, Virinder Goyal, Almas Shaikh, Aushili Mahule, Jay Dondani
Aim: The aim of this study was to evaluate the gingival microleakage and internal voids in Class II composite restoration restored with precure and co-cure lining techniques using stereomicroscopic method. Materials and Methods: Forty-five freshly extracted permanent multirooted human molar teeth were collected and used in the study. After surface debridement and scaling of all teeth, standard Class II mesio-occlusal cavities were prepared. Forty-five samples were randomly divided into three experimental groups (n = 15), and filled according to manufacturer's instructions. Group I was precure group, Group II was co-cure group, and Group III was only bulk fill. The finishing and polishing of the restorations was done after 24 h. Then, all the specimens were subjected to thermocycling for 500 cycles. The gingival microleakage and internal voids of all the groups were evaluated using dye penetration method. Samples were then sectioned and examined under the stereomicroscope at ×40. Readings obtained were subjected to statistical analysis using SPSS ver 20.0 (IBM Corp, ARMONK USA) and Chi-square test. Results: The statistical analysis revealed that extent of microleakage was maximum in Group II (co-cure), followed by Group III (only bulk fill) and Group I (precure). The gingival voids were maximum in Group III (only bulk fill), minimum in Group II (co-cure), and least in Group I (precure). The cervical voids were maximum in Group II (co-cure) and Group III (only bulk fill), followed by Group I (precure). The occlusal voids were maximum in Group II (co-cure) and similar in Group I (precure) and Group III (only bulk fill). Conclusion: The precure lining technique was better than co-cure lining technique in terms of both microleakage and internal voids.
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A cross-sectional and histological analysis to understand the cytological effects of cell phone radiation on buccal mucosa of children p. 74
Voleti Sri Srujana Aravinda, Chaitanya Ram Kandregula, Radhika Muppa, M Madhavi Krishna, BS Nikitha, Malathi Yenni
Context: The ongoing pandemic has affected all the spheres of life and one of the severely affected avenues is the education of a child. The online education has seen an upward curve since the start of COVID-19 pandemic. Schools globally have adopted online class tutorials as the main method to impart education and directly increasing the screen time for a child. Aim: The aim of the present study was to evaluate the cytological effects of prolonged mobile phone usage on the buccal mucosa of children. Settings and Design: Stratified sampling was used for the selection of subjects for the study. After a questionnaire regarding the usage of a mobile phone was distributed among the parents of children. Among them, 90 children were selected on the basis of pattern and frequency of mobile phone usage in the child. Materials and Methodology: The children were divided into three groups based on the per day hours of viewing of mobile phone, i.e., Group 1: Usage of 1–2 h a day, Group 2: Usage of 3–6 h a day, and Group 3: Usage of >6 h a day. The time frame taken into consideration was 1 year after the pandemic started. This was specifically to understand the impact of the online education. Swab was obtained by using the conventional ice-cream stick method from the buccal mucosa. Statistical Analysis: The samples were subjected to histological and microscopical analysis to observe for cytological changes. One-way ANOVA was used to determine the statistical significance if any. Results: The results obtained clearly showed that Group 3 (>6 h usage per day) showed the highest number of cellular and chromosomal aberrations which was significant. Conclusion: The results indicated that impact due to the prolonged screen time on the buccal mucosa is significant. A direct proportionality was seen between the apoptotic changes and chromosomal aberrations and the number of daily hour usage.
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Cephalometric evaluation of the cervical spine posture following fixed functional therapy with Forsus™ appliance p. 81
Nidhi Malik, Bennete Aloysius Fernandes, Priyadarshini Hesarghatta Ramamurthy, Shagufta Anjum, Amit Prakash, Abhik Sinha
Background: To investigate whether fixed functional therapy for mandibular advancement with the Forsus™ appliance would produce any changes in the cervical spine posture. Materials and Methods: This prospective clinical exploratory study was conducted on 12 patients (six females and six males) with a mean age of 15 ± 1.3 years, having mandibular retrusion, Class II malocclusion, who were treated with the Forsus™ appliance. Lateral cephalogram was taken twice, once at the baseline (T1) before the commencement of the treatment and once following termination of fixed functional treatment (T2). Eleven measurements representing the vertical and the sagittal craniofacial proportions, and the head posture, were taken into account. Data were analyzed using SPSS version 22. The variations between before and after treatment measurements were collated using paired t-test. P < 0.05 was considered statistically significant. Results: No significant differences were noticed in the angle linking the horizontal lines of the head and the superior crest of the spinal column before and after the treatment, with P = 0.73. The cervical curvature angle also failed to show any significant difference with P = 0.14. Conclusion: Fixed functional therapy with the Forsus™ device resulted in dentoalveolar and soft tissue alterations alone but did not alter the cervical spine posture.
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Pedunculated cavernous lymphangioma of the newborn oral cavity p. 86
Aditya Arvind Manekar, Narahari Janjala, Subrat Kumar Sahoo, Bikasha Bihary Tripathy, Manoj Kumar Mohanty
Oral swellings and ulcers in neonates are a spectrum of diseases often creating a sense of anxiety among parents. Early detection, high index of suspicion, proper investigations, and prompt diagnosis can aid in accurate management of the same. Lymphangiomas are benign hamartomas which are basically malformed lymphatics do not drain into other lymphatics or veins and hence there is lymphatic accumulation and enlargement following cystically dilated spaces. We hereby present a rare case of a neonate born with a cystic mucosal swelling at the upper gingival sulcus since birth.
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Talon's cusp in a primary maxillary central incisor: A report of a rare odontogenic anomaly p. 90
Virat Galhotra, Santhosh Rao, Pallavi Goel
Talon's cusp, a type of dens evaginatus (DE) in a primary tooth, is a rare odontogenic anomaly which is reported sparingly in the literature. We report this case describing the presence of a talon's cusp on the right primary maxillary central incisor in a 2-year-old boy precipitating discomfort, owing to occlusal interference. The treatment plan involved pulpectomy and reduction of the lingula DE extension under general anesthesia.
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A segmental root development as an unusual healing response to the revitalization of mandibular second premolar p. 94
Sadaf Tamanna, Aaliya Rehman, Rajendra Kumar Tewari, Surendra Kumar Mishra
A 15-year-old patient reported persistent pain in the left mandibular second premolar (#35) following a traumatic bite 3 months ago. Clinical examination revealed a fractured central cusp suggestive of dens evaginatus. Intraoral periapical radiograph revealed an immature permanent tooth with a periapical radiolucency. A diagnosis of pulp necrosis with symptomatic apical periodontitis was made. The tooth was treated according to the revised guidelines of regenerative endodontic procedure by the American Association of Endodontics. The follow-up evaluation revealed a complete resolution of periapical pathology. A detached radiopaque tissue was appreciated at the 12-month follow-up. It resembled a broken root tip at the 24-month follow-up. Both the main root body and disjointed root tip developed independently. A cone-beam computed tomography evaluation at the 36-month follow-up confirmed the segmented development of the apical root tip.
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Bibliometric report of authorship trends in a professional journal- An update p. 98
Gauri Kalra, Jatinder Kaur Dhillon, Vijay Prakash Mathur
Background: With rising trends in research and scientific writing, various ethical organizations have been vigilant over developing rigorous authorship criteria. There may be times, when authors tend to publish more due to their seniority or previously earned credit for former publications, proving the existence of Matthew effect in scientific research. It indicates that the majority of publications in a field are contributed by smaller number of authors. It was hypothesized that the Matthew effect may be still applicable for scientific work published by Indian pediatric dentists in the official Journal of Indian Society of Pedodontics and Preventive Dentistry (JISPPD) from 2015 to 2019. Methodology: To assess the number of times each author has published in the official Journal of Indian Society of Pedodontics and Preventive Dentistry, we downloaded all issues for the 5-year period from the journal website. Full names of all authors were entered year-wise in Microsoft Excel 2007 and descriptive statistics were used for finding out contribution percentages. Results: A total of 372 papers were published during the study period by 1148 authors. About 82% had at least one publication, followed by 12% publishing at least two papers; only 1% of the total authors had contributed to more than five publications. The result showed the absence of Matthew effect for publications in the JISPPD. Conclusion: The final results of the study did not show any presence of Matthew effect among authorship in the JISPPD.
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