INTRODUCTION:Dental anxiety poses a major challenge in managing children with intellectual and developmental disabilities (IDD), often exacerbated by sensory sensitivities. Weighted blankets, through deep touch pressure (DTP) stimulation, are believed to reduce stress via parasympathetic activation. This study evaluated the effectiveness of weighted blankets in reducing dental anxiety in children with mild IDD. METHODOLOGY:A randomized crossover trial was conducted on 42 children (aged 6-14 years) with mild IDD. Custom-made weighted blankets (10% of body weight, filled with kitchen grains) were used. Participants attended two appointments 1 month apart-Group 1 received the blanket first, while Group 2 served as control, with roles reversed in the second visit. Physiological (pulse rate, blood pressure, oxygen saturation) and behavioral (Venham's Anxiety Rating Scale) parameters were recorded at baseline and during Atraumatic Restorative Treatment (ART). RESULTS:Use of weighted blankets significantly reduced anxiety and physiological markers across both groups. Group 1 showed reductions in systolic/diastolic pressure (1.99/1 mmHg), pulse rate (4 bpm), improved oxygen saturation (+2.99%), and decreased anxiety scores (0.99). Group 2 showed similar trends when the blanket was introduced. CONCLUSION:Weighted blankets offer a safe, non-pharmacological option to manage dental anxiety in children with mild IDD. TRIAL REGISTRATION:Clinical trial registration - Indian was done (CTRI/2023/06/054290) dated 26/06/2023.

Aim and backgroundInfantile cortical hyperostosis (Caffey disease) is a rare inflammatory skeletal disorder characterized by episodic subperiosteal bone formation, commonly involving the mandible during early craniofacial development. Residual mandibular enlargement, feeding difficulty, and developmental challenges resulting from the disease may predispose affected children to early childhood caries (ECC). However, evidence guiding dental management in such patients remains limited. This report describes the dental management of a toddler with sequelae of infantile cortical hyperostosis, highlighting condition-specific considerations influencing treatment planning.Case descriptionA 2-year-10-month-old male with a history of infantile cortical hyperostosis, residual mandibular cortical thickening, gross motor developmental delay, and moderate acute malnutrition presented with severe ECC involving multiple cavitated dentinal lesions. Caries burden was assessed clinically using dmft criteria. Radiographic evaluation demonstrated diffuse mandibular cortical thickening without evidence of odontogenic infection. Considering high caries risk, extent of disease, limited cooperation, and systemic status, full-mouth rehabilitation under general anesthesia was undertaken. Treatment included glass ionomer restorations in posterior teeth, anterior composite restoration, extraction of a non-restorable molar, pit and fissure sealants, and topical fluoride application. Multidisciplinary preoperative assessment included evaluation of airway status and associated systemic considerations. The procedure was completed uneventfully, with satisfactory immediate postoperative recovery and short-term improvement in feeding.ConclusionThis case highlights the need for individualized, multidisciplinary dental management in children with sequelae of infantile cortical hyperostosis. While full-mouth rehabilitation under general anesthesia was successfully performed in this instance, findings from a single case should be interpreted cautiously. Further evidence is required to establish condition-specific dental management protocols.

Background: Children with special needs face restrictions in dental hygiene due to disabilities. Dental education and preventive measures can significantly improve oral health among children with special needs. This study aims to assess the oral health status of children with Cerebral Palsy, Autism and Down Syndrome and to evaluate the effectiveness of the interventional programs on oral health status in Karnataka, India. Methods: A quantitative, interventional study with a repeated measures design was conducted among 135 children diagnosed with Cerebral Palsy, Autism, and Down Syndrome. Data were gathered using a Demographic Proforma, the WHO Oral Health Status Questionnaire and WHO Oral Health Assessment Form (2013). The intervention included weekly sessions over 3 months, featuring supervised tooth brushing training, individualised dental counselling for caregivers, interactive educational modules, and distribution of a Pictorial Information Manual in local languages. Data were analysed using SPSS Version 29.0, with a significance level set at p < 0.05. Results: The study consisting 135 children, oral health status scores as evidenced by statistically significant changes (p < 0.001) indicating improvement in dental health. The Oral health of children shows substantial changes, which were statistically significant (p < 0.001), confirming the positive impact of the intervention. Conclusions: The study interventions were enriching for caregivers with sufficient information and skill on dental care. The development of the Pictorial Information Manual is a unique manual enriched with of attractive pictures and relevant information on oral health, which was made copyrighted and distributed to caregivers.

Background:Autism Spectrum Disorder (ASD) is a neurodevelopmental condition affecting social interaction, communication, and behavior. Mothers of children with ASD often experience chronic stress, leading to dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and low cortisol levels. Salivary cortisol, a non-invasive biomarker, reflects physiological stress responses. Effective behavior guidance in pediatric dentistry can improve the dental experience for children with ASD and reduce maternal stress. Video self-modeling (VSM) is a promising intervention to enhance cooperation in children with ASD during dental procedures. Aim:This study aimed to estimate the salivary cortisol levels in the mothers of children with ASD following the application of VSM as a behavior guidance technique for their children during dental procedures. Materials and methods:Twenty-two mothers of children with ASD (aged 6-12 years) participated. Salivary cortisol samples were collected at baseline and two weeks post-intervention. Cortisol levels were measured using enzyme-linked immunosorbent assay (ELISA), and a paired t-test compared pre- and post-intervention levels. Results:Pre-intervention cortisol levels ranged from 13.35 ng/ml to 63.35 ng/ml (mean 33.2 ± 15.8 ng/ml). Post-intervention levels increased, ranging from 13.35 ng/ml to 55.52 ng/ml and difference was statistically significant (mean 44.2 ± 10.1 ng/ml; t = -2.53, p = 0.019). Conclusion:This study highlights the bidirectional relationship between child behavior and maternal stress. VSM improved cooperation in children with ASD during dental procedures and positively impacted maternal stress, as shown by increased salivary cortisol, thus emphasizing the need for behavior interventions benefiting both children and their families.

Purpose Children with Autism Spectrum Disorder (ASD) often experience increased stress in unfamiliar environments like dental clinics. Both video self-modelling (VSM) and systemic desensitization are approaches to reduce stress. The aim of the study was to use salivary cortisol levels to compare between systematic desensitization and video self-modelling (VSM) on the acute stress levels of children with ASD during dental treatment. Methods This exploratory study evaluated 30 children (28 males, 2 females) aged 6–12 years diagnosed with ASD (mean age 9.2 years, SD+/- 2.1 years). Participants were age-matched and assigned randomly to either Group I (systematic desensitization, n = 15) or Group II (VSM n = 15). Early morning salivary cortisol and behaviour at the dental office were estimated pre and post-intervention. Results Both VSM (p = 0.020) and systematic desensitization (p = 0.001) significantly improved behaviour in children with ASD, the latter showing greater effectiveness (Mann-Whitney U = 40.5, p = 0.002). Both VSM (p < 0.001) and systematic desensitization (p < 0.001) groups demonstrated significant cortisol reduction, with significant differences between the two techniques. A significant negative correlation was found (r=–0.594, p = 0.001), between behaviour and cortisol levels in the systematic desensitization group but not in the VSM group. Conclusion VSM can significantly reduce acute stress in children with ASD during dental treatment at levels comparable to systematic desensitization. Clinical Trial Registration The study protocol was pre-registered before participant enrolment with Clinical Trial Registration-India (CTRI/2023/06/054026) dated 16/06/2023.

BACKGROUND AND AIM Intellectual disability, is a neurodevelopmental disorder that typically manifests early in childhood and consists of both intellectual and adaptive functioning deficits in conceptual, social, and practical domains. It can be categorized into mild, moderate, severe, and profound based on its severity. Cognitive impairment may be observed predominantly in children with intellectual disabilities. Marked deficits in areas of learning, planning, communication, social participation, and personal independence in children with mild intellectual disabilities make behavior guidance and communication a challenge during dental treatments. The aim was to evaluate and compare the use of two different distraction tools, audio, and virtual reality (VR) on the dental anxiety of children with mild intellectual disability during dental treatment. METHODS Twenty children diagnosed with mild intellectual disability were equally divided into two groups. A cross-over study design consisting of two appointments 1 month apart was employed. In the first appointment, audio and VR distractions were provided to participants in Groups 1 and 2, respectively, and the distraction tools provided to the participants were interchanged in the second appointment. A trained observer recorded physiological parameters (pulse rate and oxygen saturation) and observational parameters (Venham's anxiety rating scale) during both appointments at three-time intervals. Statistical intra-group and inter-group comparison analyses were performed using Friedman's and Mann-Whitney U tests. RESULTS A decrease in pulse, increase in oxygen saturation levels, and a decrease in Venham's Anxiety Rating Scores (statistically significant p < .05 / highly significant p < .01) was observed on introducing the distraction techniques in Groups 1 and 2 in both appointments. A statistically non-significant difference (p > .05) in physiological and observational parameters was observed between Groups 1 and 2 in both appointments. CONCLUSION Audio and VR distraction techniques can be employed for behavior guidance in children with mild intellectual disability during restorative dental procedures.

Background Children are one of the most vulnerable groups to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and depend on their parents to supervise and maintain oral hygiene. During this pandemic, disease prevention through education and awareness of the parents is the only way to maintain a child's oral health; therefore, parents must have sufficient knowledge about the ongoing pandemic and its consequences on the oral cavity. This study aims to assess the parental attitudes toward and awareness of oral health of healthy children during the COVID-19 pandemic.Methodology A questionnaire was circulated between May and September 2020 using simple random sampling of the parents of children aged between 6 and 12 years. The questions were close ended and divided into awareness and attitude-based sections so that the parents could choose the appropriate answer.Results and Conclusions In the present study, 50% of the participating parents had the right attitude in challenging times like the pandemic and appropriate knowledge about the same.

Introduction Premature loss of primary teeth due to caries or trauma can cause space discrepancies leading to malocclusion and other dental issues. Space maintainers are essential for preserving the arch space until the eruption of the permanent teeth. This case report presents an innovative modification of an existing space maintainer to address clinical challenges, improve patient outcomes, and reduce costs. Case Report An 8-year-old female presented with a broken lingual arch space maintainer impinging on the lingual mucosa. Clinical examination revealed nonrestorable teeth 84 and 75 that required extraction. Radiographs showed tooth 34 erupting soon and tooth 45 delayed. Owing to financial constraints, the existing appliance was modified by lingually cutting and adapting the wire to the distal surface of the canine. The appliance was cemented using Type I Glass Ionomer Cement in a single visit. After 6 months, tooth 35 erupted normally, without impaction. Conclusion This case demonstrates the effectiveness of modifying existing space maintainers to provide cost-effective patient-centric solutions in pediatric dentistry.

Traumatic Dental Injuries (TDIs) to the maxillary anterior teeth occur frequently in paediatric and adolescent populations. Prompt diagnosis, correct treatment planning, and a multidisciplinary approach are pertinent aspects of successfully managing multiple TDIs in a patient. The present case report of a 13-year-old female patient describes a multidisciplinary approach necessary to successfully manage dental trauma of an avulsed maxillary central incisor and a complicated crown fracture involving the maxillary left lateral incisor in an adolescent. The complicated crown-root fracture was treated with endodontic therapy, followed by the placement of a fibrereinforced post, core build-up, and the cementing of a porcelain-fused-to-metal crown. Bone grafting with a mandibular symphysis block autograft, followed by prosthetic rehabilitation with transitional implants, was performed to restore the aesthetics, form, and function of the avulsed maxillary central incisors. The use of osseointegrated implants has gained wide acceptance in the adult population. However, due to concerns regarding growth, their use in the paediatric population is not as common. This accounts for a scarcity of clinical cases reported in the literature. There are no established guidelines for the placement of implants in growing patients. Thus, authors believe that the present case report contributes to the literature on this subject. The treatment of this complex, multi-dental injury in the maxillary anterior region of a young female required a holistic approach with a step-wise progressive, long-term treatment plan. Traumatic injuries in adolescent patients can adversely impact their oral health-related quality of life if not treated correctly.

Background Oral submucous fibrosis (OSMF) is a premalignant disorder that impacts the oral cavity and pharynx. Major risk factors for OSMF are attributed to the consumption of betel nuts or tobacco. These substances harbor various carcinogens that trigger the production of free radicals and reactive oxygen species. Antioxidants are pivotal in preserving cellular integrity and impeding the oncogenic transformation of body cells. In this context, albumin and uric acid, being primary antioxidants present in body fluids, bestow a defensive effect against this condition. Thus, the present study is designed to elucidate the differential concentration of albumin and uric acid between patient cases and healthy cohorts. Methodology This case-control study was conducted to evaluate the albumin and uric acid levels in individuals diagnosed with OSMF (cases) and compare them with healthy controls for a period of six months. A cohort of 100 individuals was partitioned into four groups, with each group comprising 25 individuals: Group I was made up of healthy individuals; Group II consisted of individuals who chew tobacco and areca nuts but are not affected by OSMF; Group III included individuals who only use tobacco without areca nuts and are afflicted with OSMF; and Group IV comprised individuals who consume a combination of areca nuts and tobacco and are diagnosed with OSMF. Biochemical evaluation was carried out using the BS-380 chemistry autoanalyzer (Mindray, Shenzhen, China), and the quantification of serum albumin and uric acid was performed by the uricase-peroxidase (POD) method with dihydroxybenzene sulfonic acid (DHBS). Results The study cohort of 100 individuals was made up of 70 males and 30 females, with an average age of 42.51 (11.62) years. The comparison of the mean concentration of serum albumin across all groups revealed that healthy controls exhibited the highest serum albumin concentration of 4.284 (0.618), with a statistically significant p-value (0.001) across all groups. A comparison of the mean value of serum uric acid among all groups showed that healthy controls had the highest value of serum uric acid (5.26±1.161), with a considerable p-value (0.001) between all groups. Conclusion The present study concluded that serum biomarkers assessed were high in healthy individuals and consumption of areca nuts, tobacco, and their products was significantly associated with low levels of albumin and uric acid. Therefore, both albumin and uric acid can be used as important biomarkers for uncovering oral premalignant lesions and conditions ahead of time and can also be used in mass screening.

For years, "extension for prevention" was considered as the standard protocol for the restoration of caries. With advances in the field of cariology regarding the biofilm and improvement in materials, this perspective is being challenged. This is being challenged by more biological and less-invasive approaches, where the emphasis is on biofilm alteration to arrest carious lesions. This minimally invasive intervention is based on the concept that biofilm overlying the carious lesion is a driving force for the carious process and not the bacteria present in the infected dentin. Hence, daily removal or disruption of this biofilm will slow down the carious process or bring it to halt. One such approach is non-restorative cavity treatment, where no caries is removed but lesions are made self-cleansable that allows it to be brushed by the parent or the child. This wholesome approach targets the disease at a causal level. This review of literature describes the various advantages and limitations of this technique and the practicability of its use in pediatric patients during the pandemic COVID-19.

BACKGROUND:Three dimensions (3D) modeling, printing, and manufacturing can help in personalized and customized surgical reconstruction of complex defects in the craniofacial region with precision by manipulating tissues based on the preoperative assessment, planning the shape of metal and alloplastic materials, and reduction in the total cost and time of the surgery.AIM:The present survey study aimed to assess the approach of treating surgeons towards the role of 3D printing in post-op rehabilitation of palatal bone loss by mucormycosis.METHODS:One thousand eyes nose and throat (ENT) and maxillofacial surgeons were given a pre-formed structured survey questionnaire to be filled by subjects themselves for their view on the role of 3D printing for rehabilitation and reconstruction of palatal bone loss due to mucormycosis.RESULTS:Efficacy of 3D printing to print the pneumatic sinus design and palatal contour helping to design accurate support with a lightweight prosthesis, 67.2% (n=672) subjects whereas, exact duplication of the excised tissue, 85.4% (n=854) subjects, to detect and duplicate undercuts, 58.4% (n=584) subjects, 3D printing can be helpful as the proper extension of impression 73.2% (n=732) subjects responded positively. For reconstruction of a lost palate by prosthesis 91.2% (n=912) of study participants, in making obturators using Titanium framework and Polyetheretherketone (PEEK) was given a positive response by 82.2% (n=822) subjects, to fabricate prosthesis obturator required in palatal perforation in case of mucormycosis was given a positive response by 88.1% (n=881) subjects, the role of 3D printing to overlay zygomatic implant prosthesis was responded positively by 68.9% (n=689) study subjects.CONCLUSION:The present survey study concludes that 3D printing is a reliable and accurate method for palatal reconstruction following bone destruction by mucormycosis as reported by the majority of ENT and maxillofacial surgeons.

OBJECTIVE:We assessed the effectiveness of a modified audio-tactile performance (ATP) technique with braille (ATPb) on the oral health statuses of visually-impaired children.STUDY DESIGN:Ninety visually-impaired institutionalized children received oral hygiene instructions using audio (AM), ATP or ATPb techniques. Plaque scores were assessed at baseline and after reinforcement and non-reinforcement periods.RESULTS:In the totally visually-impaired, mean reductions in plaque scores in the ATPb, ATP and AM groups during the reinforcement period were 1.119 ± 0.260, 0.654 ± 0.239 and 0.237 ± 0.255, respectively (p <0.001), worsening to 0.107 ± 0.160, 0.083 ± 0.193 and -0.208 ± 0.267 during the non-reinforcement period (p <0.001), before culminating at 6 months at 1.227 ± 0.261, 0.737 ± 0.317 and 0.029 ± 0.108 (p <0.001). In partially visually-impaired children, reductions during the reinforcement period were 0.934 ± 0.279, 0.762 ± 0.270 and 0.118 ± 0.237, respectively, dropping to 0.176 ± 0.166, 0.083 ± 0.169 and -0.128 ± 0.114 without reinforcement and culminating at 1.109 ± 0.258, 0.845 ± 0.292 and -0.010 ± 0.226 (p <0.001). There were significant inter-group differences during the three periods (p <0.001), except in the ATP and ATPb groups during the non-reinforcement period for totally impaired (p = 0.157) and during reinforcement (p = 0.155) and non-reinforcement (p = 0.051) periods for partially impaired children.CONCLUSIONS:All three techniques were successful when reinforced periodically. However, only ATP and ATPb were successful during periods without reinforcement. The modified audio-tactile performance technique with braille (ATPb) was most effective, allowing visually-impaired children to retain oral hygiene information without intervention.

Over the last few years there has been a growing interest to cater to the requirements of children with special health care needs, especially those with autism spectrum disorder (ASD). ASD is a neurodevelopmental condition characterized by limited communication skills and an obsessive need for structured patterns. Individuals with a genetic predilection to autism can be provoked by the various prenatal, natal, or post-natal environmental factors. Drugs such as thalidomide, valproic acid and consumption of antidepressants during pregnancy as well as high maternal age and viral infections are known to be prenatal triggers for autism. Autism affects 1 in every 110 children with a significant preponderance of boys to girls with a ratio of 4:1. According to Caries Risk Assessment tool (CAT) adapted by the American Academy of Paediatric Dentistry, children with ASD are at a high risk for dental caries due to their preference for carious food, pouching of food due to poor masticatory ability combined with inadequate maintenance of oral hygiene and help required for tooth brushing. These children do not behave positively to sudden changes in their environment thus a dental operatory might be intimidating to them. A thorough understanding of the individual’s needs of these patients along with combining various behaviour management techniques will help make their dental treatment a pleasant one. This articles reviews literature on the aetiology and diagnosis of Autism Spectrum Disorder with a special emphasis on the health status and issues encountered while treating these children. This study is also an update on the various strategies such as using Applied Behaviour management approaches, Picture Exchange Communication System, Video Pedagogy, Social stories as well as pharmacological ways to communicate and also manage a child with ASD in the dental clinic. KEY WORDS Autism, Oral Health Status, Behaviour Management, Dental Management

Abstract Aim and objective To analyze the impact of Indian instrumental music on children with intellectual disability (mild) exhibiting dental anxiety during dental procedures using electrical skin resistance measured by a biofeedback machine. Materials and methods A total of 20 children of 6–14 years having an intellectual disability (mild) were randomly divided into two groups comprising of 10 each. The study was carried out in a cross-over design, with and without music distraction in two appointments spaced out at a gap of 1 month. The children were subjected to a dental examination, oral prophylaxis, and auditory operative stimuli in both appointments. The electrical skin resistance during each procedure was measured using a galvanic skin response (GSR) biofeedback machine and the values were statistically analyzed using paired and unpaired t-tests. Results A statistically significant increase in electrical resistance was observed during music distraction, which indicated an anxiety reduction when music distraction was employed. Conclusion The increased electrical skin resistance due to low anxiety proves the positive impact of music distraction in intellectually disabled children. Clinical significance Music can be employed as a distraction technique to reduce anxiety in intellectually disabled children. How to cite this article Gowdham G, Shetty AA, Hegde A, et al. Impact of Music Distraction on Dental Anxiety in Children Having Intellectual Disability. Int J Clin Pediatr Dent 2021;14(1):170–174.

In primary teeth that are pulpally involved, pulp therapy is performed with the sole aim of maintaining the teeth until normal physiological exfoliation. This is to avoid any abnormalities in occlusion in the permanent dentition. However, conditions such as the presence of extensive root resorption and/or presence of furcal radiolucency may contradict pulpectomy, and in such cases, lesion sterilization and tissue repair seems to be a promising alternative to extraction followed by space maintenance.

The first primary tooth erupts in the oral cavity at around 6 months of age and is one of the important milestones of oral development. But in rare cases, there may be accelerated eruption much earlier than the ideal time of eruption. Such eruption is termed as precocious eruption/ premature eruption. 1 It was Massler and Savara in the year 1950, who gave a definite terminology namely natal and neonatal teeth based on the timing of eruption of these teeth. Natal teeth refers to the teeth present at the time of birth whereas neonatal teeth refers to those that erupt within the first 30 days of life. 2 The incidence of natal teeth has been reported to be 1:2000 to 1:3500. 3 This condition is of clinical importance to both the pediatrician as well as the pediatric dentist due to the complications associated with it. The frequently reported consequences include, risk of aspiration, ulceration of ventral surface of tongue thereby interfering with feeding, traumatic ulceration of the mother’s nipples. These complications warrant removal of the offending tooth. But before planning the removal, the pediatric dentist should rule out if the tooth is a part of

Williams syndrome is a rare genetic disorder that occurs due to deletion on chromosome 7q11.23. The prevalence is said to be 1:7500-1:20,000. The typical presentation of the syndrome includes dysmorphic facial features, cardiovascular malformations and intellectual disability. Craniofacial features of these children include short anterior cranial base, protrusive maxilla, increased Mandibular Plane- Occlusal angle, steep mandibular plane and reduced ratio of posterior to anterior facial height. The unique characteristics of these children are over friendliness, out-going personality, hyper-acusis and tendency to get easily distracted. This is a unique case of Williams syndrome in an eight-year-old female patient.

Aims: Children with special health care needs often have poor oral health and depend on caregivers for oral care. This study looked at the prevalence of malocclusion among a group of such children and the awareness of pediatric orthodontic care among their parents Methodology: Clinical examination of 100 children aged 7-18 years who were physically/ mentally challenged or with speech or hearing deficits was carried out in a school. A validated questionnaire was given to 52 parents Results: Class I malocclusion was seen in 77.8%, Class II in 6.1% and Class III in 8.1%. Other findings were anterior crowding (43%), spacing (19%), deep bite (12%), open bite (6%) and cross bite (10%). Class I malocclusion was most common in all the three groups (p=0.144); physically challenged (73.3%), mentally challenged (82.8%), speech and hearing disorders (76.4%). Other abnormalities in the above groups in order with the ‘p” value are as follows.; spacing (12.5%,31%,14.5%,p=0.144); crowding (50%,37.9%,43.6%,p=0.729); open bite (6.3%,6.9%,5.5%,p=0.790); deep bite (18.8%,0%,16.4%,p=0.060). 69.2% of the parents were not aware of these abnormalities. Due to malalignment, 57.7% of the parents were not able to maintain oral hygiene. Though 53.8% preferred correction, only 51% were aware of the treatment options. The reasons for not obtaining treatment were the cost (55.1%), coping issues (24.5%) and lack of access (8.2%). Conclusion: Some form of malocclusion is prevalent in children with special health care needs, Class I malocclusion, anterior crowding and spacing being more common. Majority of the parents were not aware of the abnormalities and the barriers to treatment were affordability, lack of access and the coping issues. Creating awareness among caretakers and making the treatment more accessible will improve oral health of children with special care needs.