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Background This study evaluated the efficacy of three intraoral topical anesthetics in reducing the injection needle prick pain from local anesthetic among children aged 7-11 years old. Methods It is a prospective, Interventional, parallel design, single-blind, randomized clinical trial in which subjects (n=90) aged 7-11 years were included in the study based on an inclusion criteria. Subjects were divided into three groups based on computer-generated randomization with an allocation ratio of 1:1:1. Groups A, B, and C received benzocaine 20% jelly (Mucopain gel, ICPA health products Ltd, Ankleshwar, India), cetacaine anesthetic liquid (Cetylite Industries, Inc, Pennsauken, NJ), and EMLA cream (2% AstraZeneca UK Ltd, Luton, UK), respectively, according to manufacturer's instructions, for 1 minute prior to local anesthetic injection. After application of topical anesthetic agent, for all the groups, baseline pre-operative (prior to topical anesthetic administration) and post-operative scores (after local anesthetic administration) of pulse rate was recorded using Pulse oximeter (Gibson, Fingertip Pulse Oximeter, MD300C29, Beijing Choice Electronic). Peri-operative (i.e., during the administration of local anesthesia) scores were recorded using Face, Legs, Activity, Cry, Consolability (FLACC) Scale, Modified Children hospital of Eastern Ontario Pain Scale (CPS) behavior rating scale, and Faces Pain Scale (FPS-R) - Revised (For self-reported pain). Direct self-reported and physiological measures were ascertained using FPS-R - Revised and Pulse oximeter, respectively, whereas CPS and FLACC scales assessed behavioral measures. To test the mean difference between the three groups, a one way ANOVA with post hoc tests was used. For statistical significance, a two-tailed probability value of P < 0.05 was considered as significant. Results The Cetacaine group had significantly lower pain scores for self-report (P < 0.001), behavioral, and physiological measures (P < 0.001) than the other two groups. However, there was no significant difference between the Benzocaine group and EMLA group during palatal injection prick. Conclusion Cetacaine can be considered as an effective topical anesthetic agent compared to benzocaine 20% jelly (Mucopain gel) and EMLA cream.

Background To evaluate the clinical cariostatic efficacy of a concocted 5% Nano-silver incorporated Sodium fluoride (NSSF) dental varnish with 38% Silver diamine fluoride (SDF) in preventing the progression of dentinal caries of primary molars. Material and methods A total of 159 active dentinal carious lesions in primary molars (from 50 children) were selected and randomly divided into two groups; NSSF and SDF. Varnish application was performed at the baseline visit and follow-up is carried out at 1, 3, 6 and 12 months. Parameters such as caries activity, depth, size, colour, and presence or absence of pain were noted at baseline and follow-up visits. Results The intergroup comparison of caries activity status did not reveal significant difference between the number of active and arrested caries lesions in NSSF and SDF groups at any visit (p >0.05) during the 12-month follow-up. There was no difference between overall failure and success rates between the two groups at any follow-up period (p-0.48). Conclusions Annual application of 5% NSSF is better than or equal to 38% SDF in preventing the progression of dentinal caries of primary molars. NSSF does not cause dark staining of dentinal tissue compared to the SDF and the use of NSSF can be recommended in children. Key words:Children, Nano-silver fluoride, Primary teeth, Silver diamine fluoride.

Background To compare pain perception during palatal injection administration in children aged 7–9 years while using pre-cooling of the injection site versus application of topical anesthesia as a pre-injection anesthetic during the six months. Methods A prospective randomized split-mouth crossover trial was conducted among 30 children aged 7–9 years, who received topical application of either a pencil of ice (test group) or 5% lignocaine gel (control group) for 2 min before injection. The primary and secondary outcome measures were pain perception and child satisfaction, measured by the composite pain score and the faces rating scale, respectively. Unpaired t-test was performed to determine significant differences between groups. Results The test group had significantly lower pain scores for self-report and behavioral measures (P < 0.0001). The changes in physiological parameters at the baseline (P = 0.74) during (P = 0.37) and after (P = 0.88) the injection prick were not statistically significant. Children felt better by the pre-cooling method (P < 0.0001). Conclusion Ice application using a pencil of ice for 2 min reduced pain perception significantly compared to the use of a topical anesthetic. Moreover, ice application was preferred by children.

Down’s syndrome is a condition known to be associated with a chromosomal abnormality. This is usually in the form of three in place of a pair of chromosomes 21, hence the name ‘trisomy 21’ the incidence of Down’s syndrome in the population has been variably estimated between 1 and 4 per 1000 and which occurs in all races. These children are mentally retarded to some degree, they are generally smaller than average in height for their age, Midface dysplasia, flat broad bridge of the nose, “lop” ears, Epicanthal folds with slanting almond-shaped eyes which was responsible for the term mongoloid. The majority of the children exhibit brachycephaly (broad, short head) and lack of supraorbital ridges and hypotelerism, Absence of frontal sinuses and absent or reduced maxillary sinuses, nasal septum or nasal conchl deviations are often observed which can produce a partially obstructed or narrow air passage and can contribute to the problem of mouth breathing, prone to infections especially upper respiratory tract infections. They have congenitally missing lateral incisors, the morphology of the teeth may also be affected. Teeth are smaller than normal, peg shaped and tend to be rounded or bulbous, roots of the incisors are short and most of the children are having tongue thrusting habit with lack of lip seal and high frenal attachment. They have a remarkable resistance to dental caries and at least half of them are caries free, preventive procedures along with chlorhexidine mouth wash may be beneficial and they suffer from a moderate to severe degree of periodontal disease. Down’s syndrome children with congenital heart disease extractions and deep scaling should be done under antibiotic coverage and pulp treatment in primary teeth is contraindicated in patients with cardiac problems because of the risk of bacteremia whereas in permanent teeth it can be considered if an adequate apical seal can be obtained. Both orthodontic and prosthodontics appliances are usually contraindicated. Nitrous oxide analgesia or Tell show do in mildly apprehensive patients can be used, general anesthesia in severe resistance to dental treatment. This article discusses about etiological factors, clinical features and management aspects.

This article reports a dental management of children with emotional problems. The dental treatment difficulty is more often due to behavior disorders and is prone to tears or temper tantrums. A very important cause of uncooperation is fear of an unknown experience. These children are parent dependent and presence of parent during dental treatment is mandatory. Care must be taken of any casual remarks to the parent or assistant in front of child, the waiting room should have play objects, after one or two social visits treatment procedures can be introduced. They must be simple at first and are usually confined to the prophylactic polishing. The traditional method is to ask the patient to raise his hand if he wishes the dentist to pause. Toothpaste is produced and discussed as a familiar topic, dentist’s finger nail are then polished first, the parent’s and then finally child’s. From here it may be possible to polish the anterior teeth then followed by bur by introducing special small brush for posterior teeth, care should be taken to make no unexpected movements. Initially, simple restorations should be done followed by multiple restorations. If the child is not cooperative for the treatment, it has to be done under sedation. Along with dental causes and management have been also discussed.

Supernumerary molars are relatively rare entities in maxillofacial region which can be classified broadly into distomolars and paramolars. Usually these occur singly and unilaterally. Occurrence of both paramolar and distomolar together is a very rare finding. This paper reports an unusual occurrence of combination of developing unerupted paramolar and distomolar follicles in the maxilla which was an incidental finding in the Orthopantamograph of a 13 year old girl. Patient was asymptomatic, hence was kept under observation and follow up. This paper describes the incidence and prevalence, possible etiological factors, complications, treatment options for supernumerary molars along with review of literature.