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Mercury toxicity from amalgam dental fillings and their potential for creating problems in the environment and for human health have prompted the development of new restorative materials. The leading alternatives among these are glass ionomer cements. According to current understanding, restorative materials that slowly release fluoride exert a local cariostatic effect. For this purpose, glass ionomer cements have desirable properties in that they help prevent recurrence of caries by releasing fluoride over a long period. Thus, they function in accord with the major cariostatic mechanism of fluoride, which is believed to be its action to promote remineralization and to influence the morphology of teeth by reducing enamel solubility and by suppressing oral cariogenic bacteria. Although the minimum local concentration of fluoride release required to inhibit demineralization has not been determined, it is reported that the cariostatic ability of fluoride releasing restorative materials is significant. Zirconomer defines a new class of restorative that promises the strength and durability of amalgam with the protective benefits of glass ionomer while completely eliminating the hazards of mercury. The inclusion of specially micronized zirconia fillers in the glass component of zirconomer reinforces the structural integrity of the restoration and imparts superior mechanical properties for the restoration of load-bearing permanent teeth. Combination of outstanding strength, durability, and sustained fluoride protection deems it ideal for multiple applications. The aim of the present study was to determine the fluoride release from glass ionomer cements and compare it with new material zirconomer.Fluoride ion measurement was performed after 6 hours, 24 hours, 48 hours, 7 days, and 14 days under normal atmospheric conditions by fluoride ion selective electrode connected to an ion selective electrode meter.Both the material tested in the study had the ability to release fluoride but higher fluoride release was observed by zirconomer as compared to GIC at all time intervals.From a clinical point of view, both the restorative materials release fluoride at all time intervals; however, addition of zirconia particles in zirconomer increases its strength and provides superior mechanical properties. Therefore, due to the combination of both good structural integrity and fluoride releasing properties, zirconomer can be used for restoration of load bearing teeth.Kukreja R, Singla S, Bhadoria N

Aim Investigation and evaluation of remineralization potential of functionalized tricalcium phosphate paste (fTCP) and casein phosphopeptide-amorphous calcium phosphate (CPP-ACPF) paste on artificially created white spot lesion on human primary and permanent enamel through scanning electron microscopy and microhardness assessment. Materials and methods Sixty freshly extracted primary and permanent teeth were selected and artificial white spot lesion were created by using standardized demineralizing solution. Remineralization was carried out using the test pastes. The assessment of demineralization and remineralization was done through a scanning electron microscope and microhardness assessment. Results Among the three groups, fTCP shows significantly higher increase in mean microhardness (p < 0.001) through ANOVA and the LSD post hoc test when compared to CPP-ACPF and control group. Also, the unpaired t-test showed that mean change in microhardness in permanent teeth was significantly higher than primary teeth in different time intervals for both experimental groups. Surface morphology was assessed through a scanning electron microscope. Conclusion Based on the results of the current study, f-TCP showed comparatively more remineralization potential than CPP-ACP with fluoride. How to cite this article Bhadoria N, Gunwal MK, Kukreja R, et al. An In Vitro Evaluation of Remineralization Potential of Functionalized Tricalcium Phosphate Paste and CPP-ACPF on Artificial White Spot Lesion in Primary and Permanent Enamel. Int J Clin Pediatr Dent 2020;13(6):579–584.

Background/introduction Cavity disinfection before restoration aids in reducing the number of residual bacteria, thus, decreasing the rate of secondary caries. Propolis, at low concentrations, inhibits the growth of cariogenic bacteria. Liquorice roots are known to have antimicrobial, anti-inflammatory, and antioxidant properties. Aim and objectives Evaluation and comparison of antimicrobial efficacy of liquorice and propolis extract gels used as cavity cleaning agents against Streptococcus mutans in deciduous molars by confocal laser scanning microscopy (in vitro study). Materials and methods Liquorice and propolis extracts were converted into gels after recording the minimum inhibition concentration. Class I cavity was prepared on 135 extracted deciduous molars and subjected to inoculation with S. mutans. Teeth were randomly divided into groups I, II, and III which were treated with gels of liquorice, propolis, and distilled water, respectively, for 60, 120, and 180 seconds each. Specimens were sectioned and stained with fluorescent dyes and observed under a confocal laser scanning microscopy (CLSM). The data obtained were statistically evaluated. Results The mean nonviable/viable bacterial count and the depth of penetration were found to be maximum in group I and minimum in group III. A statistically significant difference was found to be between groups I and II and groups I and III, while with groups II and III, it was nonsignificant at all 60, 120, and 180 seconds. The bacterial depth penetration between groups I and II at 180 seconds was nonsignificant. Conclusion and clinical significance Though liquorice showed better antimicrobial potential as compared to propolis extract, both can be used efficiently as cavity disinfectants. How to cite this article Godbole E, Tyagi S, et al. Efficacy of Liquorice and Propolis Extract Used as Cavity Cleaning Agents against Streptococcus mutans in Deciduous Molars Using Confocal Microscopy: An In Vitro Study. Int J Clin Pediatr Dent 2019;12(3):194-200.

Probiotics, live cells with different beneficiary characteristics, have been extensively Studied and explored commercially in many different products in the world. Their benefits to human and animal health have been proven in hundreds of scientific research. Lactobacillus and Bifidobacterium are the main probiotic groups; however, there are reports on the probiotic potential of Pediococcus, Lactococcus, Bacillus, and yeasts. Some of the identified probiotic strains exhibit powerful anti-inflammatory, antiallergic, and other important properties.

Background: Pomegranate, Grape seed and Guava extracts have much been reviewed in Ayurveda and has been proven to have antibacterial action Aim: The objective of the study is to investigate and compare the mouthwash prepared from pomegranate, grape seed and guava extracts on salivary streptococci levels at the end of 48 hr and 7 days, of twice a day usage. Study design: 40 school going children aged 8–10 yrs, randomly allocated into 4 groups (n=10 for experimental group) were asked to rinse with a) Mouthwash prepared from Pomegranate extract, 15 ml twice a day b) Mouthwash prepared from Grape seed extract, 15 ml twice a day, c) Mouthwash prepared from guava extract, 15 ml twice a day, d) Control- Distil water, twice a day. The oral streptococci colony forming units/ml (CFU/ml) was assessed by inoculating the salivary samples on blood agar media at the end of 48 hrs, and 7 days. Results and Conclusion: the aqueous extracts of the chosen herbal plants showed an acceptable antibacterial efficacy against oral streptococci.

Background Pulpotomy is the treatment for cariously exposed vital primary molars. UsingfFormocresol as a pulpotomy agent is been in controversy, which has triggered the search for better alternatives. The product like 'Myristica fragrans (MF)-Nutmeg gel, Terminalia chebula (TC)-Myrobolan gel is gaining popularity as herbal pulpotomy agents. Aim To evaluate and compare clinical and radiographical success of herbal gels Myristica fragrans (MF)-Nutmeg, and Terminalia chebula (TC)-Myrobolan as pulpotomy medicaments in primary teeth. Materials and methods Twenty participants (n = 20), each with at least two primary molars requiring pulpotomy, were selected and divided into two test groups. In 10 children Terminalia chebula gel was placed in one side and Formocresol on another side. Rest 10 children were treated with Myristica fragrans gel on one side and another side with formocresol. The treated teeth selected for clinical and radiographic evaluation were monitored periodically for 3, 6 and 12 months. Results With the follow-up of 12 months there was no significant difference in efficacy of all three pulpotomy medicaments, i.e. Nutmeg, Myrobolan, and Formocresol, respectively was found. Conclusion Herbal gels have a promising role in dentistry having the proper knowledge, and their effects on teeth would prove them as a successful dental therapeutic agent. How to cite this article Mali S, Singla S, Sharma A, Gautam A, Niranjan B, Jain S. Efficacy of Myristica fragrans and Terminalia chebula as Pulpotomy Agents in Primary Teeth: A Clinical Study. Int J Clin Pediatr Dent, 2018;11(6):505-509.

Aim The aim of the present in vitro study is to evaluate and compare antimicrobial efficacy of commercially available child's dental formulas in reduced concentrations containing different forms of fluoride against Streptococcus mutans activity. Materials and methods The selected dentifrices were prepared in dilutions of 1:1, 1:2, 1:4, 1:8, and 1:16 using sterile pyrogen-free distilled water. Various dilutions of the selected toothpaste slurries were incubated in the agar plate containing pure strains of S. mutans, and antimicrobial activity of each was assessed by measuring the diameter of zones of inhibition (in mm). Agar well plate diffusion method and minimum inhibitory concentration (MIC) determination were the methods used in this study. The inhibitory circle of each dentifrice was measured and MIC was achieved by considering the value of diameter of the circle. Results The results of the study showed that even at a lower concentration of fluoride, inhibition halos were obtained for all the formulations at different dilutions. Conclusion The kid's formulations having lower fluoride concentration show antimicrobial activity even after dilutions. Thus, commercially, the fluoride concentrations can be further lowered down in the dentifrices, thereby reducing the risk associated with fluoride. How to cite this article Malhotra R, Singla S, Shashikiran ND. Comparison of Antimicrobial Activity of Child Formula Dentifrices at different Concentrations: An in vitro Study. Int J Clin Pediatr Dent 2017;10(2):131-135.

Background Evaluation of bond strength and microleakage caused by polymerization shrinkage provides a screening mechanism and an indication of the potential for the clinical success of composite restorations. Aim The aim of this study was to determine the effect on shear bond strength and microleakage of standard and expired composites. Materials and methods Selected specimens were etched using 37% phosphoric acid for 15 seconds and were randomly divided into four groups. Group I: Standard composite and bonding agent; group II: Expired composite and bonding agents; group III: Standard composite and expired bonding agent; and group IV: Expired composite and standard bonding agent. Specimens were further subdivided into two subgroups. In subgroup A, specimens were sheared with a universal testing machine, and the results were calculated in MPa; in subgroup B, specimens was sectioned longitudinally and analyzed for leakage (dye penetration) using a stereomicroscope. Results The results of the present study showed that acceptable values for bond strength and microleakage were obtained even if one of the components of the dental resin composite is expired. Conclusion In Indian scenario, the expired composite material may provide some assistance in compromised clinical situations. It can be used as an interim restoration and compensate for the high material cost. How to cite this article Talreja N, Singla S, Shashikiran ND. Comparative Evaluation of Bond Strength and Microleakage of Standard and Expired Composite at Resin-Dentin Interface: An in vitro Study. Int J Clin Pediatr Dent 2017;10(1):1-4.

Background Pulpotomy is the treatment for cariously exposed vital primary molars. UsingfFormocresol as a pulpotomy agent is been in controversy, which has triggered the search for better alternatives. The product like ‘Myristica fragrans (MF)–Nutmeg gel, Terminalia chebula (TC)–Myrobolan gel is gaining popularity as herbal pulpotomy agents. Aim To evaluate and compare clinical and radiographical success of herbal gels Myristica fragrans (MF)–Nutmeg, and Terminalia chebula (TC)–Myrobolan as pulpotomy medicaments in primary teeth. Materials and methods Twenty participants (n = 20), each with at least two primary molars requiring pulpotomy, were selected and divided into two test groups. In 10 children Terminalia chebula gel was placed in one side and Formocresol on another side. Rest 10 children were treated with Myristica fragrans gel on one side and another side with formocresol. The treated teeth selected for clinical and radiographic evaluation were monitored periodically for 3, 6 and 12 months. Results With the follow-up of 12 months there was no significant difference in efficacy of all three pulpotomy medicaments, i.e. Nutmeg, Myrobolan, and Formocresol, respectively was found Conclusion Herbal gels have a promising role in dentistry having the proper knowledge, and their effects on teeth would prove them as a successful dental therapeutic agent. How to cite this article Mali S, Singla S, Sharma A, Gautam A, Niranjan B, Jain S. Efficacy of Myristica fragrans and Terminalia chebula as Pulpotomy Agents in Primary Teeth: A Clinical Study. Int J Clin Pediatr Dent, 2018;11(6):505-509

Introduction: Dental treatment is usually a poignant phenomenon for children. Projective scales are preferred over psychometric scales to recognize it, and to obtain the self-report from children. Aims: The aims were to evaluate treatment related fear using a newly developed fear scale for children, fear assessment picture scale (FAPS), and anxiety with colored version of modified facial affective scale (MFAS) - three faces along with physiologic responses (pulse rate and oxygen saturation) obtained by pulse oximeter before and during pulpectomy procedure. Settings and Design: Total, 60 children of age 6-8 years who were visiting the dental hospital for the first time and needed pulpectomy treatment were selected. Children selected were of sound physical, physiological, and mental condition. Two projective scales were used; one to assess fear - FAPS and to assess anxiety - colored version of MFAS - three faces. These were co-related with the physiological responses (oxygen saturation and pulse rate) of children obtained by pulse oximeter before and during the pulpectomy procedure. Statistical Analysis Used: Shapiro-Wilk test, McNemar′s test, Wilcoxon signed ranks test, Kruskal-Wallis test, Mann-Whitney test were applied in the study. Results: The physiological responses showed association with FAPS and MFAS though not significant. However, oxygen saturation with MFAS showed a significant change between "no anxiety" and "some anxiety" as quantified by Kruskal-Wallis test value 6.287, P = 0.043 (

Background: Autism is a neurobiological disorder characterized by impaired social interaction, communication difficulties, and lacking manual dexterity. These limitations make the oral hygiene maintenance very difficult. Aim: The aim of this present study is to evaluate and compare the efficacy of low fluoridated and calcium phosphate-based dentifrice formulations when used with powered and manual toothbrush in children with autism. Setting and Design: Sample comprised 22 children with autism who daily visited a day care and education center named ARUSHI - a center for children with special health care needs in Bhopal. Methods: Children were divided into two groups (Group A and B) according to toothbrush used and further divided into subgroups (A1 and B1 [low fluoridated − Pediflor toothpaste] and A2 and B2 [calcium sucrose phosphate − Enafix toothpaste]). Oral hygiene instructions and brushing technique demonstration were given every day for a period of 1-month. Oral health status was evaluated before and after the study using simplified oral hygiene index (OHI-S) and its Miglani's modification for primary dentition, plaque index (PI), gingival index (GI), and decayed, missing, and filled teeth (DMFT)/deft index. The perception of parents regarding oral hygiene practices for their kids was also evaluated by an awareness and attitude questionnaire. Statistical Analysis: OHI-S, GI, PI, and DMFT/deft were statistically evaluated using Mann–Whitney U- test. Results and Conclusion: Mean value of OHI-S decreased significantly with powered toothbrush (0.035 [P < 0.05]) in both groups. However, PI decreased significantly for Enafix when used with powered toothbrush (0.042 [P < 0.05]). Perception of parents was seen to improve significantly after 1-month study (0.000 [P < 0.05]).

Context: Demineralization of tooth by erosion is caused by frequent contact between the tooth surface and acids present in soft drinks. Aim: The present study objective was to evaluate the remineralization potential of casein-phosphopeptide-amorphous calcium phosphate (CPP-ACP) paste, 1.23% acidulated phosphate fluoride (APF) gel and iron supplement on dental erosion by soft drinks in human primary and permanent enamel using atomic force microscopy (AFM). Materials and Methods: Specimens were made from extracted 15 primary and 15 permanent teeth which were randomly divided into three treatment groups: CPP-ACP paste, APF gel and iron supplement. AFM was used for baseline readings followed by demineralization and remineralization cycle. Results and Statistics: Almost all group of samples showed remineralization that is a reduction in surface roughness which was higher with CPP-ACP paste. Statistical analysis was performed using by one-way ANOVA and Mann-Whitney U-test with P < 0.05. Conclusions: It can be concluded that the application of CPP-ACP paste is effective on preventing dental erosion from soft drinks.

A 7-month-old male presented with developmental delay and multiple congenital anomalies. He was found to have partial trisomy for the distal segment of chromosome 15 (q22-qter). Chromosome analysis of the mother showed a reciprocal balanced translocation between long arms of chromosome 6 and 15, t (6;15)(q26;q22).

Aim The aim of the present in vitro study is to evaluate and compare antimicrobial efficacy of commercially available child’s dental formulas in reduced concentrations containing different forms of fluoride against Streptococcus mutans activity. Materials and methods The selected dentifrices were prepared in dilutions of 1:1, 1:2, 1:4, 1:8, and 1:16 using sterile pyrogen-free distilled water. Various dilutions of the selected toothpaste slurries were incubated in the agar plate containing pure strains of S. mutans, and antimicrobial activity of each was assessed by measuring the diameter of zones of inhibition (in mm). Agar well plate diffusion method and minimum inhibitory concentration (MIC) determination were the methods used in this study. The inhibitory circle of each dentifrice was measured and MIC was achieved by considering the value of diameter of the circle. Results The results of the study showed that even at a lower concentration of fluoride, inhibition halos were obtained for all the formulations at different dilutions. Conclusion The kid’s formulations having lower fluoride concentration show antimicrobial activity even after dilutions. Thus, commercially, the fluoride concentrations can be further lowered down in the dentifrices, thereby reducing the risk associated with fluoride. How to cite this article Malhotra R, Singla S, Shashikiran ND. Comparison ofAntimicrobial Activity of Child Formula Dentifrices at different Concentrations: An in vitro Study. Int J Clin Pediatr Dent 2017;10(2):131-135.

Background Evaluation of bond strength and microleakage caused by polymerization shrinkage provides a screening mechanism and an indication of the potential for the clinical success of composite restorations. Aim The aim of this study was to determine the effect on shear bond strength and microleakage of standard and expired composites. Materials and methods Selected specimens were etched using 37% phosphoric acid for 15 seconds and were randomly divided into four groups. Group I: Standard composite and bonding agent; group II: Expired composite and bonding agents; group III: Standard composite and expired bonding agent; and group IV: Expired composite and standard bonding agent. Specimens were further subdivided into two subgroups. In subgroup A, specimens were sheared with a universal testing machine, and the results were calculated in MPa; in subgroup B, specimens was sectioned longitudinally and analyzed for leakage (dye penetration) using a stereomicroscope. Results The results of the present study showed that acceptable values for bond strength and microleakage were obtained even if one of the components of the dental resin composite is expired. Conclusion In Indian scenario, the expired composite material may provide some assistance in compromised clinical situations. It can be used as an interim restoration and compensate for the high material cost. How to cite this article Talreja N, Singla S, Shashikiran ND. Comparative Evaluation of Bond Strength and Microleakage of Standard and Expired Composite at Resin-Dentin Interface: An in vitro Study. Int J Clin Pediatr Dent 2017;10(1):1-4.

Odontomas are hamartomas composed of various dental tissues, i.e. enamel, dentin, cementum and sometimes pulp. They are slow-growing, benign tumors showing nonaggressive behavior. Most of the odontomes are asymptomatic with unknown etiology, although occasional signs and symptoms related to their presence do occur. Presented here is the case report of 10-year-old girl with impacted left central incisor.

Synodontia or fusion is union of two independently developing primary or secondary teeth. In the case reported here, clinical and radiographic examination suggested fusion between maxillary lateral incisor and a supernumerary tooth with the resultant loss of eruption space for permanent canine. Since the teeth exhibited separate pulp chambers without any pulpal involvement, surgical separation followed by odontoplasty was done. Follow-up revealed the tooth to be asymptomatic and sufficient space for eruption of canine was created. The case report highlights the surgical management in case of fusion and timely intervention to prevent periodontal, endodontic and orthodontic complications.

Congenital rickets is a very rare entity in the spectrum of metabolic bone disease in children. The authors report an as yet unreported case of congenital rickets presenting with respiratory distress at birth. The radiographs of long bones and wrist showed generalized osteopenia with cupping and fraying of epiphyseal ends in the second week of life. The patient was managed with very high doses of vitamin D which led to clinico-radiological and biochemical improvement. More than being interesting for its extreme rarity, this report assumes importance as it brings forth the possibility of congenital rickets being a differential diagnosis for a newborn with respiratory distress.

Background: Oral and dental injuries contribute to a major part of sports related injuries in children. Trauma occurring in developing years disrupts normal social functioning and brings about a major impact on quality of life due to their cumulative effect. Objectives: To assess the prevalence and causes of various sports related traumatic orodental injuries among 8 to 16 year school students along with identifying the associated risk factors in North India. Patients and Methods: A cross sectional study consisting of high school students of different organized sports teams aged 8-16 years was carried out in geographical area of north India. The students were selected by multistage cluster sampling methodology. 1105 students from 19 school teams (sports teams) and sports academies participated in study through structured interview and clinical examination in different sports situations. Results: 30.3% (n = 335) of students suffered from orodental injuries. A higher number of girls had injury (32%) than boys (29%), though the difference was not significant. Most of the students suffered from soft tissue injuries (48%) followed by tooth fractures (43%). Maximum numbers of injuries were reported in high velocity (44.1%) and medium intensity sports (46.6%) (P < 0.001) Maximum injuries occurred in basketball (50%) and lowest in the field of badminton (6.1%) (P < 0.05). Amateurs (52%) suffered the most from injuries as per level of coaching. Only 6% of boys and 2% of girls used mouthguards. Conclusions: The result of the present study confirmed that students participating in different organized sports at high school level are at a very high risk of getting orodental injury. Hence knowledge and education regarding prevention of traumatic injuries is of paramount importance.

Aims: To study the effect of the smear layer on the penetration of bacteria along different root canal fillings and to compare the sealing ability of new endodontic material Apexit plus as compared to Zinc Oxide Eugenol (ZOE) in primary teeth. Study design: A total of 60 human root segments were instrumented for endodontic treatment. Half of the sample size was irrigated with normal saline and in other half, 3% NaOCl, 3% H2O2 and 17% EDTA was used alternatively as irrigant during instrumentation. The roots were rinsed thoroughly with distilled water and sterilized by autoclaving for 20 min at 121 ± 2 °C. Roots with and without smear layer were obturated with Apexit plus, Zinc oxide eugenol. Following storage in humid conditions at 37°C for 2 days, the specimens were mounted into a bacterial leakage test model for 180 days. Results: At 180 days, there is statistically significant difference with a P value of < 0.05 among all groups except ZOE -smear and -nonsmear. In the presence of smear layer, Apexit plus demonstrated more leakage. No leakage was observed in ZOE groups. ZOE demonstrated better sealing ability than Apexit plus. Conclusions: Removal of smear layer helps in better resistance to bacterial penetration along Apexit plus root canal fillings but no effect is seen along ZOE root canal fillings.

Introduction: A major objective in restorative dentistry is the control of marginal leakage, which may occur because of dimensional changes or lack of adaptation of restorative material to the cavity preparation. Numerous techniques have been advocated to overcome polymerization shrinkage in composite restorations. Aim and Objectives: This study investigated microleakage of three different bases under composite resin in sandwich technique using dye penetration and dentin surface interface using scanning electron microscope (SEM). Materials and Methods: Sixty extracted deciduous molars were stored in distilled water and Class I cavities with a width of about one-fourth of intercuspal distance and a depth of 0.5-1 mm below the dentino-enamel junction was prepared without bevels. In Group 1 - glass ionomer cement (GIC); Group 2 - mineral trioxide aggregate (MTA); Group 3 - Biodentine™ was placed as a base under composite. Teeth were longitudinally sectioned in two halves, through the centers of the restoration, immersed in 2% methylene blue and microleakage was evaluated under stereomicroscope and surface interface between base and dentin was evaluated under SEM. Results:Under the condition of in vitro study, less microleakage and less internal gaps were seen in Biodentine™ (0.00 ± 0.00 and 4.00 ± 1.59) group than MTA (0.00 ± 0.00 and 6.08 ± 1.82) and GIC (25.25 ± 6.57 and 14.73 ± 3.72, respectively) and showed very strong positive correlation between microleakage and internal gaps. Conclusion: Biodentine™ exhibits superior marginal sealing ability as well as marginal adaptation under composite resin as compared to MTA and GIC.

Congenital insensitivity (HSAN) to pain is a rare disorder, which affects the body's painprotective mechanism and predisposes the patient to increased risk and incidence of traumatic injuries. Currently, 5 types of hereditary sensory and autonomic neuropathies have been identified, depending upon different patterns of sensory and autonomic dysfunction, peripheral neuropathy, clinical features, and genetic abnormalities. The purpose of this report is to present the case of a 10-year-old boy with congenital insensitivity to pain (hereditary sensory autonomic neuropathy [HSAN] type V) with dental implications. History, clinical features, nerve conduction studies, and electron microscopy revealed no reaction to painful stimuli, a self-mutilating habit, multiple missing teeth, and an absence of small, unmyelinated fibers, thus indicating HSAN type V. Management included patient counseling and use of a mouthguard to prevent further damage and restore function.

Trauma to anterior tooth is prevalent among adolescents. An immediate management of complicated crown fracture is reattachment of fragments or biologic tooth restoration. The present case series elucidate the fracture reattachment using conventional preparation design for resin restoration. The adhesive reattachment provides an original tooth color and contour that aids in rehabilitation of traumatized tooth. The present case series depicts that fracture reattachment is a viable, conservative and esthetic alternative for treatment of complicated crown fracture. The long-term prognosis is still obscure, but it is an immediate technique of esthetic rehabilitation.

Objective: Repeated efforts in the form of educational programs and surveys have been made time and again to enhance the knowledge, attitude and behavior of pediatricians regarding pediatric dentistry. However, it is unfortunate to conceive that there is still a huge need to bridge the gap. This study is yet another effort to detect the loopholes so that henceforth in future a better rapport and a better consultation program can be established between pediatricians and pedodontists. Need of the hour is to improve the communication between the two fraternities. Aim and Objectives: The aim of the study of the following study is to evaluate the knowledge, attitude and behavior of pediatricians regarding pediatric dentistry in Bhopal city (Madhya Pradesh). Material and Methods: Pediatricians in Bhopal were requested to fill up an open ended questionnaire, which comprised of questions relating to the basic knowledge regarding the scope of pediatric dentistry and how according to them was this specialty beneficial to the young patients. Result: The present study shows that the pediatricians who were surveyed had poor knowledge regarding dental and oral health and treatment needs in children. Most of pediatricians were not aware of many aspects of child oral health care and areas of concerns were identified. Conclusion: Pediatricians have a fair knowledge about oral health and different treatment modalities such as pit and fissures sealants, restoration, root canal treatment, crowns, space maintainers and topical fluorides in children.

Griscelli syndrome type 2 (GS2) is a rare autosomal recessive disease caused by mutations in the RAB27A gene. It is characterized by cutaneous hypopigmentation, immunodeficiency, and hemophagocytic lymphohistiocytosis. We describe 2 brothers who had GS2 with clinically diverse manifestations. The elder brother presented with a purely neurological picture, whereas the younger one presented with fever, pancytopenia, hepatosplenomegaly, and erythema nodosum. Considering that cutaneous hypopig­ mentation was a common feature between the brothers, genetic analysis for Griscelli syndrome was performed. As the elder sibling had died, mutation analysis was only performed on the younger sibling, which revealed a novel homozygous mutation in the RAB27A gene on chromosome 15 showing a single­base substitution (c.136T>A p.F46I). Both parents were heterozygous for the same mutation. This confirmed the diagnosis of GS2 in the accelerated phase in both siblings. The atypical features of GS2 in these cases are a novel mutation, isolated neurological involvement in one sibling, association with erythema nodosum, and 2 distinct clinical presentations in siblings with the same genetic mutation.

Cherubism is a self-limiting non-neoplastic autosomal dominant fibro-osseous disorder of the jaw usually found in children between 2-5 years of age. It occurs predominantly in boys and is characterized clinically by bilateral swelling of cheeks due to bony enlargement of the jaw that gives the patient a typical cherubic look. Cherubism may occur as solitary cases or in many members of family, often in multiple lesions. Radiographically the lesions appear as multilocular bilateral radiolucent areas. The present case report describes a 13-year-old female cherubic child with progressive swelling of cheeks.

Cold agglutinin syndrome (CAS) secondary to infection is rare, usually presenting with anaemia and minor skin changes. A 12-year-old girl with secondary CAS associated with extensive cutaneous necrosis is reported. She presented with fever and multiple necrotic lesions over both cheeks, the tip of nose, ear margins, hands and buttocks, along with pallor, hepatospenomegaly, acrocyanosis and gangrene of the fifth digit of the right hand. She had anaemia, unconjugated hyperbilirubinaemia and a positive direct antiglobulin test owing to cold agglutinins of the IgM type with anti-i specificity and titres of 1:512 at 4°C. Results of bone marrow examination were normal and cryoglobulins were negative. Cold antibodies released even during a brief, self-limited febrile illness can cause widespread cutaneous gangrene. We believe this is the first report in the paediatric age group.