Tripti Chauhan

A study of prevalence and severity of dental fluorosis among school children in a Northern hilly state of India

Background: Dental fluorosis is a major public health problem in 15 states of India. Himachal Pradesh has considerable amount of problem though not an endemic zone for dental fluorosis. Aims: To determine the prevalence and severity of dental fluorosis using Deans index among school going children of rural and urban areas. Settings and Design: A cross sectional study was conducted among the students in the age group of 5, 9 and 12 years from rural and urban areas of six district of Himachal Pradesh in the year 2009 to 2010. Materials and Methods: A total of 1,800 school children of both sexes from randomly selected schools were examined as per the WHO survey proforma to identify the presence of dental fluorosis and grade it using Deans index. Statistical Analysis Used: SPSS 15.0 was used. Data expressed as proportions and test applied was Chi-square test. Results: Out of these total 1,800 children, 973 were boys and 827 were girls. Of them, 612, 564 and 624 children belonged to the age groups of 5, 9 and 12 years, respectively. The overall prevalence of dental fluorosis was 4.1%. The prevalence ranged from highest 7% in district Shimla to lowest 1.7% in district Sirmour (P < 0.002). Dental fluorosis was equally distributed in rural and urban areas of six districts but was more common among girls than boys. The trend of increase in prevalence was observed with increase in age (P < 0.00002). Conclusions: A well-designed epidemiological study should be undertaken to evaluate the risk factors associated with the condition in the study region.

A study of oral hygiene status and prevalence of gingival diseases in 9 and 12-year-old school children of a northern hilly state, India

Background: The gingival and overall oral health status is affected by the changes in lifestyle, dietary habits, and aberrant oral hygiene practices. Objectives: To determine the prevalence of gingival diseases among school children of Himachal Pradesh. Materials and Methods: A cross-sectional study was conducted among a sample of 1188 school children in the age group of 9 and 12 years from randomly selected schools of rural and urban areas of Himachal Pradesh and they were included as study subjects. The survey was carried out according to the WHO Oral Health Assessment Form (modified). Community periodontal index was used to assess gingival health, using three indicators: Healthy, gingival bleeding, and calculus. Plaque index was used to assess oral hygiene as poor, fair, and good. Statistical Analysis: SPSS version 15. Results: A total of 1188 children were examined, of these 650 (54.8%) were males and 538 (45.2%) were females. A total of 564 belonged to the 9 and 624 to 12 years age group. The overall prevalence of gingival disease was 22.9%. The majority (14.2%) were presented with calculus and 8.7% showed gingival bleeding ( P P Conclusion: There is a need for reinforcement of dental services to difficult and hard areas.

A study of malocclusion and orthodontic treatment needs according to dental aesthetic index among school children of a hilly state of India.

Background: The documentation of magnitude of malocclusion in terms of prevalence and severity has not been done till date in Himachal Pradesh, India. Aims: To assess the prevalence of malocclusion and orthodontic treatment needs (OTNs) among 9-and 12-year-old school children by using the Dental Aesthetic Index (DAI) in the state. Materials and Methods: A cross-sectional study was conducted among 1188 children from randomly selected schools. The survey was done according to the Oral Health Assessment Form (modified). DAI was used to assess the severity of malocclusion, along with collection of demographic data. Results: The overall prevalence of malocclusion was 12.5% and required orthodontic treatment, whereas 87.5% did not require treatment. A severe malocclusion for which treatment was highly desirable was recorded in 3.1%; 8% had a definite malocclusion for which treatment was elective. Only about 1.3% had a handicapping malocclusion that needed mandatory treatment. Almost equal proportions of males and females were affected with malocclusion with the means 20 ± 4.6 and 19.9 ± 4.9, respectively (P < 0.641). The prevalence and severity of malocclusion was more in 12-year age group than in 9-year age group (P = 0.002**). There was an increase in the proportion of malocclusion among older children: In 12-year age group, 15.7% with mean 20.5 ± 5.1 and in 9-year-old children, 8.9% with the mean 19.3 ± 4.1 were in the need of orthodontic treatment. Conclusion: Severity and treatment needs, both are important factors in public health planning.

Prevalence of signs and symptoms of temporomandibular disorders in urban and rural children of northern hilly state, Himachal Pradesh, India: A cross sectional survey

Background: Temporomandibular disorders (TMDs) have been recognized as a common orofacial painful condition. Many epidemiological studies of TMDs in children and adolescents have been performed. However, the results of such studies have varied, and a comprehensive view of the prevalence and severity of symptoms and signs is difficult to obtain. Objectives: To determine the prevalence of signs and symptoms of TMDs among school children of Himachal Pradesh and to establish a baseline for comparison with future studies. Study Design: Cross sectional. Materials and Methods: A sample of 1188 school children in the age group of 9 and 12 years (males n = 650 and females n = 538), from randomly selected schools of rural and urban areas of Himachal Pradesh were included as study subjects. The survey was done according to the WHO Oral Health Assessment Form (modified). Results: The results of TMDs, i.e., clicking, tenderness and reduced jaw mobility showed that overall prevalence was 2.5% and the rest 96.5% were not suffering from these disorders. In 9 years age group, the prevalence was 1.6% whereas it was more than double, 3.5% in 12 years age group. Signs and symptoms of TMDs were determined to assess their oral health status. Statistical Analysis: SPSS version 15. Conclusion: This study contrasts with what is found in the other societies regarding the high prevalence of TMDs disorders.

Closure of midline diastema through combined surgical and Removable orthodontic approach

Midline diastema is a common aesthetic problem in mixed and permanent dentition. Many innovative therapies are varying from restorative procedures such as composite build-up to surgery (frenectomy) and orthodontics are available. A high frenum attachment is often the cause of persistent diastemas. Presented herewith is a case report of a 13-year-old girl with a high frenal attachment that had caused spacing of the maxillary central incisors. This case report demonstrates the removal of the abnormal labial frenum attachment through surgery and subsequent closure of maxillary diastema following removable orthodontic treatment.

Congenital gingival cyst of neonate: Dentist's enigma

Gingival cysts of the newborn are small keratin-filled cysts on the alveolar mucosa of infants that exists at birth. They are remnants of the dental lamina and are usually multiple in numbers, but do not increase in size. The diagnosis is made at the clinical level. Since, this lesion tends to undergo involution or regresses spontaneously within a few weeks or months after birth so unnecessary therapeutic intervention is avoided. Complications are rarely observed. Pain on sucking, refusal to feed and airway obstruction can occur in rare instances. However parents remain anxious about the prevailing condition. Hence they should be reassured by providing suitable information about the simple nature of this lesion.

Restoration of function and esthetics in a patient with amelogenesis imperfecta

Amelogenesis imperfecta (AI) is a rare genetic disorder inherited as either autosomal dominant, autosomal recessive, or X- linked modes. AI is characterized by the defect in enamel formation, resulting in defective mineralization or formation of the matrix. Restoration of the dentition poses great challenges, especially when teeth are severely affected. Treatment aims to relieve pain or sensitivity of teeth and to preserve as much tooth structure as possible while preventing further loss of teeth, to maintain masticatory function, and last but not the least, to improve the aesthetic appearance and quality of life as it has a great psychological impact on the self-esteem of the patient. This case report describes the treatment of a young boy who presented with a severe form of AIimperfect (AI) with a minimally invasive, relatively simple, and cost-effective treatment with composite restorations.

Prevalence of developmental defects of enamel in mixed and permanent dentition of 9 and 12 year old children of Himachal Pradesh, India: A cross sectional study

Objective: The purpose of this study was to determine and compare the prevalence and presentation of developmental defects of the enamel (DDE) in the mixed and permanent dentition of healthy school children residing in hills. Materials and Methods: A total of 1188 healthy school children were examined using modified DDE criteria for recording enamel defects. Results: The overall prevalence of DDE of any type was (51.3%) in both mixed and permanent dentition. Diffuse opacity was (25.3%) the most common defect and demarcated opacity was (23.1%) and whereas, enamel hypoplasia was the least prevalent defect with prevalence of (2.9%). Conclusion: The study population showed a high prevalence of DDE in primary as well as in the permanent dentition, reflecting the current increasing trend of this condition, which should be considered as a significant public health problem.

A study of an association between tuberculosis and HIV among ICTC attendees at a tertiary care hospital of Shimla, Himachal Pradesh, India

Background: In India, HIV epidemic and tuberculosis (TB) have posed enormous challenges in the control of TB. Objectives: To determine the proportion of TB in HIV positive and HIV negative patients. Materials and Methods: This hospital based cross-sectional study was conducted in the ICTC of Indira Gandhi Medical College, Shimla from 1 st January 2007 to 31 st August 2007. A sample of 525 consecutive attendees in the age group of 15 to 50/> years were included as study subjects. After counseling, confirmation of HIV status was done according to NACO and diagnosis of TB as per the RNTCP guidelines. Their clinical presentations, PTB and site of EPTB were studied.A pretested questionnaire was used to collect a detailed history followed by a physical examination. Laboratory and radiological investigations were carried out appropriately. Results: Among the 525 attendees, 198 (37.7%) were seropositives and 327 (62.3%) were seronegatives. Of the seropositives more affected were females, 105 (53%) than males, 93 (47%). Wherein among seronegatives, male to female ratio was 2:1. The most common symptoms of PTB among seropositives were cough >3 weeks in 40%, followed by production of purulent sputum in 33.8% and fever >3 weeks in 23% as compared to seronegatives, where the commonly reported symptom was cough >3 weeks in 25.4% ( P P P Conclusion: TB in HIV patients presentas extra-pulmonary involvement more frequently.