Introduction Contemporary methods of teaching oral hygiene for the removal of dental plaque are not beneficial for visually impaired children, who depend on tactile sensations and hearing for learning. The present study was conducted to educate and motivate visually impaired children to maintain their oral health using specially designed methods that are easy for these children to understand. Additionally, the study evaluated the effectiveness of these methods over a 6‐month period. Methodology The investigation was done on 148 visually impaired children who were residents of two institutes for the visually impaired. The efficacy of a specially designed oral health education programme and two different motivational techniques utilising tactile (Group I: braille + plastic models) or auditory sensations (Group II: audio story + JAWS®, i.e. Job Access With Speech) was evaluated over 6 months based on the children's plaque and gingival scores. Results Significant improvement in mean plaque and gingival scores was evident in both the groups at the 6‐month evaluation, validating the effectiveness of both the programmes. In Group I, the mean plaque score decreased from 1.34 ± 0.29 at baseline to 1.09 ± 0.26 at 3 months, with a further decrease to 1.04 ± 0.31 at 6 months post‐implementation (P < 0.01). The mean plaque score in Group II decreased from 1.24 ± 0.47 at baseline to 1.15 ± 0.15 at 3 months (P = 0.12), and further to 1.10 ± 0.17 at 6 months (P < 0.01) post‐implementation of the educational programme. At baseline, 87.8% of the children in Group I had moderate gingivitis, whereas 52.7% of the children in Group II belonged to the mild category. At the end of 6 months, 52.7% of the children in Group I were in the mild category, and 62.2% children in Group II were in the moderate category. Conclusion Tactile and auditory measures were found to be effective in educating and motivating visually impaired children regarding maintenance of oral hygiene.
Background Use of rotary instruments in the root canals of permanent teeth is well known; however, there are no evidence‐based recommendations on the effectiveness of rotary canal instrumentation techniques over manual instrumentation techniques during root canal treatment in primary teeth. Aim To appraise the current literature on the effectiveness of rotary canal preparation techniques compared to manual techniques during root canal treatment in primary teeth. Data sources MEDLINE, Embase, Cochrane Library, Scopus, PubMed and Web of Science (1 January 1991 to 3 January 2019). Study eligibility criteria, participants and interventions Population: Children with primary teeth; Intervention: Rotary canal instrumentation; Control: Manual canal instrumentation; Outcomes: Success rates (clinical and/or radiographic), quality of root filling, instrumentation and root filling time, postoperative pain, cleaning effectiveness. Study appraisal and synthesis methods Cochrane risk of bias tool 2.0 was used to ascertain the validity across five domains. Risk ratio (RR) for dichotomous variables and weighted mean difference for continuous variables were used as summary measures. The GRADE approach was used to assess the certainty of evidence using GRADE‐pro software. Results A total of 13 trials were selected of 2471 records after screening of the databases. The RR of clinical success in rotary versus manual canal preparation technique was 1.01 (95% CI: 0.91–1.12; P = 0.913) at 6 months. The RR of radiographic success in rotary versus manual techniques was 0.97 (95% CI: 0.74–1.27; P = 0.805) at 6 months. The quality of root filling was not significantly different between the two groups (P = 0.062). The weighted mean difference of instrumentation time and canal filling time was significantly less with rotary techniques (P < 0.001); however, postoperative pain was non‐significant across both techniques at 12, 24 and 72 h but significantly less with rotary techniques at 6 h (P < 0.001) and 48 h (P = 0.023). Limitations Inclusion of only English literature. Conclusions and implications of key findings Rotary canal instrumentation had a similar clinical and radiographic success rate, less postoperative pain (at 6 and 48 h), and took less instrumentation time compared to manual instrumentation techniques (moderate level of evidence).
Summary Background The regular use of fluoride dentifrices is quite practical, widespread and linked to global decline of dental caries. However, the role of self-applied topical fluorides in prevention and reversal of Enamel White Spot Lesions (EWSLs) during multi-bracketed fixed orthodontic treatment is not yet explored. Objective To systematically appraise the current literature on the effectiveness of self-applied topical fluorides in the prevention and reversal of EWSLs occurring during multi-bracketed fixed orthodontic treatment. Search methods Four electronic databases (Cochrane Library, Embase via Ovid, Medline via Ovid, and Scopus) and gray literature were searched using the broad MeSH terms and keywords. Selection criteria Only randomized/quasi-randomized controlled clinical trials evaluating the effectiveness of self-applied fluorides in the prevention of EWSLs during multi-bracketed fixed orthodontic treatment or reversal of post-orthodontic EWSLs were included. Data collection and analysis Two reviewers independently screened for studies, extracted data and assessed the risk of bias using the Cochrane risk of bias tool 2.0. Due to substantial variations in the interventions, control groups, and the measurement of outcome among studies, quantitative synthesis could not be performed as planned. Results Only three studies could be included in the present review; two of them assessing prevention of EWSLs and one addressing reversal of post-orthodontic EWSLs. One of the studies was judged to be of low risk of overall bias, whereas 2 studies were adjudged to be of high risk of overall bias because of deviations from intended interventions. The certainty of evidence about the role of self-applied fluorides in prevention and reversal of EWSLs was found to be of low quality; hence, our confidence in the effect estimate is limited, and future well-conducted trials might alter the effect estimates. Limitations The inclusion of only English literature and inability to perform quantitative synthesis due to a limited number of studies. Conclusions and implications Although the review did not confirm the effectiveness of self-applied fluorides in the reversal of EWSLs, it did partially substantiate the positive role of self-applied fluorides in the prevention of EWSLs occurring during multi-bracketed fixed orthodontic treatment. The review recommends the need for well-designed randomized controlled trials evaluating the effectiveness of self-applied fluorides on the prevention and reversal of EWSLs during multi-bracketed fixed orthodontic treatment. Registration PROSPERO database (Registration number: CRD42018108590) and is freely available at: http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018108590 Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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