Category: Statistics

J Indian Soc Pedod Prev Dent. 2026 Jul 1;44(4):446-454. doi: 10.4103/jisppd.jisppd_270_26. Epub 2026 Aug 25.

ABSTRACT

BACKGROUND: Dental anxiety is a significant barrier in pediatric dentistry, particularly in children with Frankel’s negative behavior ratings. Sedation through the intranasal route offers a rapid and noninvasive alternative with high bioavailability. Among various sedatives, the relative efficacy and acceptance of midazolam and dexmedetomidine in pediatric dental care remain underexplored. Hence, the purpose of the study was to compare the sedative effect, acceptance, and side effects of intranasal dexmedetomidine and intranasal midazolam in anxious children undergoing invasive dental procedures.

METHODOLOGY: A triple-blind, split-mouth, crossover randomized clinical trial was conducted on 40 children aged 4-10 years who required either bilateral pulpectomy or extraction. The study was conducted from September 2024 to October 2025. Participants received intranasal midazolam (0.3 mg/kg) and dexmedetomidine (3 mcg/kg) in separate appointments, with a 2-week washout period between them. Behavior was assessed using the Houpt behavioral rating scale, whereas drug acceptance and side effects were recorded using the al-Rakaf scale. Statistical analysis included the Wilcoxon signed-rank test and Friedman test, with P < 0.05 considered statistically significant.

RESULTS: Midazolam demonstrated significantly higher patient acceptance compared to dexmedetomidine. Behavior scores were significantly greater with midazolam across preoperative, intraoperative, and postoperative phases ( P < 0.002). Both agents showed minimal and nonsignificant differences in side effects, with occasional sneezing and nasal irritation observed. No serious adverse effects or carryover effects were noted.

CONCLUSION: Intranasal midazolam demonstrated relatively effectiveness in comparison to dexmedetomidine regarding patient acceptance and behavioral results, with both drugs having acceptable safety profiles.

PMID:42641098 | DOI:10.4103/jisppd.jisppd_270_26

J Indian Soc Pedod Prev Dent. 2026 Jul 1;44(4):434-439. doi: 10.4103/jisppd.jisppd_129_26. Epub 2026 Aug 25.

ABSTRACT

CONTEXT: Early and accurate differentiation between reversible and irreversible pulpitis is vital for appropriate treatment planning and prognosis in pediatric patients. Conventional sensibility tests are subjective and assess neural response rather than true pulpal vitality, which is determined by blood flow. Infrared thermography offers a noninvasive, contactless technique to measure surface temperature recovery, potentially reflecting pulpal vascular status.

AIMS: The study aimed to compare thermographic rewarming time between teeth with reversible pulpitis and healthy controls, irreversible pulpitis and healthy controls, and reversible and irreversible pulpitis using infrared thermography.

SETTINGS AND DESIGN: This was a cross-sectional, observational study conducted in the Department of Pediatric and Preventive Dentistry, Goa Dental College and Hospital.

METHODS: Thirty children with symptomatic permanent molars were included, contributing 60 teeth (30 test teeth and 30 control teeth). Diagnoses were established as per the American Association of Endodontists criteria. After cold stimulus with Endo Frost spray, rewarming time was recorded at intervals up to 120 s using the TOPDON TC001 infrared camera (thermal sensitivity <0.05°C, accuracy ±2°C, and resolution 256 × 192). Blinding of the operator and statistician was maintained throughout.

STATISTICAL ANALYSIS: Median (interquartile range) values were calculated and analyzed using the Wilcoxon signed-rank test and Mann-Whitney U -test.

RESULTS: Irreversible pulpitis cases showed a significantly prolonged rewarming time (90 s; P = 0.002) compared to controls. Rewarming time also significantly differed between reversible and irreversible cases ( P = 0.003).

CONCLUSIONS: Infrared thermography reliably demonstrated delayed rewarming in irreversible pulpitis, suggesting it is a promising adjunctive diagnostic tool for distinguishing pulpal inflammatory states.

PMID:42641097 | DOI:10.4103/jisppd.jisppd_129_26

J Indian Soc Pedod Prev Dent. 2026 Jul 1;44(4):423-433. doi: 10.4103/jisppd.jisppd_155_26. Epub 2026 Aug 25.

ABSTRACT

CONTEXT: Early childhood caries (ECC) is a multifactorial biofilm-mediated disease strongly associated with cariogenic microorganisms such as Streptococcus mutans and Lactobacillus acidophilus . Salivary alpha-amylase has recently been proposed as a biochemical marker reflecting caries activity. With the availability of pediatric dentifrices of varying fluoride concentrations and herbal compositions, comparative clinical evidence of caries incidence in children with ECC remains limited.

AIM: To evaluate and compare the effects of high-fluoridated, low-fluoridated, nonfluoridated, and herbal pediatric dentifrices on salivary S. mutans , L. acidophilus, and salivary alpha-amylase levels in children with ECC.

SETTINGS AND DESIGN: Prospective, randomized, double-blind, parallel-group clinical-microbiological trial.

MATERIALS AND METHODS: Fifty-six children with Severe ECC (decayed, missing, filled, treated (dmft) ≥4) were randomly allocated into four groups ( n = 14). Participants brushed twice daily with the assigned dentifrice for 15 days. Unstimulated saliva samples were collected at baseline and postintervention. Microbial counts were assessed using selective culture media, and alpha-amylase levels were analyzed by kinetic colorimetric assay. Brushing compliance was reinforced and monitored using a mobile health application. Statistical analysis was performed using one-way analysis of variance, Tukey’s post hoc test, paired t -test, and nonparametric equivalents where applicable. The level of significance was set at P < 0.05.

RESULTS: A significant reduction in S. mutans and L. acidophilus counts was observed in all groups postintervention ( P < 0.05). The high-fluoridated dentifrice group demonstrated the greatest percentage reduction in both microorganisms. Postintervention salivary alpha-amylase levels showed better modulation ( P = 0.030), with the lowest mean value in the high-fluoride group (109.43 ± 11.62 milliunits per milliliter [mU/mL]) and the highest in the nonfluoridated group (119.93 ± 7.33 mU/mL).

CONCLUSION: High-fluoridated pediatric dentifrice demonstrated superior antimicrobial efficacy in children with ECC. Salivary alpha-amylase may serve as a useful adjunctive biomarker in caries assessment.

PMID:42641096 | DOI:10.4103/jisppd.jisppd_155_26

J Indian Soc Pedod Prev Dent. 2026 Jul 1;44(4):417-422. doi: 10.4103/jisppd.jisppd_127_26. Epub 2026 Aug 25.

ABSTRACT

BACKGROUND: Growth and remodeling of the mandible during childhood results in dynamic changes in the position of key anatomical landmarks. Accurate localization of the mandibular foramen and mental foramen is essential for the successful administration of mandibular anesthesia and to minimize complications during oral and maxillofacial surgical procedures.

MATERIALS AND METHODS: This cross-sectional study included 120 patients aged 3-18 years who underwent cone-beam computed tomography (CBCT) for diagnostic purposes. Subjects were divided into three age groups: Group I (3-6 years), Group II (7-12 years), and Group III (13-18 years), with 40 subjects in each group. CBCT images were analyzed to determine the position of the mandibular foramen relative to the occlusal plane, and the vertical and horizontal location of the mental foramen. Variations in the mandibular canal (MC), including bifid canals, were also assessed. Descriptive statistics (mean, standard deviation, and percentages) were calculated. The Chi-square test was used to assess the association between age groups and the position of the mandibular foramen. One-way analysis of variance was applied to compare the continuous variables such as the vertical distance of the mental foramen across age groups. P < 0.05 was considered statistically significant.

RESULTS: The mandibular foramen was predominantly located below the occlusal plane in younger age groups and progressively shifted above the occlusal plane in older age groups, with a statistically significant association ( P < 0.001). The mean vertical distance of the mental foramen increased from 10.76 mm in Group I to 11.59 mm in Group III. A posterior shift in the horizontal position of the mental foramen was observed, from the region of the first premolar in younger subjects to the second premolar region in older subjects. Bifid MCs were identified in 21.66% of cases, most frequently in the 7-12 years age group. No statistically significant differences were observed with respect to gender or side ( P > 0.05).

CONCLUSION: The position of the mandibular foramen and mental foramen demonstrates significant age-related variation in the pediatric population. The mandibular foramen shows a progressive superior shift relative to the occlusal plane, while the mental foramen exhibits both vertical and posterior positional changes with growth. CBCT serves as a reliable imaging modality for accurate three-dimensional localization of these anatomical landmarks. These findings highlight the importance of age-specific considerations in anesthetic and surgical procedures, particularly in improving the success of inferior alveolar nerve block in children.

PMID:42641095 | DOI:10.4103/jisppd.jisppd_127_26

J Indian Soc Pedod Prev Dent. 2026 Jul 1;44(4):411-416. doi: 10.4103/jisppd.jisppd_371_26. Epub 2026 Aug 25.

ABSTRACT

CONTEXT: Chronological age is commonly used to predict mandibular foramen (MF) position, but its use is limited by variability in dental maturation. Nolla’s developmental stages may provide a more reliable guide for MF localization, potentially improving the success of Inferior Alveolar Nerve Block (IANB) in pediatric patients.

AIM: The aim of the study is to assess the association between the position of MF and Nolla’s developmental stages of mandibular permanent first and second molars in children aged 6-15 years using Orthopantomographs (OPGs).

MATERIALS AND METHODS: This cross-sectional study analyzed 255 OPGs of children aged 6–15 years. Bilateral MF depth relative to the deepest point of the coronoid notch and height relative to the mandibular occlusal plane were measured. Developmental stages of the mandibular permanent first and second molars were assessed using Nolla’s developmental staging (0-10). Statistical analyses were performed.

RESULTS: MF depth and height increased significantly with advancing Nolla’s developmental stages bilaterally of the mandibular permanent first and second molars ( P = 0.004; P < 0.001). Chronological age showed a significant but weak positive correlation with MF depth and height ( P < 0.001). No significant gender differences were observed in MF position ( P > 0.05). Significant bilateral differences were found in MF height ( P < 0.001).

CONCLUSION: MF position correlates significantly with developmental stages of the mandibular permanent first and second molars, offering a more reliable reference than chronological age. This may improve accuracy and success of IANB anesthesia in children.

PMID:42641094 | DOI:10.4103/jisppd.jisppd_371_26

J Indian Soc Pedod Prev Dent. 2026 Jul 1;44(4):405-410. doi: 10.4103/jisppd.jisppd_181_26. Epub 2026 Aug 25.

ABSTRACT

BACKGROUND: Molar-incisor hypomineralization (MIH) is a common developmental enamel defect affecting first permanent molars and often permanent incisors in children. Dermatoglyphics, the study of fingerprint patterns, has been associated with various dental and systemic conditions and may serve as a noninvasive marker for early identification of MIH.

AIM: To assess the association of MIH with dermatoglyphic patterns and related factors in children.

MATERIALS AND METHODS: A cross-sectional study was conducted among 92 children aged 6-12 years, divided into MIH ( n = 46) and non-MIH ( n = 46) groups. Dermatoglyphic patterns were recorded using a digital scanner. Socioeconomic status and familial history were obtained via questionnaire. Salivary pH and flow rate were assessed. Statistical analysis was performed using appropriate tests (e.g., Chi-square and t -test).

RESULTS: The MIH group showed a significantly higher salivary flow rate ( P < 0.05). Salivary pH was higher in the non-MIH group, but the difference was not statistically significant ( P > 0.05). A statistically significant association was observed in the loop pattern of the left thumb ( P < 0.05), whereas no significant difference was found in the right thumb ( P > 0.05).

CONCLUSION: Dermatoglyphic analysis may serve as a simple, noninvasive adjunct for early identification of children at risk of MIH; however, further studies are required to confirm its predictive value.

PMID:42641093 | DOI:10.4103/jisppd.jisppd_181_26

J Indian Soc Pedod Prev Dent. 2026 Jul 1;44(4):399-404. doi: 10.4103/jisppd.jisppd_210_26. Epub 2026 Aug 25.

ABSTRACT

CONTEXT: The FAirEST-15 is a comprehensive 15-item clinical screening tool for pediatric sleep-disordered breathing (SDB). Although its domain structure has been previously established, the existing non-uniform scoring system-comprising both 3-point and 4-point items-limits score comparability and reduces statistical sensitivity.

AIM: To standardize the FAirEST-15 by converting all clinical items into a uniform 4-point Likert scale based on graded severity.

METHODS: A methodological refinement study was conducted using an expert consensus approach. Each of the 15 items was redefined to incorporate a four-level severity gradient: Grade 1 (Normal/Ideal), Grade 2 (Mild deviation), Grade 3 (Moderate deviation), and Grade 4 (Severe deviation). Content validity was reassessed following scale expansion to ensure clarity and clinical relevance.

RESULTS: A standardized scoring framework was developed, yielding a total score range of 15-60. The revised structure enables the calculation of domain-specific scores and enhances the tool’s ability to discriminate between varying levels of clinical risk, particularly in borderline cases.

CONCLUSION: Standardization of the FAirEST-15 into a uniform 4-point Likert scale improves its psychometric robustness and clinical applicability. The refined tool facilitates more precise risk stratification for pediatric SDB in both dental and otolaryngological settings.

KEY MESSAGES: Standardization of the FAirEST-15 into a uniform 4-point Likert scale improves scoring consistency, sensitivity, and clinical applicability in pediatric sleep-disordered breathing screening.

PMID:42641092 | DOI:10.4103/jisppd.jisppd_210_26

J Indian Soc Pedod Prev Dent. 2026 Jul 1;44(4):392-398. doi: 10.4103/jisppd.jisppd_203_26. Epub 2026 Aug 25.

ABSTRACT

PURPOSE: To compare the diagnostic accuracy and public health utility of Gemini 2.5 Flash and GPT-4 for early childhood caries (ECC) risk triage in classifying presentations as high risk (warranting immediate referral) or low risk (amenable to preventive counseling).

MATERIALS AND METHODS: A standardized dataset of 50 clinical vignettes (25 high risk and 25 low risk) was evaluated against both large language models via official application programming interfaces using a blinded, prospective comparative design (CONSORT-AI; TRIPOD+AI). This constitutes a vignette-based internal validation study and does not represent a clinical diagnostic accuracy study. Ground truth was established by two consultant pediatric dentists (intraclass correlation coefficient = 0.92). Performance was quantified using sensitivity, specificity, positive predictive value, negative predictive value, and false negative rate (FNR). Readability, actionability, and multilingual competence in Hindi and Tamil were additionally assessed.

RESULTS: Both models exceeded the 80% accuracy threshold. GPT-4 achieved significantly higher sensitivity (92.0% vs. 80.0%; P = 0.032) and a lower FNR (8.0% vs. 20.0%), with superior readability (Flesch-Kincaid Grade Level 5.9 vs. 8.1), actionability (4.8 vs. 4.2), and cross-lingual consistency. Both models achieved 100% safety disclaimer compliance in English.

CONCLUSIONS: GPT-4 demonstrates a statistically superior safety profile for ECC risk triage. As a Level 1 adjunct, it can assist pediatric dentists by prescreening caregiver-reported presentations, reducing diagnosis lag, and directing specialist capacity toward confirmed high-risk pathology without replacing clinical judgment.

CLINICAL RELEVANCE: This study establishes that GPT-4 is a safer and more accessible AI triage tool than Gemini 2.5 Flash for pediatric dental screening, particularly in linguistically diverse, resource-constrained settings where specialist access is limited.

PMID:42641091 | DOI:10.4103/jisppd.jisppd_203_26

Nurs Open. 2026 Aug;13(8):e70741. doi: 10.1002/nop2.70741.

ABSTRACT

AIMS: Pain is common and challenging to assess in the paediatric intensive care unit (PICU), highlighting the need for targeted training. We previously developed PainScan, a visualization-based training platform and aimed to investigate the efficacy of PainScan in improving PICU nurses’ pain assessment competencies and to describe their learning experience with PainScan.

DESIGN: This study employed a mixed-methods design, integrating a superiority, randomized parallel controlled trial with embedded qualitative research. The RCT component of this study was prospectively registered at ClinicalTrials.gov (NCT06431802) prior to participant enrollment.

METHODS: Eligible PICU nurses from a tertiary children’s hospital in Shanghai, China, took part in the trial. 70 PICU nurses were recruited and randomly assigned to either the PainScan training group or the on-site training group using stratified randomization, with 35 individuals in each group, over 4 weeks. Primary outcomes were PICU nurses’ knowledge and skill levels in pain assessment. Outcome assessors were blinded to group allocation. Following the training, a descriptive qualitative study was conducted using semi-structured interviews with 11 PICU nurses, who had participated in PainScan training, to gain insights into their learning experience.

RESULTS: A total of 69 participants (35 in the PainScan group, 34 in the on-site training group) were included in the primary outcome analysis, as one participant (1.4%) in the on-site training group withdrew due to a rotation change. Both PainScan training and on-site training significantly improved PICU nurses’ knowledge (PainScan: t = 10.249, on-site: t = 10.592, both p < 0.001) and skill levels in pain assessment (PainScan: Z = -5.138, on-site: Z = -4.847, both p < 0.001). Compared to traditional on-site training, the PainScan showed superior skill development (Z = -3.644, p < 0.001). Qualitative findings revealed that the platform: (1) competency enhancement in pain assessment through PainScan training; (2) advantages of the digital learning platform; and (3) limitations of the PainScan training.

CONCLUSION: PainScan effectively enhanced PICU nurses’ pain assessment competencies. It also enriched their learning experience through a realistic, immersive and flexible approach. However, improvements are needed in supervision, engagement and scalability.

REPORTING METHODS: The randomized controlled trial was reported according to CONSORT 2025, and the qualitative component was reported following COREQ.

PATIENT OR PUBLIC CONTRIBUTION: This study shows that PainScan is a practical and cost-effective training tool for PICU nurses. It can enhance pain assessment skills with flexible learning. Addressing feedback on supervision and engagement could further optimize its use in clinical practice to improve patient care.

PMID:42641083 | DOI:10.1002/nop2.70741

Lang Speech Hear Serv Sch. 2026 Aug 25:1-18. doi: 10.1044/2026_LSHSS-25-00248. Online ahead of print.

ABSTRACT

PURPOSE: Developmental language disorder (DLD) is linked to long-term academic and social difficulties. Despite these lasting impacts, state-level prevalence estimates are limited. This study estimated prevalence among early-elementary students in West Virginia who may be at risk for DLD and examined variation by grade, locale, and assessment instrument.

METHOD: A cross-sectional screening battery was administered to 252 students in Grades 1-2 across six Title I schools. Children with Kaufman Brief Intelligence Test-Second Edition Matrices standard scores ≤ 70 were excluded prior to analysis. A dual-criterion definition of DLD risk was used: ≤ 80 on the Clinical Evaluation of Language Fundamentals-Fifth Edition (CELF-5) core composite and ≤ 92 on the Test of Narrative Language-Second Edition (TNL-2). Descriptive statistics and mixed-effects logistic regression (random intercept for school) tested effects of grade, gender, and locale.

RESULTS: Using the dual-criterion definition, 72 of 252 students (28.6%) met criteria for being at risk for DLD. Adjusted models showed higher odds of DLD risk in town versus urban schools (odds ratio = 3.06, 95% confidence interval [1.31, 7.15], p = .010), whereas grade and gender were not significant predictors after accounting for school-level clustering. Instrument-specific classification rates diverged substantially, with the TNL-2 identifying a higher proportion of students relative to the CELF-5.

CONCLUSIONS: Although based on a relatively small yet representative sample of West Virginia students, prevalence estimates substantially exceed commonly cited large-scale population estimates. Results underscore the influence of instrument choice on suspected prevalence and the need for locally calibrated screening protocols and targeted service planning.

PMID:42641081 | DOI:10.1044/2026_LSHSS-25-00248