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   Table of Contents - Current issue
March-April 2022
Volume 12 | Issue 2
Page Nos. 133-265

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Meta-analysis on the effectiveness of xylitol in caries prevention p. 133
Jehan ALHumaid, Mohamed Bamashmous
Background: Oral xylitol products have been labeled as a caries preventive measure; however, their use is still limited. This study aims to summarize the evidence on the effectiveness of xylitol-containing products in dental caries prevention with a focus on dental caries as the primary outcome rather than other pseudo outcomes. Materials and Methods: A structured literature search was conducted to identify the studies related to the efficiency of products containing xylitol for the prevention of caries. The literature search was conducted through the following databases: Medline, PubMed (Central), SCOPUS, Web of Science (WoS), Open Grey, and the Cochrane Library and included papers published between 1966 and March 2020. Fixed- and random-effect models were used to obtain pooled estimates through meta-analysis. Results: Evidence-based results of this study showed that xylitol is easily available in the form of various products, but clinically tested products are few in markets. The literature review has also concluded that the most effective xylitol product in caries prevention was (100%) xylitol, chewed or consumed three to five times per day, after meals with a total dose of 5–10 g of xylitol per day. Products included xylitol-containing lozenges, candies, and chewing gum, foods based on xylitol, and xylitol-containing toothpaste and mouth rinse. Results showed that xylitol-containing products significantly prevented caries compared with the other (control) non-xylitol products. Pooled estimates using the combined fixed and random effects of standardized mean difference were −0.099 [95% confidence interval (CI): −0.149, −0.049] and −0.089 (95% CI: −2.04, 0.026), respectively. Conclusion: This review concluded that xylitol should be part of an overall strategy to decrease and prevent dental caries. Dosage and frequency should be considered strictly when prescribing xylitol as a caries preventive measure.
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Hydrophobicity of denture base resins: A systematic review and meta-analysis p. 139
Mohammed M Gad, Reem Abualsaud, Soban Q Khan
Objectives: The aim of this article is to review the factors that attract Candida albicans to denture base resin (DBR) and to verify the influence of different surface treatments, chemical modification, or structural reinforcements on the properties of DBR. Materials and Methods: Searches were carried out in PubMed, Scopus, WOS, Google Scholar, EMBASE, and J-stage databases. The search included articles between 1999 and 2020. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The keywords used during the search were “Candida albicans,” “Denture base,” “PMMA,” “Acrylic resin,” “Surface properties,” “hydrophobicity/hydrophilicity,” “contact angle,” and “surface free energy.” English full-text articles involving in-vitro studies with different acrylic resin modifications were included, whereas abstracts, dissertations, reviews, and articles in languages other than English were excluded. A meta-analysis was performed where appropriate. Results: Out of the 287 articles, 21 articles conformed to inclusion criteria. Sixteen articles were subjected to meta-analysis using random-effects model at 95% confidence interval. Results showed that DBR coatings/plasma coatings were effective methods to modify surface properties with estimated contact angle (CA) of 59.37° [95% confidence interval (CI): 53.69, 65.04]/55.87° (95% CI: 50.68, 61.06) and surface roughness (Ra) of 0.55 µm (95% CI: 0.52, 0.58)/0.549 µm (95% CI: 0.5, 0.59), respectively. Antifungal particle incorporation into poly(methylmethacrylate) DBR also produced similar effects with an estimated Ra of 0.16 µm (95% CI: 0.134, 0.187). Conclusion: The three properties responsible for C. albicans adhesion to DBR were Ra, CA, and surface free energy in terms of hydrophobicity. Therefore, the correlations between the hydrophobicity of DBR and C. albicans adhesion should be considered during future investigations for Candida-related denture stomatitis.
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Flexural strength of CAD/CAM denture base materials: Systematic review and meta-analysis of in-vitro studies p. 160
Reem Abualsaud, Mohammed M Gad
Introduction: Digital complete dentures fabrication techniques are expanding. This study aimed to review flexural strength (FS) of milled and 3D-printed denture base materials to answer the study question: is FS of computer-aided designing/computer-aided manufacturing (CAD/CAM) denture base comparable to conventional heat-polymerized materials?Materials and Methods: Search was done within different databases for articles published between January 2010 and June 2021 using specific keywords. Articles of in-vitro studies in English language with methods following International Standards Organization standardization/ADA specifications for flexural testing of conventional and CAD/CAM (milled or printed) polymethyl methacrylate (PMMA) materials were included. Results: Out of the 61 studies, 9 were processed for data extraction and only 7 underwent meta-analysis. Two, six, and one study showed high, moderate, and low risk of bias, respectively. Random-effects model was used for analysis and resulted in the average FS of 120.61 MPa [95% confidence interval (CI): 109.81−131.41] and 92.16 MPa (CI: 75.12−109.19) for CAD/CAM milled and heat-polymerized PMMA, respectively. Conclusion: Subtractive CAD/CAM technique of denture fabrication showed satisfactory FS values, whereas additive CAD/CAM method was comparable to conventional heat-polymerized technique with lower value, requiring further investigations and improvement. The clinical use of milled denture bases is an acceptable substitution to heat-polymerized PMMA, making the denture fabrication an easier and faster process.
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Anatomical variations of the anterior belly of the digastric muscle in Thai cadavers: A cross-sectional study p. 171
Tawepong Arayapisit, Chakorn Vorakulpipat, Natchalee Srimaneekarn, Anupong Songsaad, Varunya Chantadul
Aim: Because the digastric muscle is considered as an anatomical landmark, its variations may emphasize clinicians to be cautious during surgery. However, previous studies from different ethnicities reported a wide range of occurrence and several types of this muscle variation, pointing the necessity of the data from local population to better treatment decisions. Thus, this study aimed to explore the variations of the anterior belly of the digastric muscle in Thai cadavers. Materials and Methods: This cross-sectional study investigated the submental region of 91 cadavers by convenient sampling method. The characteristics of the variation in the anterior belly were recorded in accordance with sex and side of the cadavers. Multiple logistic regression was calculated for determining the association of occurrence of muscle variation with sexes and sides (α = 0.05). Results: Among 91 cadavers, the accessory bundles were observed in 16 cadavers (10 males and 6 females). The presence of the additional belly was sex and side independent. Three variation types were observed; the arrowhead type and the double-headed type have been previously reported, whereas the asymmetrical fan-shaped type is the new variant that has never been described before. Conclusions: The variation of the anterior belly of the digastric muscle including the new variant can be seen in Thais with low occurrence. To our knowledge, the present study is the first report of the aberrations of the digastric muscle in the Southeast Asian population. Therefore, our study provides the basis for anatomical study of muscular variants and helps surgeons plan the operation to prevent iatrogenic injuries.
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Predictability and accuracy of the Short-Form Fonseca Anamnestic Index in relation to the modified Helkimo Index for the diagnosis of temporomandibular disorders: A cross-sectional study p. 178
Enrique Yarasca-Berrocal, José Huamani-Echaccaya, Rita Tolmos-Valdivia, Luis Tolmos-Regal, Carlos López-Gurreonero, Luis A Cervantes-Ganoza, César F Cayo-Rojas
Aim: The aim of this study was to evaluate the predictability and accuracy of the Short-Form Fonseca Anamnestic Index (SFAI) in relation to the modified Helkimo Index for the diagnosis of temporomandibular disorders (TMDs). Materials and Methods: A cross-sectional, prospective, and analytical predictive study was conducted in 240 students of a public institute of higher technological education in Ica, Peru during the months of February to May 2018. The SFAI of 10 closed questions and the Helkimo Index modified by Maglione (gold standard) were used as instruments to diagnose TMDs. For the analysis of concordance between both instruments, Cohen’s Kappa Index was applied. To evaluate the association according to gender and age group, Pearson’s chi-square test was used. For validity of the SFAI in relation to accuracy, sensitivity and specificity were calculated, and they were verified by receiver operating characteristics (ROC) to determine the best cutoff points (area under the curve [AUC]) considering a P value < 0.05. Regarding the predictability of the SFAI, the positive and negative predictive value was calculated by applying Bayes’ theorem. Results: The SFAI was highly significantly associated with the modified Helkimo Index according to gender (P < 0.001), age group (P < 0.001), and overall (P < 0.001) moderate overall agreement (k = 0.416; 95% confidence interval [CI] = 0.287–0.545); better concordance was obtained in individuals older than 20 years (k = 0.490, CI = 0.302–0.679) and women (k = 0.565, CI = 0.371–0.759). The ROC curve analysis of the SFAI showed good accuracy (0.852, CI = 0.800–0.905) and was highly significant (P < 0.001), with an optimal cutoff point of 17.5 and good sensitivity (80.10%) and specificity (74.36%). In addition, a very good positive predictive value (PPV) (94.15%) and a fair negative predictive value (NPV) (42.02%) were obtained. Conclusions: Although there was moderate concordance between the SFAI and the modified Helkimo Index for the diagnosis of TMDs, the SFAI obtained good accuracy in the overall analysis of sensitivity and specificity. In addition, it demonstrated a high predictive efficacy for detecting positive TMD cases, whereas its ability to rule out positive cases was fair.
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Antimicrobial and anti-inflammatory effects of α-mangostin soluble film p. 189
Piyawat Tangsuksan, Teerapol Srichana, Matana Kettratad, Wipawee Nittayananta
Objectives: Plant-derived compounds are a major source of medicinal agents. Common oral diseases, including dental caries, periodontal disease, and candidiasis, are caused by biofilms. The nature of biofilm formations is complex, emphasizing the importance of finding novel products that possess bioactivity against microbes associated with those oral infections. The aims of this study were to determine the antimicrobial activity and antibiofilm formation of α-mangostin (α-MG) soluble film. Materials and Methods: Antimicrobial assays against Streptococcus mutans, Porphyromonas gingivalis, and Candida albicans were performed by identifying the minimal growth inhibition concentration and the minimal bactericidal concentration. Time-killing kinetic studies against the organisms and inhibition of biofilm formation were determined by the broth microdilution method. Human gingival fibroblast cell line and macrophage RAW267.4 cells were cultured, and the cell viability was assessed by the MTT assay. The anti-inflammatory effect of the α-MG film was investigated by measuring the inhibition of nitric oxide production. Results: The α-MG film demonstrated antimicrobial activity against the oral pathogens tested. The formulation reduced microbial growth about 1–3 Log CFU/mL at 2–4 h and complete killing at 24 h. No significant difference in inhibiting the biofilm formation of those three microorganisms was noted. In addition, the film containing α-MG demonstrated anti-inflammatory activity through the inhibition of nitric oxide production in a dose-dependent manner. The formulation was safe and showed no cytotoxicity at therapeutic dose. Conclusions: The α-MG film is effective against S. mutans, P. gingivalis, and C. albicans without significant cytotoxicity in vitro. Thus, this new product may have potential advantage in preventing those common oral infections.
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Influence of glass fiber post design and luting cements on ease of post removal and fracture strength of endodontically retreated teeth: An in vitro study p. 199
Prerna P Krishnarayan, Paras M Gehlot
Aims and Objectives: The aim of this study was to evaluate the time needed to remove two types of glass fiber posts cemented with two different cements and removed with two different techniques and to evaluate the fracture strength of teeth after post removal. Materials and Methods: Root canal treatment was completed in 80 extracted single-rooted premolars and the teeth were decoronated. Following canal preparation, the roots were coated with polysiloxane impression material and embedded in acrylic resin cubes. The specimens were randomly divided into eight experimental groups (n = 10) based on the type of fiber post inserted: Reforpost (R) or Contec Blanco (C); luting cement: Multilink-N/self-etch (M) or G-Cem/self-adhesive (G); technique of removal: Peeso reamer (P); or ultrasonic (U). The posts were removed with respective technique under magnification and the time (in seconds) of post removal was determined. Following post removal, the fracture strength of the specimens was determined using a universal testing machine. The mode of failure was also determined. Data were analyzed by three-way analysis of variance (ANOVA), one-way ANOVA, Tukey’s post hoc test, t test, and correlation. Chi-square analysis was performed to compare the failure mode. Statistical significance was set at P < 0.05. Results: The post and cement types had an influence in post removal time (P < 0.05). There was no role of post or cement types on the fracture strength of teeth after post removal with either technique (P > 0.05). A weak negative correlation was found between the post removal time and fracture resistance for both Peeso reamer (r = –0.373) and ultrasonic (r = –0.177) techniques. Both techniques of post removal produced a majority of favorable failures (P > 0.05). Conclusion: The type of post and luting cement plays a significant role in ease of post removal by Peeso reamer or ultrasonic technique. Post-removal technique had no effect on the fracture strength of teeth. Parallel serrated fiber post luted with self-etch resin cements was difficult to remove as compared with parallel smooth surface post luted with self-etch or self-adhesive resin cement.
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The implementation of PROMs/PREMs in the assessment of orthodontic treatment outcomes: A questionnaire survey p. 210
Peerapong Santiwong, Kanakorn Sommaluan, Sivakorn Mokkasak, Chutiphon Rachuratchata, Thara Rattanaopas, Kawin Sipiyaruk
Objectives: The aim of this study was to explore the impact of self-perceived treatment outcomes and experiences on psychological aspects, reflecting the importance of patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) in orthodontic practice. Materials and Methods: A questionnaire was constructed using the PROMs/PREMs concepts. It contained five parts: “Demographic data”, “Self-perceived esthetics”, “Self-perceived functional concern”, “Satisfaction of treatment procedures”, and “Psychological aspect”. The questionnaire was piloted in five experts and 50 orthodontic patients to ensure its quality, using content validity, test-retest reliability, and Cronbach’s alpha. The validated version was provided to patients who had a complete fixed appliance orthodontic treatment. These data were analyzed using descriptive statistics, Mann-Whitney U test, and Spearman correlation. In addition, a multiple linear regression was used to analyze whether there were any influential factors on a psychological aspect. Statistical significance was taken at P < 0.05. Results: A total of 271 respondents completed the questionnaire. They tended to have positive perceptions toward the outcomes of orthodontic treatment. There was a significant difference in self-perceived esthetics between the male and female groups. Self-perceived esthetic and functional concerns as well as satisfaction of treatment procedures were found to have significant correlations with the psychological aspect. Sex and self-perceived esthetics were also found to be significant predictors of the psychological aspect. Conclusion: PROMs/PREMs should be considered as an important tool to assess treatment outcomes in orthodontic practice. There appeared to be significant impact of self-perceived esthetics on psychological aspects. Consequently, PROMs and PREMs should be introduced in orthodontic postgraduate programs to enhance the concept of patient-centered care in orthodontic practice.
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Effect of fluoride recharge on the microleakage of fluoride-releasing restorative materials: An ex vivo confocal laser scanning microscopy study p. 216
Snigdha Gavini, Srihari Devalla, Pushpa Shankarappa, M Padmaja, Rishitha Tiriveedi, J Ramakrishna
Context: Success or failure of a restoration depends on its ability to bond to the tooth structure, to reduce microleakage, and to inhibit secondary caries. Fluoride-releasing materials have the inherent potential to release fluoride and are also capable of recharging themselves with topical agents. Aim: The aim of this study was to compare and evaluate the effect of fluoride recharge on microleakage of different restorative materials. Materials and Methods: Eighty extracted teeth were collected and split mesiodistally into 160 specimens. Class V cavities were prepared on buccal and lingual surfaces. Specimens were divided into four groups of 40 each based on the restorative material. Group I: Glass ionomer; Group II: Resin composite; Group III: Giomer; and Group IV: Alkasite. The restored teeth were stored in artificial saliva. Each group was divided into four subgroups for fluoride recharge and subsequent confocal laser scanning microscopy (CLSM) examination: (A) no fluoride recharge and CLSM examination after 24 h, (B) no fluoride recharge and CLSM examination after 3 weeks, (C) fluoride recharge once at third week followed by CLSM examination at 6 weeks, and (D) fluoride recharge twice at third week and sixth week followed by CLSM examination at 9 weeks. Statistical Analysis: Kruskal−Wallis and Mann−Whitney U tests were performed to analyze the obtained data. Results: A significant difference in microleakage was noted among resin composite and other groups except Cention-N, whereas no significant difference was noted pre- and post-fluoride recharge. Conclusion: Increased microleakage was noted post-fluoride recharge, although statistically not significant.
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Evaluation of YouTube videos as a source of information about oral self-examination to detect oral cancer and precancerous lesions p. 226
Nitin D Gulve, Pallavi R Tripathi, Sachinkumar D Dahivelkar, Meenal N Gulve, Reeya N Gulve, Swapnil J Kolhe
Objectives: The aim of this study was to investigate quality, reliability, and comprehensiveness of YouTube videos about oral self-examination to detect oral cancer and precancerous lesions and to assess whether the source, duration, quality, reliability, and/or comprehensiveness of videos influence their visibility and popularity. Materials and Methods: Videos on YouTube were searched using eight keywords similar to oral self-examination. The first 100 videos for each search term were included. Strict inclusion and exclusion criteria were adhered to, and videos were assessed for quality, reliability, and comprehensiveness. Upload date, views, likes, dislikes, duration, and source of the videos were noted. Viewing rate and interaction index were calculated for each video. Results: A total of 800 videos were analyzed, 24 of which met the inclusion criteria. Majority of videos (87%) were uploaded by the healthcare group. The visibility, quality, reliability, and comprehensiveness were higher in videos uploaded by the healthcare group when compared with the non-healthcare group, but not at a level of statistical significance. The mean interaction index score of the non-healthcare group was found to be higher than the healthcare group, with statistically significant difference. Duration of videos showed an impact on the comprehensiveness of the videos. Conclusion: There are relatively few videos on oral self-examination on YouTube, and most do not have satisfactory quality, reliability, and comprehensiveness. There is a potential to increase public awareness about oral self-examination by utilizing this tool. Videos with complete and accurate information regarding oral self-examination must be uploaded to YouTube, which is currently an important source of information for the general public.
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Comparison of cellular and differentiation characteristics of mesenchymal stem cells derived from human gingiva and periodontal ligament p. 235
Tarona A Subba, Sudhir Varma, Biju Thomas, Shama Rao, Mohana Kumar, Avaneendra Talwar, Keerthan Shashidhar
Objectives: Dental tissues possess multipotent stem cells with varying biological properties. The present study was aimed to establish a primary culture of human gingiva-derived mesenchymal stem cells (GMSCs) and periodontal ligament-derived stem cells (PDLSCs) from periodontally healthy subjects and compare their biological characteristics. Materials and Methods: Gingival and periodontal ligament (PDL) tissues were collected from extracted premolar teeth of five healthy subjects and primary cultures were established. Basic biological characteristics, such as cell morphology, viability, proliferation capacity, and colony-forming units, and in vitro osteogenic and adipogenic differentiation potential were performed at passage 3 of GMSCs and PDLSCs. This was followed by immuno-phenotyping and flow cytometric analysis for identification of positive mesenchymal stem cell (MSC) markers, such as CD73, CD90, and CD105, and negative markers CD45 and CD34. Statistical Analysis Used: One-way analysis of variance (ANOVA). Results: Primary cultures of GMSCs and PDLSCs were successfully established. Cells exhibited a fibroblast-like morphology with a homogeneous population at passage 3. Cells derived from both tissues were highly viable (>95%), proliferative, and capable of forming colonies. Both cells did not exhibit any noticeable differences in cellular properties. Immunofluorescence and flow cytometric analyses showed positivity for MSC markers, CD73, CD90, and CD105, and negativity for CD34 and CD45. Furthermore, GMSCs and PDLSCs were capable of differentiating in vitro into osteocytes as evidenced by Alizarin red-S staining, and adipocytes as demonstrated by oil red O staining. Conclusions: The results of the present study indicate that both GMSCs and PDLSCs have similar cellular characteristics and mesenchymal differentiation potential. Therefore, they may serve as an equally potent source of stem cells for use in cell-based periodontal therapies.
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Analysis of quality, usefulness, reliability, visibility, and popularity of videos about dental caries on YouTube: A cross-sectional analysis p. 245
Yuanita Lely Rachmawati, Devina Wardhani Putri, Ninuk Hariyani, Armasatra Bahar, Diah Ayu Maharani
Objectives: YouTube is the most popular social media and is widely used to access dental and oral diseases information. Nonetheless, the quality of online health information remains a problem. This study aimed to analyze the quality, usefulness, reliability, visibility, and popularity of YouTube videos about dental caries as a source of information. Materials and Methods: The study design was a cross-sectional analytical study. Here, 300 videos that were uploaded in September 2019–2020 were screened, and total duration, number of views, number of likes, number dislikes, uploader category (individual users or health professionals), and upload date of the videos were recorded. One hundred videos were analyzed in terms of their quality, usefulness, reliability, visibility, and popularity using the Global Quality Scale, usefulness score, DISCERN, viewing rate, and interaction index, respectively. Results: Videos were 78% uploaded by individual users. Videos uploaded by health professionals showed high scores in quality, usefulness, and reliability. Videos that were greater than 6 min long exhibited both better quality and higher popularity. Video with good-quality showed high visibility and popularity. In addition, videos with better usefulness and reliability showed high visibility; however, their popularity was low. Conclusions: Information about dental caries on YouTube is limited in quality. YouTube videos have a potentially important role in oral health education.
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The effect of toothpastes containing hydroxyapatite, fluoroapatite, and Zn-Mg-hydroxyapatite nanocrystals on dentin hypersensitivity: A randomized clinical trial p. 252
Maria Polyakova, Inna Sokhova, Vladlena Doroshina, Marianna Arakelyan, Nina Novozhilova, Ksenia Babina
Aims: The aim of this study was to compare the effect of toothpastes containing hydroxyapatite (nHAP), Zn-Mg-hydroxyapatite (nZnMgHAP), and fluorapatite (nFAP) nanocrystals on dentin hypersensitivity (DH) associated with noncarious cervical lesions. Materials and Methods: Thirty consenting volunteers aged 35−45 years with DH were enrolled in a double-blind, parallel study, randomly assigned to the nHAP group (n = 10), the nZnMgHAP group (n = 10), or the nFAP group (n = 10), and instructed to use the toothpaste twice daily for one month. The primary outcome was Schiff scores at baseline and after 2 and 4 weeks. Results: All patients fulfilled the study requirements, and no adverse effects were registered. A reduction in DH was registered in 90%, 100%, and 50% of patients using nHAP, nZnMgHAP, and nFAP-containing toothpastes with effect sizes 2.52 (confidence interval [CI] 95%: 0.82, 4.14), 3.30 (CI 95%: 1.33, 5.20), and 1.44 (CI 95%: 0.09, 2.72), respectively. At 4 weeks, Schiff index scores decreased significantly in all groups compared to baseline. Conclusions: nZnMgHAP may be considered a promising agent for DH management.
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Effect of duration of mobile phone use on the salivary flow and total antioxidant capacity of saliva and salivary immunoglobulin A level: A cross-sectional study p. 260
Divyansh Bansal, Yogesh Chhaparwal, Keerthilatha M Pai, Mathangi Kumar, Ravindranath Vineetha, Shubha Chhaparwal, Shobha Kamath, Asha Kamath
Introduction: The objective of this study was to observe the effects of the duration of handheld mobile phone usage on the salivary flow, salivary immunoglobulin A (IgA) level, and salivary markers for oxidative stress. Materials and Methods: Eighty-one students were categorized into three groups based on their duration of mobile phone usage after age- and gender-matching. Students were grouped as: mobile phone usage <20 min/day (Group A), mobile phone usage 20−60 min/day (Group B), and mobile phone usage >60 min/day (Group C). Saliva was collected to evaluate salivary flow rate, salivary IgA level, and salivary markers for oxidative stress. Results: The salivary flow rate showed no statistically significant difference between the three groups (P = 0.180). There was no statistically significant difference in the salivary IgA between the three groups (P = 0.237). There was a statistically significant difference in the malondialdehyde (MDA) level between the three groups (P = 0.042). On pair comparison between the groups, group B and group C had a statistically significant difference (P = 0.019) in the MDA level. There was no statistically significant difference in the salivary thiol level between the three groups (P = 0.237). Conclusion: The duration of handheld mobile phone usage did not show any significant effects on the salivary flow rate, salivary IgA, and thiol levels. There was an increase in the salivary MDA concentration in subjects using handheld mobile phones for a longer duration, indicating higher oxidative stress in salivary glands exposed to mobile phone radiofrequency electromagnetic waves for a longer duration.
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