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   2019| September-October  | Volume 9 | Issue 5  
    Online since September 30, 2019

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Temporomandibular disorder among women who experienced posttraumatic stress disorder after a miscarriage
Sarah Samer Abu-Raisi, Shikha A Ibrahim, Manal A Ajina, Esraa A Ibrahim, Afnan Y Almulhim, Maryam A Aljalal, Zainab S Almajed
September-October 2019, 9(5):445-452
DOI:10.4103/jispcd.JISPCD_394_18  PMID:31620376
Objectives: This study intended to understand the risk of developing temporomandibular disorder among Saudi women who experienced a miscarriage. Materials and Methods: Two hundred and eight Saudi women from several hospitals’ gynecologic clinics in two areas in Saudi Arabia were screened to fill out the Impact of Events Scale-Revised (self-reporting questionnaire) Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnostic criteria for posttraumatic stress disorder and a structured temporomandibular joint disorder (TMD) Questionnaire (Research Diagnostic Criteria for Temporomandibular Disorders). A single examiner did the clinical examination for temporomandibular joint (TMJ). One-hundred and fifty-eight of the participants were divided into two groups. Group A (85 participants) included females who had had a previous miscarriage, whereas Group B (73 participants) included females who had not had a miscarriage. IBM SPSS version 22.0 was used to conduct a nonparametric Chi-square test to find the significance of any observed differences. Results: Almost 40% of the participants had symptoms that qualified for possible TMD. Around 73% of the miscarried Saudi women in Group A showed symptoms of TMD. Furthermore, approximately 38% of the participants in Group B developed significant symptoms of TMD. The Chi-square test (Chi-test = 22.03 with P = 0.0001) shows highly significant association between treatment groups (control and study) and temporomandibular joint disorder group and non temporomandibular joint disorder group. Conclusion: Women who suffer from spontaneous single or recurrent miscarriages are advised to seek a dental specialist for diagnosis and prevention devices such as a night guard.
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Evaluation of effect of dietary solvents on bond strength of compomer, ormocer, nanocomposite and activa bioactive restorative materials
Sanjit Kumar Sahoo, Ganesh R Meshram, Anuj Singh Parihar, Deepti Pitalia, Hemjith Vasudevan, Ashish Surana
September-October 2019, 9(5):453-457
DOI:10.4103/jispcd.JISPCD_47_19  PMID:31620377
Aims and Objectives: The successful endodontic therapy is judged by ability of tooth to withstand masticatory forces. The present study focused on comparing the strength of restorative materials, i.e., compomer, ormocer, nanocomposite, and ACTIVA Bioactive after conditioning in dietary solvents. Materials and Methods: This in vitro study consisted of 26 specimens of each restorative material Compomer (F2000 3M ESPE), Nanocomposite (Filtek Z350XT), Ormocer (Admira VOCO), and ACTIVA Bioactive (Pulpdent). The I-shear–punch test was conducted with the help of custom-designed shear–punch apparatus in Universal Testing Machine in different dietary solvents. Results were statistically analyzed using IBM SPSS Statistics for Windows, Version 20.0. (IBM Corp., Armonk, NY) and using Tukey’s test and one-way analysis of variance test at P < 0.5. Results: Ormocer conditioned in heptanes had the highest mean shear–punch strength. ACTIVA Bioactive conditioned in distilled water showed the highest mean shear–punch strength. There was a significant difference in bond strength among all restorative materials (P < 0.05). Conclusion: Ormocer conditioned in heptane had significantly higher shear strength. ACTIVA Bioactive conditioned in distilled water had significantly increased shear strength. The nanofilled composite was significantly stronger than the Ormocer, ACTIVA Bioactive, and Compomer – a polyacid-modified composite.
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Cone beam computed tomography analysis of root and root canal morphology of first permanent lower molars in a Middle East subpopulation
Saaid Al Shehadat, Saad Waheb, Saad Wahbi Al Bayatti, Waad Kheder, Khaled Khalaf, Colin A Murray
September-October 2019, 9(5):458-463
DOI:10.4103/jispcd.JISPCD_41_19  PMID:31620378
Aim: The aim of this study was to investigate variations in the number of roots and root canals in first permanent lower molars (FPLMs) using cone beam computed tomography (CBCT). Materials and Methods: A total of 640 CBCT images were analyzed using SIDEXIS XG software version 2.62 (Sirona Dental Systems, Bensheim, Germany). The entire root anatomy of FPLMs was investigated in three dimensions and the number of roots, root canals, and the number of canals per root were recorded. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) software, version 24, (IBM Corporation, USA) to determine the relationship between root anatomy and gender, age, or tooth location (right or left side). Results: The majority of FPLMs had two roots (96%), whereas the remaining 32 FPLMs (4%) had three roots. Almost two-thirds of the sample (62.7%) had three root canals, whereas only three cases (0.4%) of the FPLMs had six canals. When comparing bilateral differences in the distribution of root canals, it was determined that a quarter of FPLMs (24.1%) had an unequal number of canals. Moreover, there were differences in the number of additional canals between the mesial and distal roots with 17.5% of the former having three canals as compared with only 0.5% of the distal root. Interestingly, not more than one canal was observed in all additional root cases. No significant differences were observed in the number of canals between males and females or between right and left sides of the examined FPLMs (P > 0.05). Conclusion: Dental clinicians should be aware of the presence of an additional root in 4% of FPLMs, and about a quarter of the cases (27%) had an extra middle mesial canal in the mesial root, which was found to be more prevalent in middle age groups.
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Psychometric analysis of the european medical risk-related history questionnaire within Indonesian-speaking population
Yuniardini Septorini Wimardhani, Anzany Tania Dwi Putri Baringbing, Gus Permana Subita, Luzi Abraham-Inpijn
September-October 2019, 9(5):464-469
DOI:10.4103/jispcd.JISPCD_24_19  PMID:31620379
Objectives: Medical complications during dental treatment are increasingly anticipated because advances in medical treatment have prolonged life expectancy. Therefore, a thorough analysis of medical history data to assess the medical risks that may occur before, during, and after dental procedures is required. The European Medical Risk-Related History (EMRRH) questionnaire has been used in 10 European countries to detect medical problems and determine the risks of complications. However, no similar questionnaire has been developed for Indonesian patients. This study aimed to develop an Indonesian version of the EMRRH questionnaire and analyze its psychometric properties. Materials and Methods: The EMRRH questionnaire was utilized and processed for cross-cultural adaptation according to the Beaton guidelines. The final version was used after completing all of the steps of cross-cultural adaptation. The psychometric property analysis was performed by measuring the validity, reliability, sensitivity, and specificity of the questionnaire in 172 dental patients using cross-sectional survey at the National Drug Rehabilitation Center. Results: The content validity was first measured by an internist and anesthesiologist, and the coefficient was 0.91. The construct validity assessment revealed significant associations for five of six global questions (P < 0.05). Cronbach’s alpha coefficient for internal consistency was 0.790. The test–retest reliability results were excellent based on reevaluation in 17 patients (intraclass correlation coefficient = 0.846), including sensitivity and specificity values of 69.31% and 92.2%, respectively. Conclusion: The Indonesian version of the EMRRH questionnaire is valid, reliable, sensitive, and specific for this population. Further study to explore its use in larger Indonesian populations is needed.
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Oral health knowledge, perceptions, and habits of adolescents from Portugal, Romania, and Sweden: A comparative study
Sandra R Graça, Teresa S Albuquerque, Henrique S Luis, Victor A Assunção, Sebastian Malmqvist, Marian Cuculescu, Oana Slusanschi, Gunnar Johannsen, Atena Galuscan, Angela C Podariu, Annsofi Johannsen
September-October 2019, 9(5):470-480
DOI:10.4103/jispcd.JISPCD_194_19  PMID:31620380
Aims: The study aimed to assess and compare the self-reported oral health knowledge, habits, and perceptions of adolescents in Portugal, Romania, and Sweden and the factors that may affect them. Materials and Methods: An oral health questionnaire with 25 questions was put together in English language and translated into Portuguese, Romanian, and Swedish language to investigate and compare oral health-related knowledge, habits, and perceptions of adolescents from the different countries. A voluntary sample of 879 teenagers completed it, mean aged 14.9 (±1.83) years, from Romania (n = 455), Portugal (n = 200), and Sweden (n = 224) as part of the EuHyDens project. The survey took place between November 2015 and June 2016. Results: It showed some differences between the countries studied but more similarities between Portuguese and Romanian adolescents as related to perceptions of oral health and the use of oral services. Sweden and Portugal are more similar regarding oral health habits (toothbrushing and diet) as compared to Romanian adolescents. Portuguese adolescents have a higher oral health-related knowledge. Conclusion: Assessment of knowledge, perceptions, and habits of a population is essential for the adequate understanding of the oral health-care needs of the society. From the data collected, several differences were found. These differences can be used for tailor interventions to minimize inequalities between countries.
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An in vitro comparative evaluation of volume of removed dentin, canal transportation, and centering ratio of 2Shape, WaveOne Gold, and ProTaper Gold files using cone-beam computed tomography
Shalini Singh, Muqthadir Siddiqui Mohammed Abdul, Utsav Sharma, Shan Sainudeen, Chayan Jain, Jacob Tony Kalliath
September-October 2019, 9(5):481-485
DOI:10.4103/jispcd.JISPCD_444_18  PMID:31620381
Objectives: The aim of this study was to compare the shaping ability of three file systems – 2Shape (2S), WaveOne Gold (WOG), and ProTaper Gold – using cone-beam computed tomography (CBCT). Materials and  Methods: Fortyfive freshly extracted mandibular teeth were chosen and instrumented using the following brands of NiTi files: 2S, WOG, and ProTaper Gold. Pre- and postinstrumentation CBCT imaging was performed to measure mesial and distal distance of the dentin walls and calculate the volume of removed dentin, apical transportation, and centering ratio. A statistical analysis of the data was performed using independent ttest. Statistical significance was set at 5%. Results: There were no significant differences between the 2S and WOG in terms of the total volume of removed dentin, apical transportation, and centering ratio, whereas ProTaper showed a greater significant difference when compared to 2S and WOG. Conclusion: Both 2S and WOG maintained the original canal anatomy better and did not remove excess dentin while chemomechanical preparation as compared to ProTaper Gold. Instruments that use rotary movement achieved an effect similar to that of the reciprocating instruments in relation to change in angle. 2S which is a two-file system and WOG which is a single-file system might perform better clinically and might show enhanced shaping ability with less canal transportation and more centered preparation when compared to ProTaper Gold that is a multiple file-system.
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DNA laddering to evaluate cytogenetic damage in patients with periodontitis
Baddam Harshitha, Bopparaju Subhada, Mohammed Mustafa, Hemlata Solanki, Nabeel Althaf Mammootty Safiya, Rahul Vinay Chandra Tiwari
September-October 2019, 9(5):486-491
DOI:10.4103/0972-9941.268330  PMID:31620382
Background: Inflammatory conditions show cytogenetic damage in peripheral blood leukocytes and this can be assessed using various tests. Cytogenetic damage as observed in the peripheral blood cells, is a marker of periodontal disease. DNA laddering is a sensitive assay which evaluates the cytogenetic damage. DNA laddering is a feature that can be observed when DNA fragments, resulting from apoptotic DNA fragmentation, are visualised after separation by gel electrophoresis which results in a characteristic “ladder” pattern. Aim: The aim of the present study is to investigate the cytogenetic damage in different forms of periodontitis in comparison with healthy controls. Materials and Methods: In this cross-sectional study, 15 systemically healthy subjects with moderate to severe chronic periodontitis (CGP), 15 systemically healthy subjects with generalised aggressive periodontitis(GAP) and 15 systemically healthy control subjects were recruited. Blood samples of the patients were drawn and evaluated for the cytogenetic damage by DNA laddering. Results: Apoptotic DNA fragmentation was observed as a “ladder” pattern at 180-200 BP intervals in both CGP and GAP groups indicating the DNA damage, in contrast with the healthy group where the ladder pattern was not observed suggesting of the healthy DNA. Conclusion: The results indicated that there are cytogenetic damages in both the chronic and aggressive periodontitis groups incontrast to the healthy controls.
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Effect of distinctive moisture conditions on push-out bond strength of three root canal sealers––An in-vitro study
Ishita Kapur, Aayush Malhotra, Sameer Makkar, Gayatri Galyan, Mamit Kumar, Anurag Aggarwal
September-October 2019, 9(5):492-498
DOI:10.4103/jispcd.JISPCD_240_19  PMID:31620383
Objective: Endodontic sealer should adhere to both dentin and the core filling material but the moisture conditions of the canals affect the adhesive properties of the sealer. An ideal sealer with perfect moisture conditions will lead to greater strength of the restored tooth, which may provide greater resistance to tooth fracture and clinical longevity of an endodontically treated tooth. The aim of this study was to evaluate the effect of moisture conditions on the push-out bond strength of three root canal sealers: AH Plus® (Dentsply-Tulsa Dental, Tulsa, OK), Epiphany (Pentron Clinical Technologies, Wallingford, CT), and GuttaFlow (Coltene/Whaledent, Altstatten, Switzerland). Materials and Methods: A total of 120 single-rooted, non-carious teeth were collected for the study and were stored in normal saline. The root canals were prepared using step-back technique. Teeth were divided into four groups based on type of drying procedure used and further subdivided into three subgroups based on the type of sealer used. The samples were cut horizontally to produce slices and then tested for push-out bond strength using Universal Testing Machine (Servo Series 50kN; P S I Sales Private Limited, New Delhi, India). The specimens were examined for mode of fracture under magnification and the results were analyzed statistically. Results: Distinctive moisture conditions for all sealers were observed and the highest strength of AH Plus® was evaluated under moist condition, Epiphany under dry condition, and GuttaFlow under normal condition, respectively. Conclusion: Distinctive moisture conditions affect the push-out bond strength of the sealers.
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Perception of buccal corridor space on smile aesthetics among specialty dentist and layperson
Sweta K Pisulkar, Ruchi Agrawal, Vikram Belkhode, Sharayu Nimonkar, Anjali Borle, Surekha R Godbole
September-October 2019, 9(5):499-504
DOI:10.4103/jispcd.JISPCD_2_19  PMID:31620384
Objectives: The aim of this study was to assess and compare the perception of smiles with and without buccal corridor spaces (BCSs) among prosthodontists, orthodontists and laypersons on smile aesthetics. Materials and Methods: Smiling photographs of subjects with wide BCSs were collected and digitally manipulated to eliminate the BCSs. Digitally altered and unaltered photographs were placed together and assessed for aesthetic appeal using visual analog scale of one to ten by prosthodontists, orthodontists, and laypersons. One-way analysis of variance (ANOVA) and two-way ANOVA were applied to evaluate the collected data using the Statistical Package for the Social Sciences (SPSS 22), Epi Info 6.0, and GraphPad Prism, version 6.0. Results: The total mean value scores of smiles with BCSs were significantly higher than those of smiles without BCSs (P < 0.001). Orthodontists and prosthodontists significantly appreciated BCSs and graded the smiles with BCSs to be much more attractive (P > 0.005). Laypersons rated the smiles with BCSs with greater mean values, but the difference in mean values of smiles with and without BCSs was not significant (P < 0.005). No significant difference was found between the perceptions of prosthodontists and orthodontists. Conclusion: The results of this study reveal that the smiles with BCSs were notably more desirable than the smiles without BCSs. Laypersons, orthodontists, and prosthodontists evaluated smiles differently. The smiles with BCSs were appraised much more pleasing by prosthodontists and orthodontists. Laypersons could not significantly appreciate BCSs, but rated smiles with BCSs as more acceptable.
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Evaluation Distal caries of the second molars in the presence of third molars among Saudi patients
Sultan Q AlHobail, Mohammad A Baseer, Navin A Ingle, Mansour K Assery, Jamal A AlSanea, Osamah M AlMugeiren
September-October 2019, 9(5):505-512
DOI:10.4103/jispcd.JISPCD_19_19  PMID:31620385
Objectives: To evaluate the prevalence of distal caries in second permanent molars in the presence of third molar among patients attending university dental clinics in Riyadh City, Kingdom of Saudi Arabia. Materials and Methods: Clinical and radiographic data (orthopantomographs and right and left bite wings) from 313 patients attending Riyadh Elm University dental clinics, department of oral diagnosis were collected and analyzed for the presence of third molars and caries on the distal surface of the second molar. Descriptive statistics of frequency distribution, mean and standard deviation, and binary logistic regression analysis were applied to assess the association between distal surface caries on second molars and impaction status of the teeth. Results: The mean decayed, missing, and filled teeth score of the study participants was found to be very high, that is, 23. The prevalence of caries affecting the distal aspect of the second molar was 48.6% (n = 609) in the population. The prevalence of distal caries was significantly high in patients with fully erupted wisdom teeth followed by vertical, horizontal, and mesial impacted third molars (P < 0.05). Wisdom teeth with mesioangular, vertical, and horizontal impactions showed significant association with distal caries of second molars below the contact point, whereas, fully erupted and vertically impacted wisdom teeth showed significant association with distal surface caries of second molars above contact point. Similarly, vertically impacted wisdom teeth were found to have significant association with caries of distal surface of second molars on noncontact areas (P < 0.05). Conclusion: This study showed that the distal surface of the second molars is at risk of caries in the presence of third molars. However, this risk depends on eruption status, type of angulation, and contact between third and second molars. All the preventive measures should be taken to avoid caries on distal surface of second molar.
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Prevalence and severity of molar–incisor hypomineralization, maternal education, and dental caries: A cross-sectional study of Mexican schoolchildren with low socioeconomic status
Teresa Villanueva-Gutiérrez, Maria Esther Irigoyen-Camacho, Antonio Castaño-Seiquier, Marco Antonio Zepeda-Zepeda, Leonor Sanchez-Pérez, Nelly Molina Frechero
September-October 2019, 9(5):513-521
DOI:10.4103/jispcd.JISPCD_130_19  PMID:31620386
Objectives: The aims of this study were to identify the prevalence of molar–incisor hypomineralization (MIH) in a group of low-income schoolchildren and to evaluate the role of maternal education on MIH and dental caries in these children. Materials and Methods: This cross-sectional study enrolled 686 schoolchildren. To evaluate dental caries, the International Caries Dental Assessment System II (ICDAS) criteria were utilized. MIH was assessed by using the European Academy of Paediatric Dentistry criteria. Mixed-effects models were applied for the data analysis. Results: The prevalence of MIH was 35.4% (244). Most children exhibited moderate MIH (163, 67.1%), followed by mild MIH (45, 18.5%) and severe MIH (35, 14.4%). Caries presence in the first permanent molars, evaluated using ICDAS score, indicated that the mean number of noncavitated and cavitated lesions (ICDAS ≥2) was 0.90 (±0.30); the mean number of lesions with ICDAS ≥3 was 0.36 (±0.48). Odds ratio (OR) analysis of MIH severity revealed that the children of mothers with low education were more likely to exhibit MIH (OR 2.13; 95% confidence interval [CI]: 1.25–3.85). Modeling of dental caries (ICDAS ≥3) revealed that low maternal education (OR 2.27; 95% CI: 1.25–4.16) and the presence of MIH (OR 4.37; 95% CI: 3.05–6.25) were associated with dental caries. Conclusions: There were associations between low maternal education and both MIH and dental caries. The presence of both initial and cavitated caries lesions was associated with MIH. Dentists should offer adequate advice to mothers with children with MIH, based on their educational background.
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Bond strength and fracture resistance of flowable bulk fill composite posts and cores in endodontically treated teeth
Khoa V Pham, Trang T T Huynh
September-October 2019, 9(5):522-526
DOI:10.4103/jispcd.JISPCD_187_19  PMID:31620387
Objectives: Smart dentin replacement (SDR) is a new flowable bulk fill composite with many useful characteristics such as low viscosity and higher depth of cure. This study aimed to evaluate the bond strength and fracture resistance of flowable bulk fill composite posts and cores versus that of fiber posts and cores. Materials and Methods: Forty intact, extracted human maxillary central incisor roots were endodontically treated. Group A (n = 20) was prepared for the composite space and group B (n = 20) was prepared for the fiber post space. Group A and B were divided into two subgroups A1 and A2 and B1 and B2, respectively (10 roots for each subgroup). Root canal spaces of group A1 were filled with SDR composite, X-Post fiber post with Core X Flow composite was inserted into the root canal spaces of group B1. Group A2 was restored using SDR and group B2 was restored using post and core composite. Five hundred thermocycles were applied for the sample. Bond strength values were measured for segments in A1 and B1. Fracture force values were measured for specimens of A2 and B2. Results: No significant difference was observed between the two paired groups (A1 and B1) and (A2 and B2) in bond strength and fracture force values. Conclusion: SDR could be used for restoring endodontically treated teeth.
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Ethics in children’s dental treatment under general anesthesia at the Lebanese University
Nahla F Nassif
September-October 2019, 9(5):527-533
DOI:10.4103/jispcd.JISPCD_232_19  PMID:31620388
Background: In pediatric dentistry, general anesthesia is required for dental treatment. The treatment modalities are often linked to the patient’s medical conditions. However, ethical values might influence the decisions of the treatment. Aims: To compare the treatment modalities under general anesthesia between healthy children and children with special needs (CSN) and to assess the ethical principles. Materials and Methods: An analytical retrospective study, approximately 64 patients including 26 CSN and 38 healthy children from 3 to 12 years of age, who underwent general anesthesia (GA) for dental treatment, was performed. The treatment modalities for each tooth were noted, such as fissure sealant, composite, pulp treatment, stainless steel crowns restorations, and extraction. Statistical analysis was performed to evaluate the implementation of the four principles of ethics. Statistical analyses were performed with the Statistical Package for the Social Sciences (SPSS), version 20, (Los Angeles, California), with 95% confidence interval of the difference. The significance level was set at P < 0.05 valued. Results: A total of 40.6% of the sample were CSN and 59.4% were healthy with extremely high dental fear and anxiety. Thirty-five children were <6 years old. Only 11.4% of them were CSN; 29 children were ≥6 years old and 75.9% were CSN. For 56 of 64 of the patients, the treatment plan has not been respected irrespective of the medical condition. A total of three of the eight treatment plans that have been respected were for the CSN and five for the healthy children. Conclusion: Under general anesthesia, the medical condition of the patient did not alter the dental treatment type. The four principles of ethics were respected as well in CSN as in healthy ones.
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Oxygen alkaline dental’s cleaners from tooth plaque, food debris, stains of blood, and pus: A narrative review of the history of inventions
Aleksandr Urakov, Natalia Urakova, Alexey Reshetnikov
September-October 2019, 9(5):427-433
DOI:10.4103/jispcd.JISPCD_296_19  PMID:31620374
Objective: This review shows the history of inventions of devices, hygiene products, and methods of dissolution and removal of pus, sulfur plugs, blood crusts, and plaque. Material and Methods: The search for inventions was carried out in the databases, such as Google Patent, Google Scholar, Scopus, and PubMed. The key words used in this search were as follows: toothbrushes, toothpicks, toothpastes, plaque, cleaning products for teeth and dentures, teeth whiteners and dentures, bleach bruises and blood stains, pus, sulfur plugs, and pus solvents. A total of 24 inventions were evaluated for review. Results: In recent years, hygiene products that quickly dissolve and bleach pus, sulfur plugs, blood stains, and plaque because of alkaline saponification of protein–lipid complexes and cold boiling inside the biological masses have been invented. Such an action has a heated above 37°C supersaturated sodium bicarbonate solutions containing hydrogen peroxide in moderate concentrations and gaseous oxygen under excessive pressure. Cold boiling inside the dense biological masses occurs under the action of catalase and/or due to the normalization of internal pressure in the solution. Conclusion: Alkalinity, hyperthermia, and hyperoxygenation of solutions with high internal pressure optimize whitening of teeth and dentures because of alkaline saponification and cold boiling.
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Application of policy analysis models in oral health issues: A Review
Mostafa Mozhdehifard, Hamid Ravaghi, Pouran Raeissi
September-October 2019, 9(5):434-444
DOI:10.4103/jispcd.JISPCD_252_19  PMID:31620375
Introduction: Oral health is a complex interaction that contains factors such as disease status and physiological and psychosocial properties. Because of complexity of the health system, policymakers should find some ways to simplify the relations to increase the chance of understanding the conditions, values, and ideas behind it. Policy learning could be built on the appropriate policy models application corn stone. The aim of this study was to answer this question that what policy models were applied in oral health policy studies and what oral health policy issues were analyzed by policy models. Materials and Methods: A systematic review was conducted across international electronic databases (PubMed, ISI Web of Knowledge, and Scopus) with no time limitation and using prearranged keywords. All publications such as articles and thesis were included. Searched terms were selected based on frequent health policy model components and an initial search. Search strategy based on each data base instruction was applied. Results: Eight models or frameworks were applied in total. Most of these models were focused on process stage of oral health policy making. Five main themes such as the role of stakeholders in oral health policy making, assessment of oral health system, oral health policy development, the process of oral health policy making, and oral health policy learning and capacity building were synthesized. Conclusion: Oral health policy issues could be analyzed more comprehensively, and researchers could be guided by applying policy models and frameworks to answer policy-learning questions. Application of models and frameworks should be based on the nature of problem and issue, and the level of problem screening is a critical point in applying appropriate model.
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