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   2021| July-August  | Volume 11 | Issue 4  
    Online since July 30, 2021

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Silver diamine fluoride versus atraumatic restorative treatment in pediatric dental caries management: A systematic review and meta-analysis
Tulika Wakhloo, Srinivas Gosla Reddy, Suresh K Sharma, Ashi Chug, Ashutosh Dixit, Kalpana Thakur
July-August 2021, 11(4):367-375
Introduction: The objective was to compare the clinical efficacy of silver diamine fluoride (SDF) and atraumatic restorative treatment (ART) in arresting active caries in primary teeth and first permanent molars in children. Materials and Methods: The study protocol was registered in PROSPERO (CRD42020205675). A systematic search was performed in PubMed, Scopus, Embase, Cochrane Library, and gray literature for randomized controlled trials (RCTs) published in English language with a minimum follow-up of 6 months, comparing the caries arrest potential of SDF with ART in primary teeth and first permanent molars in children. The risk of bias and quality assessment of the studies was done using the Cochrane Collaboration Tool and Joanna Briggs Institute Critical Appraisal Tool. Data analysis was performed using RevMan software; the outcomes were summarized in meta-analysis (MA) using the random-effects model, and the odds ratio (OR) at 95% confidence interval (CI) was computed. Results: A total of 1059 studies were identified, out of which 562 remained after removal of duplicates. Eight studies were considered for full-text eligibility, and four studies were included in the qualitative review. Three out of four studies were conducted on primary dentition, whereas one study was done on erupting first permanent molars in children. MA of the two studies compared 30% SDF with ART in primary molars at 12 months and revealed the OR to be 2.02 (95% CI: 0.86–4.71; I2 = 62%; P = 0.10). Conclusion: The current review points to the lack of solid evidence comparing SDF with ART for arresting active caries in primary teeth, especially in the first permanent molars. No statistically significant difference between 30% SDF and ART in primary molars at 12 months was found in the present review. Well-designed RCTs are required to determine a minimum concentration of SDF which is effective and safe for caries arrest in children.
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Clinical efficacy of a novel lipid-based Thymoquinone gel: A two-arm, single-blinded, and randomized study
Saima Y Khan, Imran Ahmad
July-August 2021, 11(4):376-381
Objective: To evaluate the clinical efficacy of topical 0.1% lipid-based Thymoquinone (TQ) gel, as an antiplaque and antigingivitis agent. Materials and Methods: A randomized clinical trial was carried out in the Outpatient Department of Pediatric and Preventive Dentistry, Dr. Z.A. Dental College, India with a purposive sample of 60 healthy children of 12–18 years of age, having a gingival and plaque index ≥1; the children were divided into two groups by simple randomization. Group A (30 subjects) was advised to apply peanut amount of Chlorhexidine (CHX) gel, twice a day for 2min. Group B (30 subjects) was advised the same but with a peanut amount of 0.1% lipid-based TQ gel. The clinical parameters were the recording of plaque and gingival indices, prior to the treatment (baseline) and at the 14th and 28th day, respectively (post-treatment). The total duration of the study was 28 days with follow-up. Results: Data analysis was done by employing IBM Statistical Package for Social Sciences Windows software, version 20 (IBM Corp, Armonk, NY, USA). The 0.1% lipid-based TQ gel had a statistically significant reduction (P < 0.001) in plaque index as compared with CHX gel during the 0–14th day and 0–28th day, respectively. Similarly, 0.1% lipid-based TQ gel showed a statistically significant reduction in gingival index (P = 0.005) during the 0–14th day and a statistically significant reduction during the 0–28th day (P < 0.001), as compared with CHX gel. Conclusions: Statistically significant reduction in plaque (P < 0.001) and gingival index (P < 0.001) with the usage of 0.1% lipid-based TQ gel.
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Medical-dental integration-achieving equity in periodontal and general healthcare in the Indian scenario
Lakshmi Puzhankara, Chandrashekar Janakiram
July-August 2021, 11(4):359-366
Aims: Dentistry and medicine have been treated as separate entities by healthcare professionals as well as the populace since a long time. Although dentistry as a standalone entity has achieved considerable progress, there is a significant inequity in the accessibility, affordability, and acceptability of dental care among various socioeconomic strata in the community. Moreover, it is becoming increasingly evident that oral diseases and systemic diseases often share multiple risk factors. Management of oral and systemic diseases as distinct units often results in duplication of care and wastage of resources. This paper gives information on the models of medical-dental integration and possible methods for integrating the same into Indian healthcare scenario. Materials and Methods: A literature search was performed in PubMed/MEDLINE, CINAHL, Web of Science, and Google Scholar for articles pertaining to medical-dental integration. The data obtained were collated. Results: Literatures show that different modalities for medical-dental integration are in practice. However, there is a paucity in conceptual models that may be applied to bring about such an integration into the Indian healthcare system. Conclusion: Integration of medical and dental care would pave the way for equity in health care for everyone. Conceptual models for integrating oral disease surveillance into systemic disease have been proposed in this paper.
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The efficacy of non-fluoridated toothpastes on artificial enamel caries in primary teeth: An in vitro study
Pornpailin Kasemkhun, Praphasri Rirattanapong
July-August 2021, 11(4):397-401
Aims: The aim of this study was to evaluate the remineralizing effect among various non-fluoridated toothpastes on artificial caries in primary teeth. Materials and Methods: Fifty sound primary incisor teeth were embedded in self-curing acrylic resin and immersed in demineralizing solution for 4 days forming artificial caries. All teeth were divided into five groups (10 teeth/group): Group I deionized water (control); Group II 1000 ppm F (Kodomo®); Group III non-fluoridated toothpaste containing calcium glycerophosphate and calcium lactate (Dokbuaku®); Group IV casein phosphopeptides-amorphous calcium phosphate (CPP-ACP) paste (GC Tooth Mousse®), and Group V non-fluoridated toothpaste containing nanohydroxyapatite (NHA) (Apagard®). The specimens were subjected to pH-cycling and immersed in toothpaste slurry twice for 7 days. Baseline, before, and after pH-cycling surface microhardness (SMH) values were measured by Vickers hardness numbers, and the percentage recovery of SMH (%SMHR) was calculated. Data were analyzed by one-way analysis of variance and Tukey’s multiple comparison at 95% confidence intervals. Results: The SMH values of test groups were significantly higher than those of the control group (p = 0.00). The %SMHR was −5.72±7.03% in the control group, Group II was significantly higher than Group III but there were no significant differences among Groups II, IV, and V (p > 0.05). Conclusion: Non-fluoridated toothpastes containing CPP-ACP or NHA for young children had efficacy in remineralizing effect on primary teeth comparable with 1000 ppm fluoridated toothpaste.
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Unexplored potential of essential oils in reducing SARS-CoV-2 viral load in dental clinics
Namrata Dagli
July-August 2021, 11(4):357-358
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Satisfaction level of the oral medicine patients using teledentistry during the COVID-19 pandemic: a factor analysis
Rahmi Amtha, Indrayadi Gunardi, Tri Erri Astoeti, Moehamad Orliando Roeslan
July-August 2021, 11(4):414-420
Objectives: The aim of this article is to describe oral medicine patients’ satisfaction level with teledentistry services during COVID-19 pandemic by a factor analysis. Materials and Methods: An observational cross-sectional study was conducted in the Oral Medicine Clinic in 31 patients who used teledentistry services at the beginning of the COVID-19 pandemic under informed consent. Questionnaire modification was validated with the Rasch model analysis and components that contribute to satisfaction were analyzed by the factor analysis. A total of satisfaction scores were then categorized into five levels (very dissatisfied; not satisfied; moderate; satisfied and very satisfied). Results: The questionnaire shows Cronbach’s alpha of 0.83 and a reliability item of 0.95 with a separation of 4.49. The factor analysis shows two components that contribute to satisfaction, namely, components convenience and communication. One hundred percent of the subjects were in the satisfied and very satisfied categories. Discussion: The Rasch model can determine the validity and reliability of the questionnaire used more accurately. The components of convenience and communication are the main things that are considered when patients choose teledentistry services. Conclusion: Oral medicine patients’ satisfaction level with teledentistry services during the COVID-19 pandemic was 100% in the satisfied and very satisfied categories, with contributing factors being convenience and communication.
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The trend of analytical approaches in dental research
Kawin Sipiyaruk, Tawepong Arayapisit, Patsachol Patthanajitsilp, Pichaya Tangpanchasil, Laksika Sukcharoenmitr, Anthony Hayter, Natchalee Srimaneekarn
July-August 2021, 11(4):463-468
Objectives: The aims of this article are to examine statistical approaches employed in international dental articles published in 2018 and 2019, as well as to examine relationships among analytical approaches, journal rankings, and types of research. Materials and Methods: International dental journals published in 2018 and 2019 were selected from the four quartiles (Q1–Q4) of journal rankings using a stratified random sampling. All original articles in a randomly sampled issue of each selected journal were reviewed to explore employed statistical approaches and to examine relationships among analytical approaches, journal rankings, and types of research. Results: One hundred and twenty-eight English-written international journals listed according to SCImago Journal Rank were selected, consisting 969 original articles. Significant differences in the use of statistics were found among the four quartiles and between types of research. The articles in Q1 tended to use more advanced analysis but lower descriptive analytics than other quartiles. The narrative approach was highly used in laboratory-based articles (18.66%), whereas clinical research was likely to use more descriptive (92.32%) and advanced analyses (26.30%). The data also found no remarkable differences in the patterns of the three most common statistical use among the four quartiles. Conclusion: This research revealed statistical use in international dental journals, which will enable educators to consider statistical content to be included in dental curricula, either for undergraduate or for postgraduate programs.
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Self-perceived needs for orthodontic retreatment among dental students: A qualitative study
Peerapong Santiwong, Phattheera Phenphasit, Rachaporn Chatthanavej, Wathistha Sonjon, Sirada Patthanapuapun, Sunchan Anantapanyagul, Kawin Sipiyaruk
July-August 2021, 11(4):402-407
Aims: The aims of this research were to explore perceptions of Mahidol dental students toward orthodontic retreatment and to examine whether there were any influential factors in a dental school toward their decision to receive the retreatment. Materials and Methods: Mahidol dental undergraduates who were requesting orthodontic retreatment were recruited into this research. A semi-structure interview with a topic guide was conducted to collect in-depth information. All responses were recorded using a digital voice recorder and transcribed using a verbatim transcription technique. The data were then analyzed using a framework analysis. Results: The common reasons for requesting orthodontic retreatment among dental students were self-perceived esthetic and functional concerns. Knowledge and experiences of dental students could raise awareness of dental problems, so they were likely to detect even a small defect of their teeth. The students also worried if their dental problems were presented to patients or other dental students. In addition, although they were requesting for orthodontic retreatment, they felt quite worried with the complications they had learned from the dental program. The students also reported that these concerns could affect their psychological well-being. Conclusion: Dental knowledge and experiences as well as surrounding people such as their peers and patients in a dental school seemed to have impact on awareness of dental problems and a decision to receive orthodontic retreatment.
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Non-specific chief complaints among oral submucous fibrosis patients at outpatient department and pan shop at rural region in India
Rohan Sachdev, Kriti Garg, Samiksha Shwetam, Akash Srivastava
July-August 2021, 11(4):382-388
Aim: The first communication with a healthcare professional is critical for determining the correct diagnosis, particularly when it comes to patients’ description of symptoms. This study aimed at exploring the primary symptoms observed in oral submucous fibrosis patients with non-specific complaints visiting outpatient department and pan shop at Kanpur, India. Materials and Methods: It was a cross-sectional study involving a two-stage sampling to select clinically diagnosed oral submucous fibrosis (OSF) patients from the outpatient department and pan shop customers (PSCs) at rural healthcare centers. A total of 321 participants were selected based on convenience sampling. Patient demographics, history of relevant habits with a period, and socioeconomic status were all documented. The extent of mouth opening was used to grade OSF cases. Data were analyzed using MedCalc Version 19.7.2 with χ2, Wilcoxon signed-rank, and t-tests used, as appropriate, to calculate P-values. Results: Out of the 184 OSF-OPD patients, only 59 (32.06%) described relevant disease symptoms of OSF: in stage III, 28.5% or stage IV, 38.7%. One hundred and twenty-five patients (67.93%) reported chief complaints (CCs) unrelated to OSF, and all of these cases were diagnosed with an early stage of OSF (stage I: 72.41% and stage II: 61.53%). Out of the total 137 PSCs, 74 PSCs have had prior dental consultations, but only 44 (32.11%) people had sought medical help because of OSF-related CCs. Conclusion: A limited number of studies were conducted in this area, particularly in the rural population of central India. Our study found that considerable amount of main complaints from OSF patients was unrelated to their symptoms. There is insufficient knowledge of OSF symptoms among rural population, which further restricts early detection of the disease.
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Influence of professional teeth whitening on oral hygiene: Long-term results
Natalia Vlasova, Vadim Samusenkov, Irina Novikova, Denis Nikolenko, Nikita Nikolashvili, Marina Knyazeva
July-August 2021, 11(4):408-413
Aims: The aim of this article is to estimate the long-term influence of professional dental bleaching on quality of oral hygiene (year after procedure). Materials and Methods: A randomized controlled prospective clinical repeated study was carried out 6 months after the previous one, i.e., 1 year after the oral hygiene procedure, among 60 patients divided into two groups. In the first group, professional oral hygiene and bleaching using 25% hydrogen peroxide were performed. In the second group only, oral hygiene was performed. Dynamics of hygienic index of Quigley-Hein modified by S. Turesky was estimated. Results: In the first group, the average value of the hygienic index of Quigley-Hein modified by S. Turesky was significantly lower a year after procedure than before (1.33±0.09 and 2.34±0.14, respectively). In the second group, this index exceeded 2.45 and nearly returned to the initiated level (2.45±0.07 and 2.44±0.08, respectively). Patients underwent professional teeth whitening in the long-term period, and the level of oral hygiene was significantly higher than that in the control group. Conclusion: Professional dental bleaching has good long-term influence on the level of oral hygiene and serves as a significant motivation factor for maintaining health of oral cavity.
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Psychodiagnostics as a mandatory element of patient protocols in dentistry
Oxana Bogaevskaya, Ekaterina Ignatova, Alexei Yumashev
July-August 2021, 11(4):389-396
Objectives: This study aims at performing psychodiagnostics of the patients` condition with removable and fixed dentures both before and after dental treatment. Materials and Methods: The first group included 200 patients with fixed-type dentures, and the second group consisted of 200 patients with removable dental devices. The control group included 200 patients with healthy teeth. All patients were subjected to Fere’s skin-galvanic reaction procedure. Patients also filled out the Dental Status Questionnaire and were then tested following the Spielberger-Hanin Scale. For a comparison of differences, a two-sample t-test for independent samples was used. The Pearson correlation between features was calculated considering their distribution as normal. Results: In the control group, the hemispheric activity index increased 1.1 times after treatment. In Group 2, following the dental status questionnaire, the index of hemispheric activity increased 1.3 times in males with a positive emotional mood (P ≤ 0.01). A 2.2-fold and 2.1-fold (P ≤ 0.01) increase was observed among female and male patients with a negative emotional mood in Group 2, respectively. After the treatment, the hemispheric activity index in Group 1 increased by 1.1 times for males with a positive mood (P ≤ 0.01) and by 1.2 times for male and female patients with a negative mood (P ≤ 0.05). Direct correlation was recorded between the increase in the number of scores and emotional mood among males and females from Group 1 (0.72 and 0.73, respectively). After the survey, a correlation was established between the values of the hemispheric activity index and the increase in scores among males (0.82) and females (0.81). There was also a connection between the increase in scores and the level of personal anxiety in both male (0.57) and female (0.66) patients, as well as between the increase in scores and the level of reactive anxiety (0.56 and 0.57, respectively). Conclusions: Changes in the hemispheric activity index were shown to be related to the patient’s dental condition questionnaire. Besides, there is a relationship with the type of dental service. The practical application of this study implies that more reliable information about the patient’s satisfaction with the quality of dental care provided can be obtained using not only standard psychodiagnostic methods but also questionnaires on the patient’s dental status. Once the survey is completed and the data obtained analyzed, it is possible to define the correct strategy to restore the patient’s physical and mental health after dental treatment.
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Micro-cleanliness of hard tissue debris after advanced irrigation and comparison between EndoVac and XP-endo finisher: A microcomputed tomographic study
Loai Alsofi, Muhanad Al Harbi, Mey Al-Habib, Martin Stauber, Khaled Balto
July-August 2021, 11(4):457-462
Introduction: Conventional irrigation techniques do not remove debris adequately. The remaining tissue debris cause infection inside the root canal and may also affect the seal of the root canal. The study aimed to compare the ability of EndoVac (EV) with XP-endo finisher (XPF) in debris removal using micro-CT analysis. Materials and Methods: We used 12 lower first permanent molar human teeth for this study. The root canals were instrumented using a small TF adaptive system. Then, the volume of debris was calculated. Teeth were divided into two groups, according to advanced irrigation methods, with six teeth per group: EV group and XPF group. The volume of debris was calculated again. The paired-sample t-test was used to compare the volume of the debris before and after the use of advanced irrigation methods with the statistical significance of P < 0.05. The percentage of debris reduction was also calculated. Results: Both EV and XPF showed a significant decrease of debris in the mesial canals (P < 0.05), whereas EV only showed a significant reduction of debris in the distal canals. Conclusion: Both EV and XPF were able to significantly reduce debris after instrumentation in the mesial canals of lower first mandibular molars. Clinical Significance: The study provides insight into the recent advanced methods used in debris removal and canal disinfection.
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Expression of p63 and proliferating cell nuclear antigen in oral submucous fibrosis
S Suwasini, Manisha Shrikaar, Nishu Kumari, Abhishek Singh, Khusboo Kumari, Madhuresh Kumar
July-August 2021, 11(4):448-456
Aim: Oral squamous cell carcinoma (OSCC) may be preceded by potentially malignant disorders such as oral submucous fibrosis (OSMF). p63 can detect genetic changes in OSMF and it facilitates early detection of malignant transformation, whereas proliferating cell nuclear antigen (PCNA) is a marker of proliferation and may prove to be a useful objective indicator of the biological behavior of various tumors. The aim of this study was to investigate the expression and pattern of the intensity of p63 protein and PCNA in normal oral mucosa and OSMF using immunohistochemistry (IHC) and to correlate the expression of these biomarkers. Materials and Methods: A total of 15 archival paraffin-embedded blocks obtained from our department, which were histopathologically diagnosed early OSMF (n = 4), intermediate OSMF (n = 4), and advanced OSMF (n = 2) and normal mucosa (n = 5), were taken as the standard for comparison. p63 and PCNA positivity was analyzed using Kruskall-Wallis test followed by pairwise comparison using Mann-Whitney U test. The pattern of staining and intensity was compared using Chi-Square test for which Statistical Package for the Social Sciences (SPSS, v 22.0, IBM Corporation, Armonk, New York) was used. Results: All samples showed positive staining for p63 and PCNA. A statistically significant difference (P < 0.05) was seen between the frequency of occurrence of p63 and the PCNA pattern of expression among all the groups. The intensity of staining was mild to intense in the basal layer, as there was a progression toward the severity of the disease. Almost 75.4% correlation existed between p63 and PCNA, with high correlation and marked relationship. Conclusions: The OSMF is considered a potentially malignant disorder that has the potential to get transformed into OSCC. The malignant transformation is often associated with changes at the genetic level, and these are reflected by the altered expression of proteins. Our results showed that biomarkers such as p63 and PCNA are significant in predicting the malignant transformation in OSMF, so in future they may serve as a prognostic tool in the early detection of malignancies.
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Patients’ perspectives of grafting materials in implant dentistry: A qualitative analysis
Mai E Khalaf, Neamat H Abubakr, Hanadi M Alenezi, Hassan M Ziada
July-August 2021, 11(4):428-436
Aims: The aim of this study was to evaluate the cultural, psychological, and religious influences on the choice of autografts, allografts, xenografts, and synthetic bone products for the grafting procedure and with implant placement. Materials and Methods: A qualitative methodology was employed, using the principles of the constant comparative method of the grounded theory; to investigate how people perceive and understand their experiences regarding the graft materials in implant dentistry. The data were collected using detailed qualitative interviews, till saturation was achieved, from 10 patients. Results: The three main themes that emerged in the analysis were: (a) grafting material preference, (b) religious and psychological influences, and (c) trust the doctor and cost influences. The three themes that emerged seemed to be interrelated. There were many statements of preference or rejection of choice based on religious, cultural, and psychological influences. Conclusions: Within the limitations of this study, three themes emerged and they indicated that the influence on the grafting material’s choice is unique to every individual; it also shares similarities, based on common religious and cultural values.
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Effects of the healing chambers in implant macrogeometry design in a low-density bone using conventional and undersized drilling
Sergio A Gehrke, Antônio Scarano, José H C de Lima, Marco A Bianchini, Berenice A Dedavid, Piedad N De Aza
July-August 2021, 11(4):437-447
Background: The ideal installation technique or implant macrogeometry for obtaining an adequate osseointegration in low-density bone tissue follows a challenge in the implantology. Aims and Objective: The aim of the present study was to evaluate the behavior of three osteotomy techniques and two implant macrogeometries in two low-density polyurethane blocks. The insertion torque (IT), initial stability, pullout resistance, and weight of the residual bone material deposited on the implants were assessed. Materials and Methods: A total of 120 implants with two different macrogeometries were used. They were divided into six groups according to the implant macrogeometry and the drilling technique performed (n = 20 implants per group). The implants were installed in polyurethane blocks with pounds per cubic foot (PCF) 10 and PCF 20 densities. The IT, initial stability, pullout resistance, and weight residual bone were measured. Results: Differences were found in the values referring to the macrogeometry of the implants and the type of osteotomy performed. In all groups, the initial stability of the PCF 10 blocks was quite low. The undersized osteotomies significantly increased the values measured in all tests in the PCF 20 density blocks. Conclusions: In conclusion, even when a modified (undersized) osteotomy technique is used, implants inserted in low-quality bone (type IV) can present problems for osseointegration due their low initial stability and bone resistance. However, the modification in the implant macrogeometry (with healing chambers) presented more quantity of bone on the surface after the pullout test.
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Efficacy of xanthan-based chlorhexidine gel on the levels of Interleukin-1β in chronic periodontitis: An interventional study
HR Sajna, Amitha Ramesh, Madhurya N Kedlaya, Biju Thomas
July-August 2021, 11(4):421-427
Aims and Objectives: Xanthan-based chlorhexidine gel (Chlosite®) is a local drug delivery system that exposes the sub-gingival bacteria to the effects of chlorhexidine (CHX) for a prolonged time. Hence, the study aimed at evaluating the clinical efficacy of the subgingival application of Chlosite gel as an adjunctive to mechanical scaling and root planing (SRP) and at evaluating the salivary interleukin (IL)-1β level to substantiate the clinical efficacy of xanthan-based CHX gel. Materials and Methods: A total number of 40 patients with chronic periodontitis in the age group of 30–50 years were enrolled in this interventional study. The patients were assigned to group A, in which only SRP was done, and group B, in which SRP along with the subgingival application of Chlosite gel was done. Periodontal parameters and salivary IL-1β level were evaluated, and the data obtained were statistically analyzed by using paired and unpaired “t” tests. Results: The results obtained showed a statistically significant reduction in the mean gingival index (GI), probing pocket depth (PPD), clinical attachment level (CAL), and salivary IL-1β values in both the groups from baseline to 30 days. There was a statistically significant reduction in GI, in group B when compared with group A, after the treatment. Salivary IL-1β value in group B was slightly lower when compared with group A after the treatment, but it was not statistically significant. Conclusions: The xanthan-based CHX gel is therapeutically effective when used as an adjunct to SRP. The study also indicated that salivary IL-1β can be used as a reliable biomarker.
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