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   2021| September-October  | Volume 11 | Issue 5  
    Online since September 21, 2021

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The systematic review and meta-analysis of oral sensory challenges in children and adolescents with autism spectrum disorder
Sachin Haribhau Chaware, Surekha Godbole Dubey, Vinay Kakatkar, Ajit Jankar, Swati Pustake, Abhishek Darekar
September-October 2021, 11(5):469-480
Objectives: The purpose of the systematic review was to provide a summary and evaluation of oral sensory challenges in children and adolescents with autism spectrum disorder (ASD). Materials and Methods: The review evaluated 19 studies that met the inclusion and search criteria. The review is registered in Prospero Database (CRD42020179852). The 14 studies (8 case–control, 4 cohort, 1 observational, and 1 randomized clinical trial) were related to speech disorders and five studies (case–control studies) were associated with feeding and eating behavior in ASD. The meta-analysis of speech and feeding behavior was analyzed by using risk ratios (RRs) and standardized mean difference (SMD), with 95% confidence interval (CI). Results: The meta-analysis found a statistically significant difference of speech disorder between children and adolescents of ASD when compared with typically developed or other neurotypical children of similar age [0.4891 (95% CI = −2.4580; 1.4799), fixed effect; −0.1726 (95% CI = −14.2925; 7.5697), random effect]. Feeding and eating behavior reported a statistically significant difference between ASD children and adolescents with similar age group of typically developed controls [0.0433 (95% CI = −0.3531; 0.4398), fixed-effect; 0.3711 (95% CI = −3.0751; 3.8172), random effect]. Conclusion: The speech errors and feeding behavior were more consistent in ASD than in typically developed controls. The oral sensory challenges such as speech disorder and feeding behavior were more prevalent in ASD children and adolescents than in typically developed children and adolescents of the same age group. There was a significant lack in oral sensory-motor synchronization, incomplete motor planning, and poor oral neuromuscular coordination.
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Correlations between mandibular asymmetries and temporomandibular disorders: A systematic review
Nasser Alqhtani, Deema Alshammery, Nawaf AlOtaibi, Faisal AlZamil, Aljowhara Allaboon, Dana AlTuwaijri, Mohammad Abdul Baseer
September-October 2021, 11(5):481-489
Objective: This systematic review aimed to investigate the correlation between mandibular asymmetry and temporomandibular disorders (TMDs). Materials and Methods: A systematic search of the published literature was performed in electronic databases such as PubMed (MEDLINE), Scopus, Web of Science, Cochrane, Google Scholar, Clinicaltrials.gov, and Saudi Digital Library. Gray literature was searched through System for Information on Grey Literature through OpenGrey. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed in the investigation. The focussed question according to PICO format was: “does the mandibular asymmetry contribute to temporomandibular disorders”? Eligibility criteria included clinical trials (CTs), observation studies, cross-sectional and cohort studies in English that investigated mandibular asymmetries and TMD among patients. Blind and duplicate study selection, data extraction, and risk of bias assessment were carried out. Results: The initial search resulted in 1906 articles, of which 11 (8 CTs, 1 cross-sectional, 1 retrospective, and 1 observational) studies were selected for qualitative synthesis after fulfilling the eligibility criteria. Conclusion: Most of the studies included in this review showed either very high risk or high risk of bias. Despite the low certainty of evidence, the current study indicated a likely relationship between mandibular asymmetries and TMDs.
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Fungicidal effect of lemongrass essential oil on Candida albicans biofilm pre-established on maxillofacial silicone specimens
Shamsiahwati Mat-Rani, Natdhanai Chotprasert, Natchalee Srimaneekarn, Suwan Choonharuangdej
September-October 2021, 11(5):525-530
Aims: This in-vitro study aimed to evaluate the efficacy of lemongrass (Cymbopogon citratus) essential oil in eradicating Candida albicans biofilm pre-established on the maxillofacial silicone specimens. Materials and Methods: Two maxillofacial silicones, namely, MDX4-4210 and Multisil Epithetik, were used for the fabrication of 6 mm diameter disks (n = 21 for each brand of silicone). A 48-h mature C. albicans ATCC 10231 biofilm was pre-established on sterile silicone specimen. These disks were then exposed to various concentrations of lemongrass essential oil ranging from 0.31% to 5% (v/v), 20% (v/v) nystatin, and RPMI-1640 medium for 18–20 h. After exposure, the remaining viable fungal biofilm was examined by the XTT [2,3-bis-(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide]-reduction assay. All data were analyzed by using a regression coefficient and a post hoc Tukey HSD multiple comparisons test (α = 0.05). Results: Different brands of silicone used for fabrication did not significantly affect the formation of mature C. albicans biofilm (P =0.302). A 5% (v/v) lemongrass essential oil significantly eliminated fungal biofilm by approximately 95% (P =0.031). However, less than 50% of the fungal biofilm was eliminated by the tested oil at a concentration as low as 0.31% (v/v). Furthermore, the fungicidal efficacy against C. albicans biofilm of lemongrass essential oil at 2.5% (v/v) was as potent as that of 20% (v/v) nystatin suspension (P = 0.99). Conclusion: Lemongrass essential oil expressed fungicidal effect on C. albicans biofilm pre-established on the disks fabricated from different brands of silicone. Additionally, the fungicidal effectiveness of the oil against the mature fungal biofilm was dose-dependent.
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Evaluation of oral health-related quality of life for adult individuals with cleft lip and/or palate using OHIP-49 and compared with a control group: A cross-sectional study
Marwan Aljohani, Falah Alshammari, Hamdan Alamri, Abdullah Bin Rahmah, Martin Ashley, Julian Yates
September-October 2021, 11(5):516-524
Objectives: This study aimed at evaluating oral health-related quality of life (OHRQoL) among adults with cleft lip and/or palate (CL/P) and compared it with adults with no orofacial cleft. The study also intended to find out the impact of cleft severity, gender, and age on the perceived OHRQoL. Materials and Methods: The study was composed of a sample of 70 adult participants who received and completed dental treatments: 35 participants with CL/P (CL/P group) and 35 participants with no orofacial cleft (control group) agreed to participate. Each participant completed the Oral Health Impact Profile (OHIP-49) with no missing data. The OHIP-49 data were analyzed using the Mann–Whitney U test, and a P-value <0.05 was considered as statistically significant. Results: Adults with CL/P reported higher scores in all the seven subscales of the OHIP-49. These results were statistically significant in physical disability (mean scores of 1.22, p = 0.017) and social disability (mean scores of 0.93, p = 0.046). Females with CL/P recorded better OHRQoL in the handicap domain (p = 0.026). Participants with cleft lip only recorded better OHRQoL compared with those with cleft lip and palate, and that was statistically significant at both the functional limitation (p = 0.003) and the physical pain (p = 0.046). There was a significant positive correlation between increasing age and functional limitation (p = 0.025). Conclusion: CL/P negatively affected OHRQoL for adults with CL/P mainly on physical and social disabilities of OHIP-49 when compared with a general non-cleft sample.
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Online professionalism of Facebook usage in dental education: A retrospective exploration
Tawepong Arayapisit, Jidapa Jarunsiripaisarn, Thitaree Setthamongkol, Dhitaya Ochaphan, Tanaporn Songsomsup, Kawin Sipiyaruk
September-October 2021, 11(5):539-545
Aims: Unprofessionalism in the use of Facebook has been found among healthcare professionals including dental students. The improper content may be shared to the public, negatively impacting their professions. This study explored account privacy and professionalism on Facebook usage in conjunction with evaluating whether there were correlations among presence of clinical experience, account privacy, and professionalism. Materials and Methods: This study retrospectively explored professionalism in the use of Facebook among Mahidol dental undergraduates in the academic year 2019. The students who had identifiable Facebook and accepted a friend request were included into this study. The content on both “About” and “Wall” sections was examined and analyzed using descriptive statistics and χ2 test. Results: Facebook profiles of 522 students were identified. There were 382 (73.18%) students who accepted the friend requests, revealing account privacy: 32 (8.38%) private, 200 (52.36%) limited, and 150 (39.27%) public profiles. Clearly unprofessional content was mostly relevant to sharing information of patients (15.97%), followed by parody content of patients (8.9%). Questionably unprofessional misconducts included political discriminations (14.66%), profanity (3.14%), and alcohol consumption (2.88%). Professionalism was found to be significantly correlated with privacy (p<0.001) and clinical experience (p<0.001). Conclusion: Unprofessionalism tended to be higher in clinical years, so professionalism should be emphasized constantly throughout the dental program, especially before starting clinical practice. Privacy concerns should also be suggested for students at the beginning of the program.
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Impact of air and manual scaling on dental anxiety and blood glucose level among diabetic patients
Alyamama M Alwan, Hussein A Mousa, Haider J Talib, Tameem K Jassim
September-October 2021, 11(5):510-515
Aims: The current study aimed at describing the short-term effect of nonsurgical periodontal treatment on dental anxiety and blood glucose level change among diabetic patients. Materials and Methods: One hundred and fifty patients with diabetes participated in a cross-sectional study design. All of them were divided into two groups, with 75 patients in each group. The first group was treated with air scaling, whereas the second group was treated with manual scaling. The determination of treatment needs and the evaluation of periodontal health status were achieved by using Community Periodontal Index for Treatment Need (CPITN). The level of dental anxiety was assessed by using Visual Analogue Scale (VAS). The glucose change was calculated by subtracting the glucose level before treatment from the glucose level straight after treatment. Results: No significant difference in glucose level was observed between manual scaling and air scaling after treatment (P = 0.076), and the level of glucose was significantly lower after scaling treatment within the treatment groups (P = 0.000). The level of glucose change between the groups was significantly lower for the manual scaling treatment group (P = 0.013), and it was significantly correlated with VAS (P = 0.000). Multiple regression analysis showed a significant association between the treatment groups (P = 0.007). Conclusions: Scaling reduced blood glucose and dental anxiety levels in patients with diabetes. Manual scaling was associated with reduced glucose level change less than air scaling after treatment.
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Diagnostic accuracy of ultrasonography for the assessment of maxillofacial fractures: A meta-analysis
Srikanth Gadicherla, Kalyana-Chakravarthy Pentapati, Nasrullah Rustaqi, Anupam Singh, Komal Smriti
September-October 2021, 11(5):503-509
Objective: To evaluate the pooled sensitivity and specificity of ultrasonography (USG) in maxillofacial fractures. Materials and Methods: A systematic search was performed in five databases (PubMed, Scopus, CINAHL, Web of Science, Dentistry and Oral Sciences Source) from inception to September 12, 2020. Studies that reported or from which sensitivity and specificity can be calculated and studies published in the English language were included. Conference proceedings, letter to editors, and case reports were excluded. Screening of studies, data extraction, and risk of bias assessment (QUADAS -2) were done separately by two review authors. A bivariate random-effects model was used to calculate the pooled estimates. Results: After the removal of duplicates, 1852 studies were included for screening of title and abstracts. Only 22 studies were included in the quantitative synthesis. The sample size ranged from 6 to 87. The majority of the studies assessed orbit and nasal bones fractures. Only two studies included a comprehensive assessment of facial fractures. The overall sensitivity and specificity values were 0.94 and 0.96, respectively. Conclusion: USG has good diagnostic accuracy for the assessment of fractures of orbit and nasal bones. Clinicians need to consider the advantages and limitations of USG before recommending advanced imaging modalities.
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Plaque removal efficacy of triple-headed toothbrush in 4–6-year-old children: A randomized crossover study
Kwanchanok Youcharoen, Narawit Thomngam, Natchanok Aranya, Yasumin Wongphanthuset, Mintita Rungruangpattana, Nathawut Kaewsutha
September-October 2021, 11(5):546-552
Objectives: The objective of this randomized crossover designed study was to compare the efficacy of plaque removal between a triple-headed toothbrush and a conventional single-headed toothbrush in 4–6-year-old children. Materials and Methods: A total of 73 children, aged 4–6 years, were randomly divided into two groups (triple-headed toothbrush and conventional single-headed toothbrush). The children were instructed on how to use the toothbrush by watching a video clip for each toothbrush type and then brushed their teeth for 2 min. The remained plaque was recorded by Greene and Vermillion plaque index (PI). After a 3-week washout period, the toothbrush type was switched, the children brushed their teeth with the alternate toothbrush, and the PI scores were re-recorded. Results: Plaque scores in the triple-headed toothbrush group were statistically significantly lower than those in the single-headed group in almost all (10 out or 12) surfaces measured (P < 0.05). Plaque scores were not significantly different on the buccal surfaces of the upper posterior teeth. Conclusion: The triple-headed toothbrush showed better efficacy in plaque removal and could potentially be a good alternative to the conventional single-headed toothbrush in young children with limited hand skill.
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Common risk factor approach to limit noncommunicable diseases and periodontal disease—the molecular and cellular basis: A narrative review
Lakshmi Puzhankara, Chandrashekar Janakiram
September-October 2021, 11(5):490-502
Introduction: The link between periodontal disease and noncommunicable diseases (NCDs) has been the subject of major research over the past several years. The primary objective of this review is to understand the cellular and molecular components that link common risk factors (exposure) in adult patients (population) with periodontal disease and other NCDs (outcome). The secondary objective is to interpret from existing literature the possibility of identifying the molecular plausibility of the Common Risk Factor Approach (CRFA). Materials and Methods: A literature search was performed in PubMed/MEDLINE, CINAHL, Web of Science, and Google Scholar for all published articles pertaining to the molecular and cellular basis of the risk factors between periodontal diseases and major NCDs. Data from all randomized and nonrandomized clinical trials, cross-sectional studies, case-control, cohort studies, literature, and systematic reviews were included. Results: Periodontal pathogens, stress, obesity, smoking, and dietary factors are some of the common risk factors between periodontal disease and NCDs. Conclusion: Understanding the molecular and cellular link of common risk factors between NCDs and periodontal disease would ensure the application of CRFA. The CRFA implies that controlling the risk factors associated with NCDs can have an incredible positive impact on regulating many chronic conditions, which would extend to periodontal health also.
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Unsupervised machine learning identified distinct population clusters based on symptoms of oral pain, psychological distress, and sleep problems
Nontawat Chuinsiri
September-October 2021, 11(5):531-538
Objectives: The aims of this study were to explore the use of unsupervised machine learning in clustering the population based on reports of oral pain, psychological distress, and sleep problems and to compare demographic and socio-economic characteristics as well as levels of functional domains (work, social, and leisure) between clusters. Materials and Methods: In this cross-sectional study, a total of 1613 participants from the National Health and Nutrition Examination Survey in 2017–2018 were analyzed. Five variables, including oral pain, depression, anxiety, sleep apnea, and excessive daytime sleepiness, were selected for cluster analysis using the k-medoids clustering algorithm. The distribution of categorical variables between clusters was assessed using χ2 test. One-way analysis of variance and Kruskal–Wallis H test were used to compare numerical variables as appropriate. Results: Five distinct clusters were identified: healthy, norm, anxiety, apnea-comorbid, and pain-comorbid. The apnea-comorbid cluster had mean age of 59 years and higher proportion of men. The pain-comorbid cluster had mean age of 56 years and higher proportion of women. Whites constituted a majority of both comorbid clusters. The pain-comorbid cluster demonstrated the least percentage of individuals with college degree, the lowest income, and significant impairment in all functional domains. Conclusion: Through the use of unsupervised machine learning, the clusters with comorbidity of oral pain, psychological distress, and sleep problems have emerged. Major characteristics of the comorbid clusters included mean age below 60 years, White, and low levels of education and income. Functional domains were significantly impaired. The comorbid clusters thus call for public health intervention.
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Clinicopathological correlation of cyclooxygenase 2 expression in oral submucous fibrosis: An immunohistochemical study
Catakapatri Venugopal Divyambika, Sankarapandian Sathasivasubramanian, Shyamsundar Vidyarani, Austin RaviDavid, Srinivasan Harinee, Ramshankar Vijayalakshmi
September-October 2021, 11(5):553-560
Background: Oral submucous fibrosis (OSMF) has a high prevalence in Southeast Asia with increased malignant transformation rates. Numerous biomarkers are currently being investigated to predict the disease prognosis and for early detection of malignant changes. Materials and Methods: A prospective study was conducted comprising 40 subjects with clinically and biopsy-proven OSMF being included in the study as experimental group (n = 28) and patients with no tobacco/betel nut habit, who underwent surgical removal of third molar, being included as control group (n = 12). About 5-μm sections from formalin-fixed paraffin-embedded tissue blocks were obtained for immunohistochemical (IHC) study. The expression of cyclooxygenase 2 (COX 2) was evaluated in the experimental group and compared in morphologically normal oral epithelium. The intensity of stain was assessed at different levels of epithelium (basal, stratum spinosum, superficial level) and connective tissue. Results: Based on IHC expression of COX 2, all the patients of the control group were negative for COX 2, and among the OSMF group, 19 patients (67.9%) were positive and 9 patients (32.1%) were found to be negative for COX 2. The association of COX2 expression on comparison of controls with OSMF was found to be statistically significant (χ2 =21.955; P = 0.000). On comparison of immune expression of COX 2 in different clinical stages based on functional staging, we found significant association of COX 2 expression with the stage of OSMF (χ2 = 7.368; P = 0.025). Conclusion: The significant expression of COX 2 in different clinical stages of OSMF when compared with normal shows the role of COX 2 in the pathogenesis of OSMF and could serve as a potent biomarker for assessing the disease progression.
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Evaluation of IL-1α and IL-1β, COX-2, and iNOS mRNA expression in orthodontic patients given chitosan mouthwash during treatment with miniscrew
Haru Setyo Anggani, Erlina Hasriati, Endang Winiati Bachtiar
September-October 2021, 11(5):561-565
Objective: Chitosan is a biomaterial with antibacterial properties that may benefit from maintaining peri-miniscrew hygiene and preventing inflammation. This study aimed to evaluate the expression of inflammatory-related molecules from the gingival crevicular fluid (GCF) after treatment of 1% chitosan when compared with 0.2% chlorhexidine mouthwash of patients with orthodontic miniscrew. Materials and Methods: A total of 30 subjects were divided into three groups: the first group received mouthwash containing 1% chitosan, the second group 0.2% chlorhexidine digluconate, and the control group received aquadest. The GCF was collected before and after 4 days of rinsing, and relative expressions of IL-1α and IL-1β, cyclooxygenase-2 (COX-2), and inducible nitric oxide synthase (iNOS) were evaluated by real-time qPCR. Results: The expression of IL-1α was the highest in chitosan-treated patients when compared with that of IL-1β in between-groups. Patients receiving chlorhexidine have the highest expression of COX-2 and iNOS when compared with the chitosan and control groups, respectively. Conclusion: A mouthwash containing 1% of chitosan could suppress the expression of inflammatory mediators IL-1β, COX-2, and iNOS.
  604 62 -
Evaluation of novel topical camel whey protein gel for the treatment of recurrent aphthous stomatitis: Randomized clinical study
Walid A Elamrousy, Ahmed Mortada, Malak Shoukheba
September-October 2021, 11(5):574-581
Aim: The aim of this article is to evaluate the topical effect of camel whey protein (CWP) on the healing of recurrent aphthous stomatitis (RAS) and the serum levels of interleukin (IL)-1, IL-6, and tumor necrosis factor (TNF)-α. Materials and Methods: Forty patients with minor RAS were randomly assigned into control and study groups. The control group applied placebo methylcellulose gel topically over the aphthous ulcer, whereas the study group used CWP dissolved in methylcellulose gel topically over the aphthous ulcer. Healing period, pain scale, and serum inflammatory biomarkers were evaluated before and after gel application. Collected data were analyzed statistically using the paired t-test or independent sample t-test. Results: Ulcer healing period, pain scale, and immunological biomarkers were statistically improved in both groups with significant shortening of the ulcer duration and significant regulation of immunological values related to the study group. Conclusion: Topical CWP gel is potentially effective in the treatment of RAS.
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Expression of cathepsin B and cystatin A in oral lichen planus
Pear Bangsuwan, Worawalun Hirunwidchayarat, Pimporn Jirawechwongsakul, Sineepat Talungchit, Patrayu Taebunpakul
September-October 2021, 11(5):566-573
Objective: Cathepsin B (Cat-B), a cysteine protease, and cystatin A (Cys-A), a protease inhibitor, are involved in the immune response. This study determined Cat-B and Cys-A expression in oral lichen planus (OLP) by immunohistochemistry. Materials and Methods: Thirty specimens each of OLP and healthy gingiva (HG) were included. The expression pattern, the number of positive cells, the staining intensity, and the immunoreactive score (IRS) of Cat-B and Cys-A were investigated. The data were analyzed by using unpaired t-test, Chi-square, and Spearman’s rank correlation. Results: The Cat-B expression in OLP was observed as cytoplasmic staining in the epithelial cells, whereas Cys-A expression was exhibited in the nucleus and cytoplasm of the epithelium. An increase in Cat-B staining intensity was also observed in the basal cells. Conversely, the high staining intensity of Cys-A was observed in the stratum spinosum, but not the stratum basale. In HG, Cat-B expression demonstrated a relatively consistent intensity in the epithelial layer. The Cys-A expression in HG was similar to OLP with a lower staining intensity. The mean percentage of positive cells and the IRS score of Cat-B and Cys-A in OLP were significantly higher than HG (P < 0.05). There was no correlation between Cat-B and Cys-A levels in OLP. Interestingly, Cat-B expression in erosive OLP was greater than in non-erosive OLP (P < 0.05). Conclusion: The Cat-B and Cys-A expression in OLP was more outstanding than in HG, suggesting possible roles for the process of OLP pathogenesis. In addition, Cat-B expression may be an indicator of the disease severity.
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Possible role of Porphyromonas gingivalis in the regulation of E2F1, CDK11, and iNOS gene expression in neuronal cell cycle: A preliminary study
Endang W Bachtiar, Tienneke R Septiwidyati
September-October 2021, 11(5):582-587
Objective: This study aimed at evaluating the in vitro effect of Porphyromonas gingivalis exposure in gene expression of E2F1 (family of transcription factors), cyclin-dependent kinase-1 (CDK11), and inducible nitric oxide synthase (iNOS) of the neuronal cell cycle. Materials and Methods: The culture of neuronal cell line SH-SY5Y was exposed to P. gingivalis ATCC 33277, and the gene expression of E2F1, CDK11, and iNOS was analyzed by using a real-time polymerase chain reaction. Results: It was shown that E2F1, a G1 phase biomarker and transcription factor, was upregulated in neuronal cells exposed to P. gingivalis compared with that in control cells. However, CDK11, a biomarker of G2/M checkpoint and iNOS, was downregulated in neuronal cells exposed to P. gingivalis compared with that in control cells. Conclusions: P. gingivalis can regulate the neuronal cell cycle, as indicated in the E2F1, CDK11, and iNOS gene expression.
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