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   Table of Contents - Current issue
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May-June 2020
Volume 10 | Issue 3
Page Nos. 237-378

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EDITORIAL  

How to face the post-SARS-CoV-2 outbreak era in private dental practice: Current evidence for avoiding cross-infections p. 237
Romeo Patini
DOI:10.4103/jispcd.JISPCD_202_20  
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REVIEW ARTICLE Top

Prevention of dental caries in Nigeria: A narrative review of strategies and recommendations from 1999 to 2019 p. 240
Sunny A Okeigbemen, Olushola Ibiyemi
DOI:10.4103/jispcd.JISPCD_423_19  
Objectives: This narrative review aimed to show the approaches recommended for the prevention of dental caries in Nigeria by epidemiological surveys (P), primary preventive methods and strategies,( I) comparison preferred by experts (C) in the prevention of dental caries (O). Methods: An electronic literature search of some databases such as Pubmed, Pubmed Central, Google Scholar, African Journal Online (AJOL) and Medline was conducted using these keywords delimited by Boolean operators AND, OR and NOT: “dental caries” “prevention” “Nigeria. Epidemiological studies using WHO criteria published in English between 1999 and 2019 were included in this study. Results: All studies that met the inclusion criteria were epidemiological cross-sectional studies, non-clinic –based. The approaches recommended include need for continuous caries surveillance, preventive and restorative programmes, primary prevention, use fluorides, oral health education and atraumatic restorative treatment. Conclusions: The recommended approaches should include continuous caries monitoring, comprehensive preventive and restorative programmes, primary prevention, use fluorides, oral health education and atraumatic restorative treatments in public schools and primary health care (PHC) centres. It is necessary to augment these approaches with undergraduate cariology curriculum review of dental schools, public-private partnership and oral health policy implementation with emphasis on prevention.
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ORIGINAL ARTICLES Top

An in vivo investigation of diagnostic performance of DIAGNOdent pen and the Canary System for assessment and monitoring enamel caries under fissure sealants p. 246
Nada Jaafar, Hala Ragab, Ahmed Abedrahman, Essam Osman
DOI:10.4103/jispcd.JISPCD_480_19  
Aim and Objectives: The aim of this study was to evaluate and compare the diagnostic performance of a quantitative light-induced fluorescence (DIAGNOdent pen [DP]) and a photothermal radiometry (Canary System [CS]) for assessment and monitoring occlusal enamel caries under fissure sealants placed on young permanent teeth. Materials and Methods: Forty-five patients of mean age 9.96 (1.4) years, having at least two occlusal surface sites of non-cavitated lesions (International Caries Detection and Assessment System [ICDAS], 1–3 at baseline), were assigned for this clinical study as per specific inclusion/exclusion criteria. A total of 90 permanent teeth were examined using a visual examination method (ICDAS), a quantitative light-induced fluorescence (DP), and a photothermal radiometry (CS). Teeth were randomly divided into two groups based on the type of fissure sealants: a resin sealant and a glass-ionomer sealant. Sealants were placed over the study sites, and caries assessment was performed with each caries detection method at 3- and 6-month recall appointments. Numerical data were presented as mean, standard deviation, median, and interquartile range values. Qualitative data were presented as frequencies and percentages. Receiver operating characteristic (ROC) curve was constructed to determine the diagnostic accuracy measures of the two modalities and compared using z-statistic. ROC curve analysis was performed with MedCalc software, Ostend, Belgium, version 11.3 for Windows (MedCalc Software). Changes by time in caries progression were analyzed using McNemar test and Cochran Q test. The significance level was set at P ≤ 0.05. Statistical analysis was performed with the IBM Statistical Package for the Social Sciences (SPSS) software for Windows, version 23.0 (IBM, Armonk, New York). Results: The CS and DP were able to distinguish between sound and carious tissue beneath fully and partially retained sealants at 6-month follow-up with an accuracy of 46.7% and 33.4%, respectively. Conclusion: The diagnostic performance of the CS and DP are acceptable and can be considered as useful adjunct tools in the clinical evaluation and monitoring the changes in enamel due to lesion progression under fissure sealants. However, in the clinical setting, sensitivity and specificity of these devices may be influenced by the sealant type, thickness, retention, and the differences in the lesion characteristics over time.
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Demographic and behavioral risk factors for oral cancer among Florida residents p. 255
Denice C Curtis, Scott C Eckhart, Amanda C Morrow, Laura C Sikes, Tasnim Mridha
DOI:10.4103/jispcd.JISPCD_39_20  
Objectives: Almost 29,000 new cases and approximately 7,500 deaths are directly attributable to oral cancer in the United States. Understanding the impact of specific behavioral and demographic characteristics on oral cancer is crucial to being able to promote early diagnoses through oral cancer screening. This study hypothesized that selected factors would be predictive of the incidence of oral cancer in Florida’s population. Materials and Methods: Approximately 74,000 cases from the Florida Cancer Data System (FCDS) were included in the study. Demographic and risk factors evaluated included sex, age, marital status, ethnicity, race, primary insurance payer, birthplace, cigarette use, smokeless tobacco use, cancer behavior, and other tobacco use. Logistic regression analysis was used to assess the association of 11 risk factors and oral cancer in Florida. Results: Males, Blacks, Hispanics, married individuals, and current smokers were significantly more likely to be diagnosed with oral cancer compared to their counterparts. Conclusion: Florida’s health providers need to be aware of the risk factors for oral cancer, look for early signs of oral cancer and recommend routine screenings in patients with history of known risk factors. Including additional reported elements such as human papillomavirus (HPV) history, sunlight exposure, vaping and use of e-cigarettes, and alcohol consumption (by amount) in the cancer registry would be greatly beneficial.
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The influence of the suture-less anterior releasing incision in a triangular flap design on postoperative healing following surgical removal of impacted mandibular third molars p. 262
Sunil S Nayak, Anushka Arora, Ashmeet Shah, Amee Sanghavi, Abhay T Kamath, Vanishri S Nayak
DOI:10.4103/jispcd.JISPCD_444_19  
Objectives: The objective of this study was to determine the effect of suture-less anterior releasing incisions on postoperative wound healing following surgical removal of impacted mandibular third molars. Materials and Methods: A total of 112 patients were included in the study. Group 1 had 56 patients in which the anterior releasing incision was not sutured postoperatively, and group 2 had 56 patients, in whom the anterior releasing incision was sutured. The two groups were compared in terms of pain, swelling, and trismus at 1 day, 3 days, and 7 days postoperatively. The Univariate Type III Repeated-Measures ANOVA Assuming Sphericity was used to compare the two modes of treatments at different time points. The periodontal healing distal to the second molar was assessed on the first day and at 2 months following the surgical intervention. The independent t test was used to compare the periodontal healing between the two groups at two time points. Results: No significant difference was observed between the two groups for pain and trismus (P > 0.05). However, the swelling was significantly greater in group 2 as compared to group 1 (P < 0.001). Periodontal healing was better in group 2, which showed lower periodontal probing depth distal to the mandibular second molar, compared to group 1 (P < 0.05). Conclusion: Suture-less anterior releasing incision decreases the postoperative swelling and edema, but the periodontal healing was poor when compared to the sutured anterior releasing incision cases. The type of closure technique did not have any significant influence on pain and trismus.
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Comparative evaluation of hair, fingernails, and toenails as biomarkers of fluoride exposure: A cross-sectional study p. 269
Mathew Vidyadharan, Jyothi S Issac, Angel M Joseph, Ashwin Joseph, Dhanya John, Vinutha K Varadharaju
DOI:10.4103/jispcd.JISPCD_52_20  
Background: The increased prevalence of fluorosis has led to a search for biomarkers of fluoride exposure. Among the biomarkers of sub-chronic exposure to fluoride, hair, fingernails, and toenails have the advantage of being noninvasively collected, easily transported, and stored. Objective: The objective of this study was to comparatively evaluate coronal hair, fingernails, and toenails as biomarkers of fluoride exposure from drinking water; the study was designed as a population-based observational cross-sectional study. Materials and Methods: A population-based observational cross-sectional study was conducted in 60 children (20 subjects per group) of ages 12–17 years in three villages of Nilakottai block, Dindigul district, Tamil Nadu, India (Thomaspuram, Bangalapatti, and Singampatti). The fluoride concentration in the household drinking water was analyzed and compared with the fluoride content in the coronal hair, fingernail, and toenail clippings, which was estimated by potentiometric method (fluoride-ion-selective electrode) and expressed in ppm (parts per million). A two-tailed probability value of P < 0.05 was considered significant. Results: The mean fluoride concentration in drinking water was 0.63ppm in Thomaspuram, 1.63ppm in Bangalapatti, and 2.92ppm in Singampatti. The mean fluoride content in hair samples was 2.84ppm, 4.67ppm, and 6.53ppm; fingernail clippings was 2.99ppm, 4.94ppm, and 6.84ppm; and toenail clippings was estimated as 3.13ppm, 5.10ppm, and 7.24ppm in Thomaspuram, Bangalapatti, and Singampatti residents, respectively. The mean fluoride content in the hair, fingernails, and toenails was significantly higher as compared to the mean fluoride content in the drinking water (viz., toenail fluoride > fingernail fluoride > hair fluoride). Conclusion: Coronal hair, fingernails, and toenails are useful biomarkers for both sub-chronic and chronic fluoride exposure from drinking water. Due to ample sample availability and the highest fluoride content, toenails are the most suitable biomarkers of fluoride exposure from drinking water.
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Numerical three-dimensional finite element modeling of cavity shape and optimal material selection by analysis of stress distribution on class V cavities of mandibular premolars p. 279
Swathi Pai, Vishal Bhat, Vathsala Patil, Nithesh Naik, Swetank Awasthi, Nithin Nayak
DOI:10.4103/jispcd.JISPCD_75_20  
Aim: Adhesive restoration does not depend primarily on the configuration of the shape of the cavity. Under varying loading conditions, it is essential to know the stress concentration and load transfer mechanism for distinct cavity shapes. The aim of this study was to evaluate and compare the biomechanical characteristics of various cavity shapes, namely oval, elliptical, trapezoidal, and rectangular shapes of class V cavities on mandibular premolars restored with amalgam, glass ionomer cement, and Cention N using three-dimensional (3D) finite element analysis. Materials and Methods: A 3D prototype of a mandibular premolar was generated by Digital Imaging and Communications in Medicine (DICOM) images obtained from the cone beam computed tomography and imported to 3D modeling software tool, SpaceClaim. The four distinct load magnitudes of 100, 150, 200, and 250N were applied as a pressure load perpendicular to the lingual plane of the lingual cusp of the occlusal surface (normal load) and at 45° to same (oblique load). The stress distribution patterns and the maximum von Mises stresses were analyzed and compared. Results: The occlusal stresses were distributed from the force loading point in an approximate actinomorphic pattern, and when the force load was close to the margin, the stress was much greater. Conclusion: Ovoid cavity showed lesser stress concentration and deformation for each of the tested restorative material.
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Comparative evaluation of CephNinja for android and NemoCeph for computer for cephalometric analysis: A study to evaluate the diagnostic performance of CephNinja for cephalometric analysis p. 286
Mukesh Kumar, Sommya Kumari, Ambuj Chandna, Konark , Anju Singh, Harsh Kumar, Punita
DOI:10.4103/jispcd.JISPCD_4_20  
Background: Since the introduction of digitization in cephalometrics, orthodontics has experienced a new horizon. Technological advancement is usually followed by comparisons between the methods. Aims: The aim of this study was to compare values of cephalometric analysis performed by CephNinja and NemoCeph for Downs’s analysis. Settings and Design: This prospective study was conducted using 100 diagnostic digital lateral cephalograms taken from the same machine. The samples were collected by non-probability convenience sampling procedures. Materials and Methods: The diagnostic images were cropped to standard lateral cephalogram film dimension; a scale image was placed on the top for calibration, numbered 1–100 for identification and was saved in Joint Photographic Experts Group (JPEG) format. A laptop with mouse-controlled cursor was used for NemoCeph and an android phone controlled with finger touch screen was used for CephNinja. Landmark identification for cephalometric analysis was carried out as demanded by the software. Statistical Analysis Used: One-way analysis of variance (ANOVA) was used for comparison between the variables, and one-way ANOVA followed by post hoc test was carried out to check the level of significance using Statistical Package for the Social Sciences software program, version 11.0. Results: The result showed that the difference of mean values obtained using the two software showed no statistical significance for 70% variables. Y-axis, incisor occlusal plane angle, and the upper incisor to A-Pog showed a statistically significant difference. Conclusion: CephNinja presented a satisfactory result with NemoCeph, and can be used interchangeably with confidence.
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Cephalometric evaluation of maxillary incisors inclination, facial, and growth axes in different vertical and sagittal patterns: An original study p. 292
Samar Bou Assi, Anthony Macari, Antoine Hanna, Roula Tarabay, Ziad Salameh
DOI:10.4103/jispcd.JISPCD_60_20  
Aim: The aim of this study was to evaluate the inclination of the maxillary incisors (I), facial axis (FA), and growth axis (GA) in different vertical and sagittal patterns. Materials and Methods: A total of 498 consecutive orthodontic patients, with an average age of 18.87 years (range = 5–63 years), were grouped based on their vertical and sagittal patterns. Maxillary incisors, FA, and GA axes were traced and their corresponding angles to nasion-basion and true horizontal lines were measured. The sample was divided into three groups based on the mandibular divergence (mandibular plane-MP/sella-nasion [SN]): Group 1—hypodivergent pattern (MP/SN ≤ 27; n = 30), Group 2—normodivergent pattern (27 < MP/SN <37; n = 254), and Group 3—hyperdivergent pattern (MP/SN ≥ 37; n = 214); the sample was then divided into three groups based on the sagittal pattern (ANB, angle between points A, Nasion and B): Group I—skeletal CLI (Class I) (0 <ANB <4; n = 228), Group II—skeletal CLII (ANB ≥ 4; n = 216), and Group III—skeletal CLIII (ANB ≤ 0; n = 54). Group differences were evaluated using the analysis of variance and post hoc tests. Chi-square tests were used for testing relationships between categorical variables. Results: FA/nasion-basion (NBa) and GA/NBa were different among the vertical groups (P < 0.001). FA/NBa was found significantly different in the sagittal groups, whereas GA/NBa was only different between CLII and CLIII groups. Compensation in maxillary incisors' inclination was present in the sagittal groups, but not in the vertical ones. CLI patients when stratified in vertical groups showed FA/NBa and GA/NBa to be different across the three vertical groups. Conclusion: FA/NBa was found different in the vertical and the sagittal groups. Maxillary incisors compensation was only found in the sagittal and not in the vertical groups.
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The vital pulp therapy of permanent teeth: A dental practitioner’s perspective from Saudi Arabia p. 300
Mazen D Doumani, Waod A Arnous, Malak F Alsafadi, Heba A Alnazer, Salman M Alanazi, Khaled S Alotaibi, AbdulAziz I Al-Ammari
DOI:10.4103/jispcd.JISPCD_69_19  
Aims and Objectives: The aim of this study was to determine the levels of knowledge and attitude of dental practitioners (DPs) toward vital pulp therapy (VPT) of young permanent teeth in Riyadh city, Saudi Arabia. Materials and Methods: A descriptive cross-sectional study was carried out by taking convenient sample of general DPs and specialist attending Saudi International Dental Conference, Riyadh, Saudi Arabia. A total of 200 DPs administered a structured, self-administered questionnaire to evaluate their knowledge and attitude toward VPT. The questionnaire comprised four parts: Part I: Characteristics of the study participants; Part II: Items related to indications and diagnosis of VPT; Part III: Questions related to the different VPTs for immature permanent teeth; and Part IV: Dental materials used in VPT and restoration. All the data were entered into the statistical analysis software Statistical Package for the Social Sciences version 21.0 (IBM, Armonk, NY) and analyzed by using descriptive statistics of frequency distribution and percentages for the categorical variables. Results: A total of 193 (men = 57% [110] and women = 43% [83]) DPs participated in this study with a response rate of 96.5%. Less than half of correct responses were observed with (Item 1) related to the duration of complete closure of root apex (43%) and (Item 14) use of sodium hypochlorite to serve as an excellent diagnostic tool to differentiate irreversible from reversible pulpitis. A high percentage of correct responses were seen with the (Item 9) indirect pulp capping––a procedure performed in a tooth with a deep carious lesion without signs or symptoms of pulp degeneration (75%). All other item responses ranged in between 52% and 72%. Conclusion: DPs showed fair-to-good knowledge and attitude toward VPT of young permanent teeth. In general, there is a need to improve knowledge and attitude of dental professionals about the VPT by attending continuing dental educational programs.
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Knowledge and awareness of effective recycling of dental materials and waste management among Peruvian undergraduate students of dentistry: A logistic regression analysis p. 309
Ana Diaz-Soriano, Walter Gallo, Silvia Luza, Arnaldo Munive-Degregori, Rocio Bocanegra, Frank Mayta-Tovalino
DOI:10.4103/jispcd.JISPCD_191_20  
Objective: Biomedical waste management and recycling is a very important topic today to preserve the environment, especially at the university level where future specialists in the health sciences are trained. So, the aim of this study was to evaluate the knowledge and awareness about recycling of dental materials and waste management among Peruvian undergraduate students of dentistry. Materials and Methods: This cross-sectional study evaluated 254 Peruvian undergraduate dentistry students from October 2019 to January 2020, at the National University of San Marcos. The associated factors evaluated were age (X1), sex (X2), year of study (X3), and marital status (X4), which were analyzed using a logit model to identify the influence of the intervening variables with a P value <0.05. Results: None of the variables studied were considered to be a factor affecting the awareness, knowledge, and management of biomedical waste in Peruvian dentistry students, with the following odds ratios (OR) being obtained: age (OR = 0.96; confidence interval [CI]: 0.85–1.08), sex (OR = 1.69; CI: 0.98–2.90), year of study (OR = 1.18; CI: 0.91–1.54), and marital status (OR = 1.84; CI: 0.14–23.68). Conclusions: The results of this study show that Peruvian Public University students have knowledge and are aware of the need for adequate management and/or recycling of biomedical waste dental care products, with none of the possible associated variables studied significantly affecting this relationship.
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Thickening of Schneiderian membrane secondary to periapical lesions: A retrospective radiographic analysis p. 316
Mohammed G Sghaireen
DOI:10.4103/jispcd.JISPCD_101_20  
Aim: The aim of this study was to investigate the possible correlation between adjacent periapical lesions of maxillary teeth and Schneiderian membrane thickness (SMT). Materials and Methods: An analytical study of case-control study design was conducted. From the archives, cone beam computed tomography (CBCT) images of 83 patients with periapical lesion in any of the maxillary posterior teeth were randomly selected as the case group. The normal, contralateral teeth in the same patient were considered in the control group. Eighty-eight teeth were considered in each group, comprising a total sample of 176. For each sample in case group, the distance from the border of the periapical lesion to the cortical bone of the bony floor of the maxillary sinus and SMT were measured. SMT on the contralateral side adjacent to the healthy (control) teeth was also measured. Data were presented in mean ± standard deviation and inferential statistics was performed using independent t test and analysis of variance (ANOVA). Later Pearson correlation and multiple linear logistic regression were carried out using Statistical Package for the Social Sciences software program, version 21.0 at 95% confidence interval. Results: Teeth with periapical lesion were found to have significantly (P < 0.001) increased SMT when compared with that of adjacent to healthy teeth. On the contrary, nonsignificant differences were found in SMT when genders and age groups were compared (P = 0.295 and 0.060, respectively). A strong negative correlation was observed between distance of the lesion to the sinus and SMT (P = 0.003). Conclusion: Neighboring periapical lesions of maxillary teeth are associated with SMT that is worsened when the lesion is close to the sinus.
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Extramural oral health educational program involving individuals with disabilities: Impact on dental students’ professionalism p. 323
Mas S Ahmad, Ilham W Mokhtar, Norhayati L A Khan
DOI:10.4103/jispcd.JISPCD_74_20  
Context: Oral health inequalities experienced by patients, including people with disabilities (PWD), have been related to dentists’ lack of professionalism and inadequate experience in managing patients with special needs. Aims: This study investigated the impact of an extramural program involving PWD on dental students’ professionalism and students’ perception of training in managing patients with special needs. Materials and Methods: A group of 165 undergraduate dental students (year 1 to year 5) participated in a voluntary program, involving 124 visually impaired children, at a special education school in Kuala Lumpur, Malaysia. A dedicated module in oral health was developed by specialists in special care dentistry, pedodontics, and medical sciences. Dental students then participated in a semi-structured focus group interview survey to discuss perceptions of their learning experiences. Qualitative data were analyzed via thematic analysis. Results: The program had positive impact on various aspects categorized into four major domains: professional knowledge (e.g., understanding of oral-systemic-social-environmental health interaction and understanding of disability), professional skills (e.g., communication and organizational skills), professional behavior (e.g., empathy and teamwork), and value-added learning (e.g., photography and information technology skills). Students showed improved willingness to manage, and comfort in managing PWD, and expressed support for future educational programs involving this patient cohort. Conclusion: Improved knowledge, skills, attitudes, and personal values, as well as support for future programs, indicate the positive impact of extramural educational activities involving PWD in developing professionalism in patient care, while providing an opportunity for students to be exposed to managing patients with special needs.
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Impact of demographic factors, obesity, and oral health status on self-esteem among school-going children in United Arab Emirates: A cross-sectional study p. 329
Foroogh Abdalla Khadri, Vellore K Gopinath, Mark P Hector, Elizabeth S Davenport
DOI:10.4103/jispcd.JISPCD_422_19  
Objectives: The objective of this study was to determine if oral health, obesity, and demographic factors have an impact on self-esteem among school-going children in United Arab Emirates. Materials and Methods: Ten schools (six private and four public) were selected using random digit table. Decayed, missing, and filled teeth index according to the World Health Organization criteria was used to assess dental caries. Obesity was measured by body mass index (BMI = weight [kg]/height [m2]). Data related to demographic details and toothbrushing were collected and entered into assessment forms. The mental well-being was assessed using Rosenberg Self-esteem Scale. Results: Self-esteem score was 19.8 (standard deviation [SD], ±3.8) mean, and ranged from 19.1 to 20.5. The presence or absence of dental caries or their body shape (obesity/overweight/normal weight) had no impact on the self-esteem scores. Of the participants, 93% brushed daily, whereas the brushing frequency was significantly greater in female children (98%) (P < 0.001) and children with higher self-esteem scores (P = 0.066). The self-esteem scores of school children was positively associated with age as elder children had higher scores (P = 0.001). Children of Indian origin had lower self-esteem (P = 0.004). BMI was negatively associated (P = 0.006). Conclusion: Rosenberg Self-esteem Scale scores were found to be lower in young children and Indian children. The child’s obesity and dental caries status had no significant influence on their self-esteem. High self-esteem in older children can be linked with increased toothbrushing frequency.
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The effect of number of patients treated, dental loupes usage, stress, and exercise on musculoskeletal pain among dentists in Jeddah p. 336
Ehab N Alshouibi, Lolo A Almansour, Assalah M Alqurashi, Faten E Alaqil
DOI:10.4103/jispcd.JISPCD_2_20  
Objectives: The aim of this study was to investigate the prevalence of musculoskeletal pain (MSP) and to explore its potential risk factors among dentists in Jeddah, Saudi Arabia. Materials and Methods: A cross-sectional survey of private and government dentists in Jeddah, Saudi Arabia was undertaken between January and December 2018. A self-administered questionnaire was distributed randomly to consenting participants. Descriptive data analysis involved measures of central tendency and percentages, t test, chi-square, and logistic regression analysis were used to evaluate relationships among the variable “having MSP experience after dental work” and other potential predictors among dentists. Results: A total of 300 dentists completed the questionnaires. The overall prevalence of MSP was 68%, with back pain as the most frequently reported symptom (54%). The results revealed significant association of MSP with number of patients treated per day, nonuse of dental loupes during dental work, stress, and lack of regular exercise (P < 0.05). Conclusion: The prevalence of MSP among dentists in Jeddah is high attributable to poor ergonomics and stress, which further impact the quality of life of practitioners.
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Cellular and biochemical changes in different categories of periodontitis: A patient-based study p. 341
Fiona Shee, Swati Pralhad, Srikant Natarajan, Nidhi Manaktala, S Arun, Aradhana Marathe
DOI:10.4103/jispcd.JISPCD_42_20  
Objectives: The aim of this study was to study the effects of periodontitis, diabetes mellitus (DM), and tobacco smoking and chewing habits (TBSCH) on the oxidative stress biomarker levels, namely malondialdehyde (MDA), and the mucosal genotoxic nuclear damage in the marginal gingival cells of subjects. Furthermore, the correlation of the biomarkers, MDA, and nuclear changes in the form of micronucleation (Mn) and binucleation (Bn) was investigated. Materials and Methods: Forty study participants were divided into five subject categories, which were established based on the presence of periodontitis, DM, and TBSCH. Whole saliva and marginal gingival smears collected from subjects were used to determine MDA levels and nuclear changes, respectively. A full-mouth assessment of periodontal pocket depth, clinical attachment loss, and bleeding on probing was performed for each subject to determine periodontal status. Results: MDA and Mn levels between control group and subjects with only periodontitis (MDA: P < 0.9990; Mn: P < 0.8200) showed no significant difference, whereas levels among subjects with DM, TBSCH, and periodontitis, and all other categories were statistically significant (MDA: P < 0.001). DM and/or TBSCH superimposed on periodontitis cause an exponential increase in biomarker levels. Furthermore, MDA and Mn showed poor correlation (r = 0.162; P = 0.318). Periodontitis alone did not significantly increase oxidative stress levels compared to healthy controls, whereas DM and TBSCH resulted in augmented oxidative stress levels, implying that increased stress produced by DM and TBSCH aggravates or exaggerates periodontal inflammation. Conclusion: Poor correlation between MDA and Mn indicated that the mechanisms involved in their production are independent of each other.
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Occupational stress among orthodontists in Saudi Arabia p. 350
Nasser D Alqahtani, Shahad Aljajji, Nouf Alshalan, Aljazi Aljabaa, Mohammad Aldosari, Sahar Albarakati
DOI:10.4103/jispcd.JISPCD_376_19  
Aim: The aim of this study was to identify potential occupational stressors among orthodontists practicing in Saudi Arabia, and to evaluate their relationship to personal and professional characteristics. Materials and Methods: Using a validated occupational stress assessment (OSA) questionnaire, demographic information and data pertaining to potential occupational stressors and professional characteristics of the participants were collected. The OSA questionnaire was adopted and modified based on Cooper et al. classification of potential stressors. To assure anonymity of the protocol, the respondents were given the OSA questionnaire at their clinical settings or scientific meetings and requested to return the filled copy of the questionnaire without any personal disclosures. The severity of stressors was assessed using a five-point Likert scale, and individual scores were summed to obtain the overall severity score. The collected data were coded, tabulated, and analyzed using statistical software. Results: Samples of 253 orthodontists were evaluated with a response rate of 82.6% (209) and a higher proportion of male participants (75.1%). The mean severity score for stress was higher among orthodontists of age less than 30 years when compared with those more than 50 years of age (F = 3.486; P = 0.017). Similarly, the mean severity score was higher among orthodontists who had completed their residency program in Saudi Arabia, Arab countries, and Asian countries (F = 5.425; P < 0.0001). Further categorization of the stressors based on patient-, time-, staff-, work-, referral-, and income-related factors were carried out. Although patient-related factors (mean = 3.38) were considered the most stressful, referral- and income-related factors (mean = 2.39) were considered the least stressful. Conclusion: Pronounced variation was evident in assessing the potential stressors among orthodontists. Nevertheless, time management and proper patient education can address the most concerning stressors among orthodontists in Saudi Arabia.
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Qualitative and quantitative assessment of remineralizing effect of prophylactic toothpaste promoting brushite formation: A randomized clinical trial p. 359
Maria A Polyakova, Marianna G Arakelyan, Ksenia S Babina, Edita G Margaryan, Inna A Sokhova, Vladlena Yu Doroshina, Nina E Novozhilova
DOI:10.4103/jispcd.JISPCD_493_19  
Background: Currently various studies are conducted to improve the effect of existing and developing new remineralizing agents. One of the trends in remineralizing therapy is the development of toothpaste allowing brushite crystals formation in the demineralized lesions of hard tooth tissues. Aim: The aim of this study was to assess the effect of toothpaste, forming a brushite, on the functional acid resistance of enamel and the speed of its remineralization. Materials and Methods: This was a randomized controlled double-blind clinical study. Sixty consent patients aged 20–25 years were enrolled in the three groups: test group (n = 20), positive control group (n = 20), and negative control group (n = 20), which used brushite-forming toothpaste, toothpaste with hydroxyapatite (HAP), and toothpaste without remineralizing agents, respectively. The hygiene indices, the rate of enamel remineralization, the dynamics of acid resistance of enamel, and the level of enamel sensitivity were determined at baseline, after 2 and 4 weeks to assess the effectiveness of toothpastes. Friedman rank sum test (for related variables) and the Kruskal–Wallis rank sum test (for independent variables) with Nemenyi post hoc test were used for statistical comparisons. Results: The study test and positive control groups showed significantly greater acid resistance of enamel (P > 0.05) and rate of its remineralization at the study endpoints as compared with negative control group.In the test and positive control groups, Schiff index values significantly decreased after 4 weeks, whereas in the negative control group no significant differences were observed at the study time points. The oral hygiene level improved significantly after 2 and 4 weeks in all groups. Conclusion: The 30-day use of paste that promotes brushite formation and paste with hydroxyapatite resulted in faster enamel remineralization and higher enamel resistance. Brushite-containing toothpaste may be used as an alternative to HAP containing for remineralizing and desensitizing treatment.
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Evaluation of the papillary gingival vasculature in smokers and nonsmokers with chronic periodontitis: A clinical in vivo study p. 368
Mohamad Rifai, Georges Aoun, Zeina Majzoub
DOI:10.4103/jispcd.JISPCD_134_20  
Aim: Cigarette smoking has been recognized as an important risk factor in periodontal diseases. One of the suggested mechanisms behind this association is that nicotine alters the microcirculation and causes vasoconstriction and reduced blood flow through the periodontal tissues. Scarce information is currently available relative to the microvascular alterations associated with smoking and the distribution of capillaries through the various areas of the gingival tissues. The aims of this study were to assess, in human interproximal gingival biopsies, the number and diameter of gingival capillaries in periodontally affected smokers and nonsmokers using the CD34 immunohistochemical staining method. The pattern of distribution of vessels in the different areas of the gingival tissues was also assessed. Materials and Methods: Systemically healthy patients with moderate chronic periodontitis and ranging in age between 30 and 60 years were recruited for the study from the patient population attending the Periodontology Department of the Faculty of Dental Medicine at the Lebanese University of Beirut. The patients were selected to have a group of 10 patients (Group SP) of smokers (>10 cigarettes/day for the last 10 years) and a second group (Group NP) consisting of nonsmoking periodontally affected patients. Three to four weeks following initial preparation, one interproximal gingival biopsy was obtained from each patient. Immunohistochemical staining with CD34 mouse monoclonal antibody was used to identify the endothelial cells of the blood vessels within each sample. Twelve biopsy samples (five in Group NP and seven in Group SP) were chosen for the measurement of the number and diameter of vessels in three regions of the connective tissue of the biopsy under a blinded protocol. Results: In the two groups, the quantitative distribution of small, medium, and large vessels followed a similar trend with the number of small vessels being significantly greater than both medium and large vessels. Small vessels prevailed in the peripheral regions, whereas large vessels were more abundant in the deeper connective tissue areas. The total number of vessels seemed unaffected by chronic cigarette smoking in both groups in the entire biopsy area and in the separate connective tissue regions. Quantitative alteration in the total number of gingival capillaries was not observed in chronic smokers. A redistribution of small and large vessels in the superficial and deeper connective tissue areas of the gingival papilla was noted as a result of smoking in periodontal patients. Conclusion: The quantitative distribution of small, medium, and large vessels follows a similar trend with the content in small vessels being significantly more important than both medium and large vessels. Smoking and periodontitis result in a redistribution of small and large vessels in the superficial and deeper connective tissue areas of the gingival papilla compared to nonsmoking periodontal patients. The significance and clinical implications of such rearrangement of vasculature within the gingival tissue need to be further investigated.
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Role of telemedicine and smartphone for distant patient management in dentistry: The new way of triage p. 376
Giorgia Capocasale, Giulio Perno, Riccardo Nocini, Massimo Albanese, Francesca Zotti
DOI:10.4103/jispcd.JISPCD_6_20  
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