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   Table of Contents - Current issue
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November-December 2020
Volume 10 | Issue 6
Page Nos. 681-811

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REVIEW ARTICLES  

Povidone–iodine solution: A potential antiseptic to minimize the risk of COVID-19? A narrative review Highly accessed article p. 681
Carmen Castro-Ruiz, Andrea Vergara-Buenaventura
DOI:10.4103/jispcd.JISPCD_304_20  
Objectives: Patients are mask-free during dental attention. In addition, dentists and dental staff after working for hours need to hydrate or eat. Removing the mask makes them vulnerable to the risk of contamination. For those cases, a prophylactic decontamination protocol could be useful as an adjunct to the most recommended biosecurity protocols. This article aims to provide a comprehensive review of the published evidence about the use of povidone–iodine (PVP-I) against SARS-CoV-2 and to propose a prophylactic protocol for dental attention using PVP-I during the COVID-19 pandemic. Materials and Methods: An electronic search in Medline via PubMed, Scopus, Cochrane Library and Scielo databases was performed up to July 24, 2020, to identify relevant literature focusing on Povidone Iodine, SARS-CoV-2, COVID-19, SARS-COV, MERS, antiviral mouthwashes, and oral cavity. Results: Clinical studies on the virucidal effectiveness of PVP-I against SARS‐CoV‐2 have not yet been reported. We identify a recent in vitro study showing PVP-I effectiveness at 0.5, 1, and 1.5% within 15s of contact. Moreover, another in vitro study has shown ≥99.99% virucidal activity as 1% mouthwash and 0.45% throat spray. The only study in SARS-CoV-2 confirmed patients reported a significant 3h drop in viral load after rinsing with 15 mL of 1% PVP-I for 1min. Conclusions: Although no clinical trials have reported the efficacy of PVP-I on SARS-CoV-2, recent studies in patients with positive PCR to SARS-CoV-2 found a significant 3-h drop in viral load. We believe that an oral prophylactic protocol with PVP-I for dental healthcare workers and patients as an adjunct to the current biosecurity protocol could minimize the transmission risk during COVID-19 pandemic.
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Efficacy of lignocaine with buprenorphine versus lignocaine in the management of postoperative pain after minor oral surgical procedures: A systematic review and meta-analysis p. 686
Anupam Singh, Srikanth Gadicherla, Komal Smriti, Kalyana C Pentapati
DOI:10.4103/jispcd.JISPCD_316_20  
We aimed to review the efficacy of lignocaine with buprenorphine versus lignocaine alone in the management of postoperative pain after minor oral surgical procedures. Randomized controlled trials evaluating the efficacy of use of lignocaine with buprenorphine versus lignocaine for intra-oral procedures were included by searching multiple databases. Outcomes assessed were onset of the time of anesthesia in seconds, duration of postoperative analgesia, postoperative pain (maximal follow-up), the number of rescue analgesics required, and adverse events. The search strategy yielded 167 publications for the title and abstract screening out of which only two trials were included for full-text screening. There was considerable heterogeneity among the included studies with regards to the outcomes assessed. The need for rescue analgesics was the only outcome that was included for meta-analyses. Forest plot showed that lignocaine with buprenorphine compared to lignocaine showed a significantly lower requirement of rescue analgesics (–0.22[–2.9,–1.55]). No trial reported any adverse effects. The results show that lignocaine with buprenorphine is effective in reducing the number of rescue analgesics required by the patient.
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Scaffolds— The Ground for Regeneration: A Narrative Review p. 692
Sourabh Ramesh Joshi, Gowri Swaminatham Pendyala, Pratima Shah, Viddyasagar Prabhakar Mopagar, Neeta Padmawar, Meghana Padubidri
DOI:10.4103/jispcd.JISPCD_198_20  
Aim: The aim of this study was to comprehensively review the various biomaterials used as scaffolds, rates of biodegradability of natural, artificial and composite hybrid scaffolds, and the role of controlled biodegradability in tissue engineering. Materials and Methods: An electronic search for systematic review was conducted in PubMed/MEDLINE (www.ncbi.nlm.nih.gov), Cochrane (www.cochrane.org), Scopus (www.scopus.com) databases, and dental journals related to endodontics and pediatric dentistry to identify the research investigations associated with the degradation profiles, factors relating to degradation, rates of biodegradability and the role of controlled biodegradability of natural, artificial and composite scaffolds. A sample of 17 relevant studies and case reports were identified in our search of 100 using simple random sampling. Results: Naturally derived scaffolds degrade at a much higher rate than artificial and composite scaffolds. The degradation profiles of composite scaffolds can be much better controlled than naturally derived scaffolds. Conclusion: Composite scaffolds are more favorable as compared to natural or artificial scaffolds, as it has superior mechanical properties, minimal immune response, and a controlled rate of degradation and consequent tissue regeneration.
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Implant bio-mechanics for successful implant therapy: A systematic review p. 700
Khaled Mosfer Alzahrani
DOI:10.4103/jispcd.JISPCD_138_20  
Background: Dental implants are considered the best treatment option for replacement of missing teeth due to high survival rates and diverse applications. However, not all dental implant therapies are successful and some fail due to various biological and or/mechanical factors. The objective of this study was to systematically review primary studies that focus on the biomechanical properties of dental implants in order to determine which biomechanical properties are most important for success of dental implant therapy. Materials and Methods: An electronic database search was performed using MEDLINE (PubMed), EMBASE, Google Scholar, and CAB Abstracts. Six principal biomechanical properties were considered to prepare the search strategy for each database using key words and Boolean operators. Human and animal studies (observational studies, trials, and in vitro studies) were included in this review. Human studies that were considered eligible needed to have subjects above 18 years who received permanent restorations after implant surgery and followed up for at least 6 months after receiving permanent restorations. Studies with subjects who had absolute contraindications at the time of dental implant surgery were excluded. Results: In total, 28 studies were included in the review after application of the eligibility criteria; 18 in vitro studies, 5 cohort clinical studies, 3 animal studies, and 2 nonrandomized trials. Six in vitro studies assessed loss of preload, five in vitro studies assessed fatigue strength, four assessed implant abutment connection design, and one assessed implant diameter. Two nonrandomized trials assessed torque and six observational studies assessed the effect of cantilevers. Gold alloy coating of abutment screws resulted in higher preload values followed by titanium alloy coating and gold coating; there was a difference in preload values between coated and uncoated screws when tightened repeatedly. Preload values decreased as a function of time with majority of preload loss occurred within 10s of tightening. The 8-degree internal conical implant performed better than the internal hex design. Higher rate of complications (porcelain chipping, de-cementation) was observed in the cantilever groups in studies. Conclusion: Biomechanical properties of implants like preload, torque, cantilever design, implant abutment design have profound effects on the survival rates of dental implants. With limiations, this review provides some important parameters to consider for successful implant therapy.
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Pathogen reduction technology: A novel possibility for inactivation of blood products used in oral and periodontal surgeries p. 713
Sudhir Rama Varma, Mohamed Jaber, Salem Abu Fanas, Vijay Desai, Sam Thomas, Moutassem Khair
DOI:10.4103/jispcd.JISPCD_327_20  
Emergency surgical treatment has been challenging and the risk of blood contamination has been high, which is a concern among the medical and dental fraternity. The risk outweighs the benefits in these unprecedented times if proper screening and inactivation of blood products are not performed. Pathogen reduction technologies incorporate various modalities for the inactivation of blood products mainly related to blood transfusion. Oral surgical procedures and periodontal surgeries use platelet-rich fibrin for various regenerative procedures that amplify the prognosis positively. The use of blood products for various treatments could result in contamination, a factor which should be significant attention. The objective of this study was to review the role of pathogen reduction technology in inactivating pathogens in blood products and its use in oral and periodontal surgical procedures. The literature presented in the study is from original studies from a period of 2000 to 2020 which was sourced from Medline, PubMed, and Cochrane central databases. Relevant published papers and in-press papers that provided information were identified and selected. The studies presented have shown data related to implementation of pathogen reduction technologies in relation to the severe acute respiratory syndrome, Middle East respiratory syndrome, and its possible implementation in coronavirus disease-2019 (COVID-19). The paper reviews the various technologies offered and the possibility to eradicate pathogens found in routine blood products, used in oral and periodontal surgical procedures. In all probability, the use of pathogen reduction technology might offer a ray of light to contain the spread among dental treatment procedures
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ORIGINAL ARTICLES Top

Antimicrobial efficacy of charcoal vs. non-charcoal toothbrushes: A randomized controlled study p. 719
Reema Zaid AlDhawi, Najla Hamad AlNaqa, Oula Esam Tashkandi, Ahmed Tawfiq Gamal, Haifa Fahad AlShammery, Samar Mohammad Eltom
DOI:10.4103/jispcd.JISPCD_290_20  
Aim: To assess the efficacy of the antimicrobial properties of charcoal vs. non-charcoal toothbrushes and the level of bacterial contamination in the oral cavity using a charcoal toothbrush. Materials and Methods: This was a randomized, double-blind controlled study in which both male and female subjects aged from 18 to 35 were included (n = 30; 15 males and 15 females). The subjects were selected from (students) of Riyadh Elm University in Riyadh, Saudi Arabia. Subjects were informed about the study and signed the consent form before participation. From January to April 2019, subjects were given charcoal and non-charcoal toothbrushes. Results: The Wilcoxon signed rank test showed that there was a significant difference in bacterial counts between non-charcoal and charcoal toothbrushes (P = 0.000). Of the subjects, 70% showed a decrease in the number of bacterial counts while 30% showed no increase in bacterial counts. There was a statistically significant decrease in the number of bacteria in the gingival crevicular fluid (GCF) with charcoal treatment (P < 0.001). Of the subjects, 96.6% showed a decrease in the count of bacteria in GCF after using a charcoal toothbrush. Only 3.3% of the subjects had the similar counts of bacteria in GCF after using the charcoal toothbrush. Conclusion: The study demonstrates that charcoal toothbrushes reduce bacterial contamination and the poor effects on oral health after 1 week of use.
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Antifungal efficacy of four different concentrations of the essential oil of Cinnamomum zeylanicum (Canela) against Candida albicans: An in vitro study p. 724
René Hurtado, Nimia Peltroche, Franco Mauricio, Walter Gallo, Daniel Alvítez-Temoche, Luzmila Vilchez, Frank Mayta-Tovalino
DOI:10.4103/jispcd.JISPCD_251_20  
Objective: The objective of this study was to compare in vitro the antifungal efficacy of the essential oil of Cinnamomum zeylanicum (Canela) (EOC) at 25%, 50%, 75%, and 100% against strains of Candida albicans ATCC 10231. Materials and Methods: The design was experimental, in vitro, prospective, and longitudinal study, having a sample of n = 30 petri dishes per six groups. The test was conducted in the microbiology laboratory of the Universidad Nacional Federico Villarreal. The essential oil was prepared by steam distillation, which means that the pressure steam enters in connection with the plant cells and breaks them, releasing the essence and trapping it in drops of water. Cinnamon essential oil was obtained using the hydrodistillation method, subsequently the oil obtained was dehydrated with sodium sulfate and then filtered at 0.22 µm. Then the vials were stored at a temperature of 4°C. Finally, Candida albicans ATCC 10231 was used as the biological material. Antifungal efficacy was measured by the Kirby–Bauer method (disk diffusion). Results: It was found that in the 24-h group the concentration that had the greatest antifungal effect was 100% EOC with a mean of 22.1 ± 11 mm; however, the lowest antifungal activity was seen in the 25% EOC with 17.9 ± 1.6 mm. On the contrary, in the 48-h group, it was shown that the highest antifungal efficacy was also observed in the 100% EOC with an average of 31.2 ± 3.2 mm, but the lowest antifungal activity was in the 25% EOC with 22.6 ± 1.7 mm. Although in both groups, both at 24 and 48h, nystatin was the one with the lowest antifungal efficacy 15.1 ± 1.0 and 19.9 ± 0.1 mm, respectively. Conclusions: EOC had a better statistically significant antifungal effect compared to nystatin. Otherwise, on analysis of the results in different concentrations, the EOC showed a directly proportional antifungal effectiveness as the concentration against the strains of C. albicans ATCC 10231 increased, compared to nystatin, suggesting its potential use as a possible attractive therapeutic alternative for the control of diseases caused by strains of C. albicans resistant to nystatin.
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Evaluation of hydrogen peroxide and cetylpyridinium chloride as bacterial decontaminants of dental unit water lines at a private Peruvian dental school p. 731
Arnaldo Munive-Degregori, Frank Mayta-Tovalino, Walter Gallo, Silvia Luza, Franco Mauricio, Saul Ilizarbe, Arnaldo Munive-Méndez
DOI:10.4103/jispcd.JISPCD_265_20  
Aim: The aim of this study was to evaluate the hydrogen peroxide and cetylpyridinium chloride as bacterial decontaminants of dental unit water lines at a private Peruvian dental school. Materials and Methods: Water samples were obtained from 66 dental units of a University Dental Clinic before decontamination treatment and at days 3 and 7 thereafter. The biofilm treatments were applied equitably among the two treatment groups (n = 22) and one negative control (distilled water). The samples obtained on each collection day were taken to the biochemical laboratory in thermal boxes and then diluted, seeded, and incubated at 37°C for 24h to count colony forming units per milliliter (CFU/mL). Results: The samples to which hydrogen peroxide were applied had a mean of 1.53 × 105 CFU/mL before application, 0.04 × 105 CFU/mL at day 3, and 0.03 × 105 CFU/mL at day 7, whereas the samples undergoing cetylpyridinium chloride treatment had a mean of 1.74 × 105 CFU/mL before application, 615.38 CFU/mL on day 3, and 307.69 CFU/mL on day 7. Distilled water treatment showed a mean of 1.72 × 105 ± 0.39 × 105 CFU/mL at baseline, 1.51 × 105 ± 1.40 × 105 CFU/mL at day 3, and a mean of 1.74 × 105 ± 0.47 × 105 CFU/mL at day 7. Statistically significant differences were found among the three treatment groups at days 3 (P ≤ 0.001) and 7 (P ≤ 0.001) but not at baseline (P = 0.306). Conclusions: The antibacterial effect of cetylpyridinium chloride was significantly greater than that of hydrogen peroxide and distilled water, and can, therefore, be used for bacterial control in the water lines of dental units.
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Comparison and evaluation of linear dimensional accuracy of three elastomeric impression materials at different time intervals using vision inspection system: An in vitro study p. 736
Shabab Ahmed Khan, Tushar, Sumaiya Nezam, Puja Singh, Neelu Kumari, Shashank Shekher Singh
DOI:10.4103/jispcd.JISPCD_282_20  
Background: Making an impression represents a crucial step in fabrication of a prosthesis. Elastomers are the most commonly used materials for precise and accurate recording and reproduction of tooth morphology and surrounding soft tissue. Aims and Objective: The aim of this study was to compare and evaluate the linear dimensional accuracy of three elastomeric impression materials: addition silicone, condensation silicone, and polyether at different time intervals up to 15 days using a vision inspection system. Materials and Methods: Dimensional accuracy of impression materials was measured at certain designated time periods using stainless steel die. The impressions of die were made using one representative material of each type of elastomeric impression material. The die along with the impression material in the mold was held using a clamp and put in a water bath maintained at mouth temperature. The linear dimensional changes taking place in each material with time were measured using the vision inspection system. Results: On comparison with master die impression at 30min, 1h, and 1½ h time interval, a significant decreased mean dimension of condensation silicone was observed, whereas addition silicone and polyether showed statistically nonsignificant difference. At 2, 3, 4, and 12h time span, a significant difference in mean dimension of addition and condensation silicone was noted, whereas polyether showed a nonsignificant difference. At 24h, 1 week, and 15 days duration, on comparison with the master die, a significant reduction in mean dimension of condensation silicone was discovered, whereas addition silicone and polyether showed nonsignificant difference. Conclusion: Polyether showed significantly lesser dimensional changes among all three materials, though the differences were small enough to be considered clinically acceptable.
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Comparison of regenerative potential of platelet-rich fibrin alone and in combination with bovine bone graft in intraosseous defect by single flap approach: A clinical and radiographic study p. 743
Bhaumik Thakkar, Sarath Chandran, Shivlal Vishnoi, Priyadarshini Nadig, Ruchi Raval, Priyanka Doshi
DOI:10.4103/jispcd.JISPCD_200_19  
Aim: To compare the regenerative potential of platelet-rich fibrin alone and in combination with bovine bone graft in intraosseous defect by the single flap approach. Materials and Methods: A total of 32 sites of intrabony defects were selected and were treated with platelet-rich fibrin (PRF) alone or in combination with bovine bone graft. Clinical parameters [Gingival index (GI), probing depth (PD), clinical attachment level (CAL), Gingival recession, and radiographic parameters (defect fill, alveolar crest level, and defect depth)] were recorded at baseline, 3 months, and 6 months. Results: Statistical analysis was done by independent and paired t-test. There were statistically significant changes in GI, PD reduction, CAL gain, defect fill, alveolar crest level changes, and defect depth resolution from baseline, 3 months, and 6 months in both the groups (P < 0.001). On intergroup comparison, Group II showed statistically significant changes in a reduction in pocket depth and defect depth resolution at P < 0.001. Conclusion: PRF in combination with bovine bone graft was more effective in the treatment of intrabony defects.
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Endodontic length measurements using different modalities: An in vitro study p. 752
Phuc Ngoc Nguyen, Khoa Van Pham
DOI:10.4103/jispcd.JISPCD_357_20  
Introduction: The aim of this study was to investigate and compare the accuracy of the 3D Endo software, conventional CBCT software Romexis Viewer, and the EAL E-Pex Pro in WL determination. Materials and Methods: Three hundred and two root canals in 110 intact human extracted molars were accessed. The actual lengths (ALs) were measured. Root canal lengths were measured using 3D Endo with proposed length (3D-PL) by software, correct length (3D-CL), Romexis Viewer, and the E-Pex Pro. The percentages of the measurements in the range of ±0.5 mm to the AL were compared using the Fisher’s exact test. The paired t test and Bland–Altman plots were calculated to detect the agreement of the four methods with the AL measurements. The statistical significance was set at P<0.05. Results: The accuracies in the range of ±0.5 mm to the AL were 83.8%, 86.7%, 48.3%, and 99.7% for 3D-PL, 3D-CL, Romexis Viewer, and E-PexPro, respectively. There were agreements between 3D-PL and Romexis Viewer with the AL measurements. Conclusion: The CBCT measurements using 3D Endo with the proposed length by the software and Romexis Viewer with the voxel size of 0.15 mm agreed with the AL measurements of the root canals.
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Plaque removal efficiency of chewable toothbrushes among 10–12-year-old children: A randomized control trial p. 759
Sridhar Nekkanti, Kanwardeep Kaur, Shwetha Balagopal, Priyanka Agarwal
DOI:10.4103/jispcd.JISPCD_339_20  
Aim and Objectives: Toothbrushing is one of the most important factors in controlling plaque accumulation and dental caries. There are vast varieties of toothbrushes available in the market. This study was designed to evaluate the effectiveness of novel chewable toothbrushes as compared to manual toothbrushes in plaque removal among 10–12-year-old children. Materials and Methods: This randomized controlled trial was conducted on 40 healthy children aged between 10 and 12 years of age who were randomly assigned to either of the groups: Group I––Chewable Toothbrushes and Group II––Manual Toothbrushes. Following oral prophylaxis, baseline records of oral hygiene indices (Simplified oral hygiene index (OHI-S) in indexed teeth and Turesky modification of Quigley Hein plaque index (TMQHI) were taken. Baseline Saliva samples were collected and sent for Streptococcus mutans counts. Children were then instructed to use their respective toothbrush twice daily for a week. Oral hygiene indices and S. mutans counts were repeated after 1 week. Results: Differences in pre-brushing and post-brushing plaque scores and salivary S. mutans counts were statistically significant when compared using paired-sample t test and independent-sample t test. There was a significant reduction in salivary S. mutans counts after using both chewable and manual toothbrushes. However, there was no statistically significant difference between the two groups (P = 0.08). Conclusion: Chewable toothbrushes are equally effective in plaque control when compared to manual toothbrushes. These can be a reliable alternative for children who lack manual dexterity.
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CBD-supplemented polishing powder enhances tooth polishing by inhibiting dental plaque bacteria p. 766
Kumar Vasudevan, Veronica Stahl
DOI:10.4103/jispcd.JISPCD_351_20  
Objective: Air polishing is a safe tooth polishing technique used by dental professionals for stain and plaque removal and as a preventive procedure for dental health. We previously reported the antibacterial properties of cannabinoids against dental plaque bacteria. The objective of this study was to analyze the possibilities to improvise the existing air-polishing technique by supplementing cannabinoid powder into the classic polishing powder for effective removal of supragingival and subgingival plaque and for inhibition of plaque-forming bacteria. Materials and Methods: The cannabidiol (CBD) powder was added to the tooth polishing powder (AIR-N-GO, classic) at a 1% (wt/wt) ratio. The study was conducted on 12 patients, of whom six received regular polishing treatment and six received CBD-supplemented polishing treatment. The dental plaque samples were collected before and after each treatment and subjected to in vitro microbiological analysis, and the colony forming units (CFU) were analyzed by using an automated colony counter. Results: Based on in vitro microbiological analysis, the average CFU of interdental space samples collected from post-CBD-supplemented polishing treatment was significantly reduced (linear fold change between 3.9 and 18.4) compared with that of postregular polishing (linear fold change between 1.0 and 2.6) treatment. Conclusions: The CBD-supplemented polishing powder can help in effective removal and killing of dental plaque bacteria during the polishing treatment; it can also be added as an enhancing supplement to the existing polishing powders.
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Clinical quantitative antibacterial potency of garlic-lemon against sodium hypochlorite in infected root canals: A double-blinded, randomized, controlled clinical trial p. 771
Riluwan Siddique, Manish Ranjan, Jerry Jose, Ankita Srivastav, Rajamohan Rajakeerthi, Ajith Kamath
DOI:10.4103/jispcd.JISPCD_287_20  
Introduction: Sodium hypochlorite for endodontic treatment has been shown to exhibit significant antimicrobial properties, with adverse effects such as sodium hypochlorite accidents. Natural irrigants have shown significant antimicrobial action and the added advantage of being biocompatible. This study proposes an alternative intracanal irrigant made from Garlic-Lemon (Ga-Li) extract. Aim: To evaluate the antimicrobial action of 1.8% Garlic-Lemon (Ga-Li) mixture in contrast to 3% sodium hypochlorite in a tooth diagnosed with asymptomatic apical periodontitis. Materials and Methods: Thirty patients were randomly allocated into two groups: Group A, 3% sodium hypochlorite and Group B, 1.8% Garlic-Lemon. Single- or multirooted teeth root canals were instrumented and prepared by using ProTaper Gold. Root canal samples were taken both pre- and postinstrumentation. These samples were subjected to DNA extraction, amplification, and quantification by using a real-time polymerase chain reaction (qPCR). Results: Samples before preparation (S1) were tested positive for microbial presence, with mean numbers of 7.0 ×107 and 12.4 ×107 bacterial cells for the sodium hypochlorite and Garlic-Lemon groups, respectively. Postpreparation (S2), in sodium hypochlorite and Garlic-Lemon groups, bacterial counts were still present with mean counts seen at 27.4 ×105 and 7.7 ×105 bacterial cells, respectively. Intergroup comparison resulted in a statistically insignificant difference (P > 0.05). Conclusion: Garlic-Lemon has shown microbial load reduction that is as effective as sodium hypochlorite, with the highest mean bacterial reduction percentage. The results of the present randomized, controlled clinical trial suggest that Garlic-Lemon is a potential new alternative as an endodontic irrigant.
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Comparative evaluation of efficacy of diode laser and Clinpro XT varnish for treatment of dentin hypersensitivity: A randomized clinical trial p. 779
Bhavika Alpesh Bhavsar, Michelle Vaz, Kamei Neilalung, Tanisha Das, Swarnaditya Majumdar, Jagriti Talukdar
DOI:10.4103/jispcd.JISPCD_356_20  
Context: Dentin hypersensitivity (DH) is a very common dilemma and often results in temporary relief by the conventional treatment method. An in vivo comparative study of various methods and materials helps in evaluation of a superior method to provide a long-lasting relief. Aim: The aim of this study was to evaluate the efficacy of diode laser (DL) and Clinpro XT Varnish for managing DH. Materials and Methods: This study was a randomized, single-blinded, clinical trial, designed, adhering to the CONSORT (Consolidated Standards of Reporting Trials) Guidelines using DL and fluoride-based varnish for managing DH. A total of 40 teeth were selected from eight patients and randomly divided into two groups. All patients received tactile and air syringe stimulus to assess for DH and a visual analog scale (VAS) was used to obtain readings at baseline, 15min, 1 week, and 3 weeks, posttreatment. Student’s t test was used, paired t test was for the intragroups, and unpaired t test was for intergroups. Results: This study showed that the effect of DL and Clinpro XT Varnish results in a significant decrease of DH. However, success decreased gradually over time. Conclusion: Clinpro XT Varnish presented superior immediate effect and DL effect tends to become better with time. Hence, both had good results in the end.
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Myofascial pain syndrome and its relation to trigger points, facial form, muscular hypertrophy, deflection, joint loading, body mass index, age and educational status p. 786
Abrar Majed Sabeh, Samaher Abdulaziz Bedaiwi, Osama Mahmoud Felemban, Hani Haytham Mawardi
DOI:10.4103/jispcd.JISPCD_328_20  
Introduction: Myofascial pain (MFP) is a type of pain characterized by the presence of a trigger point (TrPs) in taut band of skeletal muscles or its fascia. Based on the current literature, the prevalence of head and neck myofascial pain (HNMFP) varies among different communities. To better understand this condition and its relation to facial form, muscular hypertrophy, deflection, and joint loading, the study aimed at evaluating the prevalence of HNMFP among the population of Jeddah, Saudi Arabia. Materials and Methods: This was a cross-sectional study to survey a sample of Jeddah residents, Saudi Arabi between the ages of 18–65 for HNMFP who were attending a public event in December 2019. Participants were asked to complete a questionnaire for demographics and history of HMFP signs and symptoms followed by a comprehensive clinical examination including facial form, muscular hypertrophy, maximum vertical opening, and joint loading. In addition, examination of upper quarter muscles was completed using flat or pincer palpation as needed. Data were collected and summarized as frequencies and percentages and group differences were tested using the chi-square statistical method. Results: A total of 197 participants were examined in this study, in which 136 (69.0%) had signs and symptoms consistent with HNMFP. Study subjects’ educational status was significantly associated with HNMFP (P = 0.008). Older subjects were more likely to report spontaneous pain whereas younger subjects were more likely to report pain following trauma (P = 0.049). Older subjects were more likely to have muscular hypertrophy (P = 0.011), while Younger subjects were more likely to have symmetrical facial form (P = 0.004). In terms of gender, males were more likely to experience pain aggravation with pressure and cold application whereas females were more sensitive to jaw function (P = 0.015). Distribution of joint loading showed a statistically significant difference between males and females (P = 0.008) with females having deflection on opening more frequently compared to males (P = 0.001). Furthermore, female subjects showed a significantly higher frequency of positive TrPs compared to males. Conclusion: Based on the current data, HNMFP is a common condition among the population of Jeddah. Factors such as body mass index and educational level were found to be linked to HNMFP. Younger subjects were more likely to have symmetrical facial form while older subjects were more likely to have muscular hypertrophy. The distribution of joint loading showed a statistically significant difference between males and females with females having deflection on opening more frequently compared to males. Further studies with a larger group of patients are needed to confirm these findings.
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Assessment of level of perceived stress and sources of stress among dental professionals before and during the COVID -19 outbreak p. 794
Supriya Mishra, Shweta Singh, Vaibhav Tiwari, Bhavuk Vanza, Neha Khare, Punit Bharadwaj
DOI:10.4103/jispcd.JISPCD_340_20  
Context: The recent spread of SARS-CoV-2 pandemic has resulted in a number of mental health issues among healthcare workers and dentists are no exception to this due to their nature of work. Hence, the aim of this study was to evaluate the level of perceived stress (PS) among Chhattisgarh dentists and identify the sources of stress before and during the COVID-19 crisis. Materials and Methods: An online questionnaire-based survey was done to assess the level of PS using perceived stress scale (PSS) and sources of stress among dentists of Chhattisgarh state of India before the onset of COVID-19 in the state and immediately after the nationwide lockdown was announced owing to COVID-19 outbreak. Based on the type of work, the dental practitioners were categorized into three groups––dental practitioners (group A), dental academicians (group B), and dentists who are practitioners as well as academicians (group C). Frequency, percentages, and mean values were calculated and compared among different participant characteristics using Student’s t test, paired t test, and one-way ANOVA. Results: During phase I, mean PSS for dentists was 18.61 ± 6.87 which increased to 20.72 ± 1.95 in phase II. Group C dentists recorded higher mean PSS during phase I, while group A dentists reported higher mean PSS during phase II. No family time due to long working hours (90%) was the major stressor among the three groups of dentists during phase I and concern about getting infected (83.3%) was identified as the most frequent stressor during phase II followed by stress over financial implications. Conclusion: Chhattisgarh dentists are reeling under psychological stress, which could be highly deteriorating to their mental health. Hence, concerned authorities should come forward and support the dentists by providing adequate guidelines, policies, and monetary support to them.
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Effectiveness of alcohol-free mouth rinse containing essential oils and fluoride as an oral hygiene adjunct among pregnant Thai women: A randomized clinical trial p. 803
Jaranya Hunsrisakhun, Supitcha Talungchit, Supawadee Naorungroj
DOI:10.4103/jispcd.JISPCD_289_20  
Aim: This 3-month, double-blind, two-center, parallel, randomized controlled clinical trial compared the improvement of oral hygiene status from alcohol-free essential oils (EO) with 0.05% fluoride mouthwash to the control (0.05% fluoride mouthwash). Materials and Methods: One hundred and fifty-four pregnant women were clinically examined to determine Modified Gingival Index (MGI), Plaque Index (PI), and Winkel Tongue Coating Index (WTCI) at baseline, 2 weeks, and 3 months by calibrated examiners. After supragingival scaling and provision of a tooth brushing method, participants were randomly assigned to daily use of alcohol-free EO or the control rinse for 30s at bedtime. Repeated measures of analysis of variance (ANOVA) were performed to assess the effectiveness of alcohol-free EO with 0.05% fluoride mouthwash on MGI, PI, and WTCI scores. Results: One hundred and forty subjects completed the study. The dropout rate of 9.1% (n = 14) was mainly due to loss of follow-up. At baseline, no significant differences were observed between the intervention and the control groups for MGI (1.19±0.57 vs. 1.11±0.48, P = 0.371), PI (1.53±0.56 vs. 1.47±0.48, P = 0.439), and WTCI (0.88±0.48 vs. 0.88±0.50, P = 0.990). There was a statistically significant reduction of MGI, PI, and WTCI scores over time (P < 0.001). However, no significant differences were observed for between-group comparisons for all measured indices at any time point. No adverse effect was reported in either group. Conclusion: At the end of 3-month period, improvement of oral hygiene of pregnancy women in this study was evidence. However, the use of alcohol-free EO mouthwash as supplements to the daily oral hygiene did not provide a significant improvement in terms of plaque, gingival, and tongue coating indices.
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