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   2020| July-August  | Volume 10 | Issue 4  
    Online since August 6, 2020

 
 
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ORIGINAL ARTICLES
Awareness of, beliefs about, practices of, and barriers to teledentistry among dental students and the implications for Saudi Arabia Vision 2030 and coronavirus pandemic
Khalid T Aboalshamat
July-August 2020, 10(4):431-437
DOI:10.4103/jispcd.JISPCD_183_20  
Objectives: Saudi Arabia launched multiple initiatives to overcome the problem of health-care access. The recent coronavirus pandemic created urgent demand to deal with the problem using nonconventional venues such as telehealth and teledentistry. This study aimed to investigate teledentistry knowledge, attitudes, and practices, and barriers to its use among dental students and teaching staff in Makkah province, Saudi Arabia. Materials and Methods: A total of 314 dental students participated in this cross-sectional study. Data were collected using a validated self-reported questionnaire to measure teledentistry awareness, attitude, practices, and barriers to teledentistry. The study was approved by Umm Al-Qura University, Saudi Arabia. Results: Only 17.2% were aware of the term “teledentistry.” However, after it was explained, participants were able to correctly answer 25.16%–62.42% of items about teledentistry. A total of 67.83% would practice teledentistry, and 70.7% support using teledentistry on a national scale for Vision 2030. Only 25.16% used teledentistry before, but 56.05% did dental consultations via smartphone. The most common barriers were patient satisfaction requiring a dentist’s physical presence, violation of patient privacy, and low levels of population education. Conclusion: Dental students seem to know little about teledentistry. However, they are open to learning and using it. It is encouraged to include the topic in continuing dental education, including how to use it during health disasters such as the coronavirus pandemic.
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REVIEW ARTICLES
Clinical success of platelet-rich fibrin and mineral trioxide aggregate (MTA) or MTA-like agents in healing of periapical lesion in nonsurgically treated pulpless immature permanent teeth: A systematic review
Sourabh R Joshi, Aparna U Palekar, Gowri S Pendyala, Viddyasagar Mopagar, Neeta Padmawar, Pratima Shah
July-August 2020, 10(4):379-383
DOI:10.4103/jispcd.JISPCD_97_20  
Background: The chances of extrusion of mineral trioxide aggregate (MTA) are quite high if apical barrier is not present in immature pulpless permanent teeth. Platelet-rich fibrin (PRF) enriched with platelets and growth factors serves to accelerate the wound healing of periapical lesion in immature pulpless permanent teeth and also serves as internal matrix to condense MTA. Aim: The aim of the present study was to comprehensively review the clinical success of MTA+PRF in healing of periapical lesions in immature pulpless permanent teeth. 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 upto 15th January 2020 related to the healing of periapical lesions in permanent teeth with immature apices when combination of MTA+PRF was used. A sample of 10 relevant studies and case reports were identified in our search out of 65. The sampling method was simple random technique. The studies and case reports with Randomised Controlled Trials(RCTs), Invitro studies, Case reports and animal studies in healing of periapical lesion were included in our comprehensive systematic review. Results: The search showed that the combination of MTA+PRF showed faster and definite periapical lesion healing in immature permanent teeth. The follow-up period was also recorded in all the relevant studies and case reports. Conclusion: Acclerated bone filling was seen in healing of periapical leions when MTA+PRF was used.
  648 169 -
Applications of lasers in refractory periodontitis: A narrative review
Sudhir Rama Varma, Maher AlShayeb, Jayaraj Narayanan, Eyas Abuhijleh, Abdul Hadi, Mohammad Jaber, Salim Abu Fanas
July-August 2020, 10(4):384-393
DOI:10.4103/jispcd.JISPCD_241_20  
Objective: The purpose of the study is to evaluate the various lasers in dentistry and to investigate if it can be used for treatment of refractory periodontitis. Methods: The study followed partially the PRISMA guidelines as it is a narrative review. A number of articles were selected from a period of 1980 to 2020 from databases, PubMed, PubMed central, Cochrane and Scopus. Articles related to the effects of lasers on periodontitis both refractory and aggressive were investigated. Results: After reviewing the literature, 70 articles were found, related to application of lasers in periodontal diseases. Out of the 70, 11 articles pertained to the effect of laser for the treatment of Refractory and inflammatory periodontitis. 5 articles related to experimental animal models, one pertaining to in-vitro and six studies related to in-vivo in human cohorts. Discussion: It was found that lasers if used in controlled parameters by incorporating laser assisted treatment such as Photodynamic therapy and low level laser therapy can be of use as an adjunct therapy for treatment of refractory periodontitis. The use of different wavelengths in the initial and maintenance phase of periodontal disease plays a positive role. The presence of in-vitro and animal model studies is one of the limitation to this study. The available studies have shown marked reduction in inflammation and better clinical and microbiological parameters. The drawback of this study is the limited literature involving laser management for refractory periodontitis in human cohorts. Conclusion: Different wavelengths of laser and choice of laser assisted periodontal treatment plays an important role in the overall progress and prognosis of periodontal disease activity.
  615 146 -
ORIGINAL ARTICLES
Association of periodontitis with metabolic syndrome: A case-control study
Anuradha Sadanand Bandiwadekar, Namita Shanbhag, MS Madhuniranjanswamy, Sanjeev Balappa Khanagar, Sachin Naik, Salman Siddeeqh
July-August 2020, 10(4):458-465
DOI:10.4103/jispcd.JISPCD_91_20  
Aim: This study was undertaken to assess the association between periodontitis and metabolic syndrome. Materials and Methods: A case-control study was designed among 100 cases as patients with metabolic syndrome aged 35–74 years, and age- and sex-matched 100 controls as apparently healthy relatives or friends accompanying the cases visiting the diabetic outpatient department at Victoria Hospital, Bengaluru, Karnataka, India, using convenience sampling method. Information related to diabetes, hypertension, and oral hygiene practices was collected. Periodontal health status was measured using community periodontal index. Metabolic syndrome was diagnosed based on the criteria of National Cholesterol Education Program Adult Treatment Panel III. Chi-square test and logistic regression were used for analysis. Results: Significantly more number of cases had shallow pockets 4–5 mm, deep pockets ≥ 6 mm, and also more number of loss of attachment code 1, code 2, code 3, and code 4 compared to controls. Bivariate analysis showed significant association between metabolic syndrome and body mass index, smoking, and tobacco chewing. The association between periodontitis and metabolic syndrome was significant with increased risk of developing metabolic syndrome among the subjects with community periodontal index code 3 and code 4 (odds ratio [OR] = 17) and among the subjects having loss of attachment code 1, code 2, code 3, and code 4 (OR = 12). Association remained significant even after adjustment with other variables (adjusted OR = 6). Conclusion: This study showed significant association between periodontitis and metabolic syndrome. Further prospective and randomized control trials are recommended to assess causal association between these two diseases.
  640 87 -
Comparison of digital and conventional impression methods by preclinical students: Efficiency and future expectations
Halenur Bilir, Ceren Ayguzen
July-August 2020, 10(4):402-409
DOI:10.4103/jispcd.JISPCD_330_18  
Aims and Objectives: The purpose of this study is to compare digital and conventional impression methods by preclinical students in terms of time and ease and to evaluate their preferences and future expectations. Materials and Methods: Twenty volunteered, 2nd year preclinical students (11 females and 9 males) participated in this study. Students took digital and conventional impressions of the left lower first molar which was made full ceramic crown preparation and opposite full arch from a typodont model (Frasaco, Frasaco GmbH, Tettnang, Germany). They used intraoral scanner (CEREC Omnicam, Sirona Dental GmbH, Bensheim, Germany) for digital impression and also used additional type (Express XT Penta H, 3M ESPE, Seefeld, Germany) and condensation type (Zetaplus, Zhermack SpA, Badia Polesine, Italy) silicones for conventional impression. Their taking impression time was measured. Before taking impression and after taking impression, two kinds of questionnaires were conducted to students about their preference, ease of impression methods, and their future expectations. Statistical analysis was performed by IBM SPSS 23 and Excel 2010 version. Differences between conventional and digital impression in terms of time were analyzed by student’s-t paired test and effect of gender was analyzed by students’s-t independent test. Results: There were statistically significant differences between digital and conventional impression methods in terms of taking impression and total impression time (P < 0.001). But there wasn’t any statistically significant difference between two methods in terms of preparation time. About 85% of students preferred the digital impression method and also 85% of students found that the digital impression method was easy. 95% of students expected to find intraoral scanner in the clinic where working first time. Conclusions: As a result of this study, it has been seen that the students preferred the digital impression method to the conventional impression method and found that the digital impression method was easier.
  523 146 -
A novel, simple, frequent oral cleaning method reduces damaging bacteria in the dental microbiota
Pranav Chhaliyil, Kael F Fischer, Bernd Schoel, Pradheep Chhalliyil
July-August 2020, 10(4):511-519
DOI:10.4103/jispcd.JISPCD_31_20  
Aim: Dental diseases can be prevented by reducing early bacterial colonization in biofilm, a precursor to mature dental plaque. Most studies on dental disease pathogenesis focus on mature plaque and fail to address the impact of oral cleaning on biofilm formation. Here we used next-generation metagenomics to assess the effects of a new method of regular, simple biofilm disruption on the oral metagenome. Materials and Methods: This was a randomized, controlled study of 45 healthy children divided into three groups. Participants avoided oral cleaning for 3 days and then performed 10 days of oral cleaning either by: (1) brushing and tongue cleaning twice a day (BT) with toothpaste; (2) Gum and tooth rubbing with Index Finger Tongue cleaning and water Swishing (GIFTS) after each meal, snack, and drink; or (3) GIFTS twice a day with nano-charcoal and tongue cleaning (CT) (n = 15 per group). Saliva, plaque, and tongue scraping samples were collected on day 0 and 10 for quantitative polymerase chain reaction (qPCR) and next-generation metagenomics sequencing to analyze microbiome taxa differences between groups. Results: GIFTS more significantly reduced (P < 0.004) total bacteria in saliva than BT (P < 0.02). Metagenomics revealed a significant reduction in Firmicutes in GIFTS and CT tongue samples compared to BT samples. BT and CT saliva samples showed significantly more Streptococcus species than GIFTS saliva samples. In the plaque samples, GIFTS cleaning significantly reduced early colonizers, including Streptococcus, compared to the BT and CT methods. Conclusion: Here, we introduce the “frequent disruption of biofilm” concept for enhanced oral hygiene. GIFTS can be used to prevent early bacterial colonization of biofilm and plaque formation in both small children and adults. Frequent biofilm disturbance more effectively disrupts early bacterial colonization than twice oral cleaning, is nonabrasive, and is, therefore, a practical and straightforward complement to regular toothbrushing for improved oral hygiene and disease prevention.
  551 75 -
Evaluation of vision in gnathological and orthodontic patients with temporomandibular disorders: A prospective experimental observational cohort study
Chiara Vompi, Emanuela Serritella, Gabriella Galluccio, Santino Pistella, Alessandro Segnalini, Luca Giannelli, Carlo Di Paolo
July-August 2020, 10(4):481-490
DOI:10.4103/jispcd.JISPCD_273_19  
Objectives: Temporomandibular disorders (TMDs), orthodontic diseases, and vision dysfunctions seem to be strictly related. The purpose of this study was to prove the relationship, to evaluate the prevalence and the distribution of vision defects in dysfunctional and orthodontic patients, and to establish the type of the relationship. Materials and Methods: A total of 100 patients with TMDs were selected and studied through epidemiological analyses of the following factors: gnathological parameters (temporomandibular joint pathologies according to Diagnostic Criteria for Temporomandibular Disorders); occlusal and skeletal parameters (overjet, overbite, dental class, transversal discrepancies, and mandibular asymmetry); and orthoptic parameters (refractive defects and oculomotor diseases). A prospective experimental observational cohort study was conducted. A comparison with the average frequency of vision defects of the Italian population was performed. The prevalence of vision defects was evaluated. All gnathological and orthodontic parameters were associated with the orthoptic ones. A descriptive and statistical analysis of the data was carried out with the Statistical Package for the Social Sciences software; z test (P < 0.05), frequency analysis (frequency >50%), chi-square test, and Student’s t test (P < 0.05) were performed. The scientific consistency was evaluated by using the scientific criteria of Bradford Hill. Results: The comparison with the Italian population showed a higher frequency of refractive defects in the study sample (P < 0.001). The most frequent vision defects were phorias (92%) and tropia (3%). The increased frequency of ocular convergence reduction in the presence of disc displacement with reduction was significant (n = 28; 60%; P < 0.05). In the presence of asymmetry, low frequencies of astigmatism (n = 18; 30%) were observed compared to its absence (n = 22; 54%) (P < 0.05) and high frequencies of motor ocular deviations (n = 59; 100%) were observed compared to its absence (n = 36; 88%) (P < 0.05). In the presence of headache, low frequencies of emmetropia (n = 13; 22%) and higher frequencies of hyperopia (n = 18; 30%) were observed (P < 0.05). Two of five scientific criteria of Bradford Hill were met. Conclusion: It seems to emerge a possible positive relationship between TMD and vision defects. In particular, the most interesting associations were found between functional or skeletal orthognathic alterations and oculomotor dysfunctions. However, it was not possible to establish the type of relationship.
  548 58 -
The efficacy of resin infiltrant and casein phosphopeptide–amorphous calcium fluoride phosphate in treatment of white spot lesions (comparative study)
Hussain A Baafif, Ibrahim F Alibrahim, Sami H Alotaibi, Hatem G Alharbi, Meshal N Shubaily, Wahdan M A Elkwatehy
July-August 2020, 10(4):438-444
DOI:10.4103/jispcd.JISPCD_483_19  
Background: White spot lesions (WSLs) are considered as the first sign of the progression of dental caries that can be reversed. Casein phosphopeptide–amorphous calcium fluoride phosphate (CPP-ACFP) varnish can promote remineralization process of the demineralized tooth structure. Also, WSLs can be managed by using caries infiltrant (ICON), which infiltrates etched enamel surface of the WSLs. Objectives: The main aim was to evaluate and compare the efficacy of ICON versus CPP-ACFP varnish to treat WSLs in the same oral environments. Materials and Methods: A total of 30 participants aged 20–40 years with at least two WSLs have participated in this trial. Split-mouth technique has been used in this trial where WSLs on the left side have been treated with ICON, whereas WSLs on the right side have been treated with CPP-ACFP varnish. Clinical evaluation using DIAGNOdent was carried out at baseline, 1 week, 1, 3, 6, and 12 months after application to determine the effectiveness of these materials in treating WSLs. Results: Significant differences were observed between all follow-up DIAGNOdent scores compared to baseline readings of both ICON and CPP-ACFP (P = 0.000 for all comparisons). Statistically significant differences were observed between DIAGNOdent scores of ICON compared to CPP-ACFP at all follow-up intervals (P = 0.006, 0.008, 0.045, 0.036, and 0.000). Conclusion: Both ICON and CPP-ACFP were effective in the treatment of WSLs of smooth surfaces but the efficacy of CPP-ACFP was better than ICON.
  491 73 -
Sugary snack consumption and tooth retention among middle-aged Thai adults
Supawadee Naorungroj
July-August 2020, 10(4):394-401
DOI:10.4103/jispcd.JISPCD_249_20  
Objectives: This study investigated whether the habit of consuming sugary snacks was independently associated with the loss of permanent teeth. Materials and Methods: Eight hundred ninety-seven adults aged 35–65 from four communities in the lower regions of Southern Thailand completed a structured questionnaire interview and dental examinations. The independent variable was frequency of sweet snack consumption between meals in the previous week and coded as: never (0 days), occasionally (1–4 days), or frequently (≥5 days). The outcome was the number of permanent teeth (1–19 vs. ≥20 teeth). Multivariate logistic regression was used to examine the adjusted associations between sugary snack consumption and the number of retained teeth. Odds ratio (OR) and 95% confidence intervals (CI) were calculated. Results: Approximately 23% of participants retained fewer than 20 permanent teeth. Approximately 30% of participants reported sugary snack intake most days. Fewer teeth were positively associated with high-frequency sugary snack consumption, older age, Muslim, ≤ 6 years of education, universal healthcare, infrequent tooth brushing, smoking, and alcohol consumption, but not sugar-sweetened beverages. After adjusting for sociodemographic characteristics and other potential confounders, the odds of having fewer teeth were higher among participants who frequently consumed sugary snacks (OR = 2.03, 95% CI = 1.21–3.39), but was not significantly different from those who occasionally consumed sugary snacks (OR = 0.93; 95% CI = 0.58–1.50) compared to nonsugary snack consumers. Conclusion: In this study, habitual sugary snack intake was associated with fewer teeth among middle-aged Thai adults. To improve oral health and prevent further tooth loss, efforts to reduce sugary snack consumption would be needed.
  403 136 -
The effectiveness of visual pedagogy for toothbrushing in children with autism spectrum disorder
Apiwan Smutkeeree, Tippawan Khrautieo, Sasithorn Thamseupsilp, Natchalee Srimaneekarn, Praphasri Rirattanapong, Wimonrat Wanpen
July-August 2020, 10(4):415-423
DOI:10.4103/jispcd.JISPCD_248_20  
Objectives: The aim of this study was to evaluate toothbrushing effectiveness in children with mild and moderate levels of severity of autism spectrum disorder (ASD) after using visual pedagogy. Materials and Methods: This quasi-experimental study was carried out with 30 children with ASD aged 5–17 years; 21 had mild ASD and 9 had moderate ASD. Informed consent and the subject’s demographic information were obtained from caregivers. All subjects were then asked to show their toothbrushing practices, which were recorded by video. The toothbrushing ability, toothbrushing cooperation, and plaque index were evaluated before the study and at 2 weeks, 4 weeks, 3 months, and 6 months after visual pedagogy had been used. Results were analyzed by the Friedman test, Pearson’s chi-square test, Fisher’s exact test, and Mann‒Whitney U test. Results: Toothbrushing ability was significantly improved at all periods of follow-up. Toothbrushing cooperation and the dental plaque index were significantly better than before the study at 4 weeks, 3 months, and 6 months of follow-up. The toothbrushing ability of subjects with mild ASD was significantly better than that of subjects with moderate ASD at 4 weeks and 6 months of follow-up. The toothbrushing cooperation of the mild group was significantly better than that of the moderate group at 2 weeks, 4 weeks, and 3 months. There was no statistically significant reduction in the plaque index between the two groups. Conclusion: Visual pedagogy is useful for improving toothbrushing effectiveness in children with mild or moderate severity ASD. However, children with moderate severity ASD take longer to improve.
  374 82 -
Relationships of acculturative stress, perceived stress, and social support with oral health-related quality of life among international students in Malaysia: A structural equation modelling
Hala Fathalla BenGhasheer, Roslan Saub
July-August 2020, 10(4):520-529
DOI:10.4103/jispcd.JISPCD_192_20  
Aim: This study aimed to investigate the relationships between acculturative stress, perceived stress, social support, and subjective oral health outcomes among international graduate students in Malaysian public universities. Materials and Methods: A total of 312 international graduate students completed a web-based questionnaire, including measures of acculturative stress (ASSIS-36), perceived stress scale (PSS-4), social support (MSPSS-12), oral health perceptions (global rating item), and oral health-related quality of life (OHRQoL, OIDP-8). The hypotheses of the conceptual model were tested using structural equation modeling-partial least squares (SEM-PLS) with the support of SmartPLS. Results: Twenty-seven percent (27.1%) of the variance in OHRQoL was explained by acculturative stress, perceived stress, social support, and oral health perceptions. The path coefficient between oral health perception and OHRQoL was the strongest (β = –0.385, P < 0.001). Acculturative stress directly influenced OHRQoL (β = 0.20, P = 0.009) and indirectly through perceived stress (β = 0.05, P = 0.019). Social support mediated the relationship between perceived stress and OHRQoL (β = 0.046, P = 0.02). The overall predictive power of the model was 23%. Conclusion: Results indicated that acculturative stress, perceived stress, and social support are among the predictors of OHRQoL. Oral health perceptions and acculturative stress were the most significant predictors that contributed the largest amount to the model. The findings emphasize the potential role of psychosocial factors in relation to oral health. The empirical evidence of this study could facilitate the planning of targeted strategies that address stress reduction and social support. Such strategies might be a new promising way to enhance OHRQoL as these elements can be modified and response to interventions.
  339 69 -
Comparison of the efficacy of CanalBrush, EndoActivator, and Passive Ultrasonic Irrigation on the removal of triple antibiotic paste from root canal walls: An in vitro study
Santosh Kumar, Kavisha Desai, Aparna Palekar, Baswaraj Biradar, Ananjan Chatterjee, Khushboo Kumari
July-August 2020, 10(4):424-430
DOI:10.4103/jispcd.JISPCD_13_20  
Aim: The aim of this study was to compare the efficacy of CanalBrush (CB), EndoActivator (EA), and Passive Ultrasonic Irrigation (PUI) on the removal of triple antibiotic paste (TAP) from root canal walls. Materials and Methods: Thirty-six extracted human single-rooted teeth were prepared using ProTaper Universal rotary files (DentsplyMaillefer, Ballaigues, Switzerland) up to size F5. The root canals were filled with TAP, and after 21 days, roots were randomly assigned to three groups (n = 10) according to irrigation regimens used: CB, EA, and PUI. In three teeth, TAP was not removed (positive controls), and the other three teeth were not filled with TAP (negative controls). The roots were sectioned, and the amount of TAP remaining was evaluated at the mesial halves of each tooth at ×30 magnification under a stereomicroscope using a 4-grade scoring system. Data were evaluated using the Kruskal–Wallis and Mann–Whitney U tests. Results: There were significant differences among the experimental groups according to the different parts of the root canals (P < 0.05). At the apical and middle third, EA and PUI groups removed more TAP than CB group; however, there was a statistically significant difference only between CB and PUI groups (<0.01 at apical third and <0.05 at middle third). At the coronal third, there was no statistically significant difference between all the three groups (P > 0.05). Conclusion: PUI led to superior results compared to CB in the middle and apical thirds. There was no significant difference between EA and PUI techniques.
  301 80 -
Assessment of oral health-related quality of life among expatriate working population, Saudi Arabia: A cross-sectional study
Hidayathulla Shaikh, RH Shilpa, Asiya Fatima, Kailash Asawa, Karthiga Kannan, Abid Lankar
July-August 2020, 10(4):504-510
DOI:10.4103/jispcd.JISPCD_149_20  
Background: The expatriate workers (foreign workers) come from various countries having different languages, cultures, and tradition to work in Kingdom of Saudi Arabia (KSA); here they adopt to local customs, traditions, and work ethics in this new environment. How they perceive their oral health-related quality of life (OHRQoL) is important for health-care provider for understanding and planning in patient management. The data of expat workers and their OHRQoL in KSA are meager; hence, assessment of OHRQoL among expatriate working population in Al Zulfi, Saudi Arabia was planned. Materials and Methods: A cross-sectional study was conducted on adult expat working population of various nationalities who were working in Al Zulfi, KSA. The study sample comprised 600 adult expats. OHRQoL was analyzed by using 14-Item Oral Health Impact Profile (OHIP-14) questionnaire as instrument. Clinical examination for oral health status was carried out using decayed, missing, and filled teeth (DMFT) index and Oral Hygiene Index simplified (OHI-S). Student’s t test and analysis of variance (ANOVA) were used to compare data using Statistical Package for the Social Sciences (SPSS) software program, version 20.0 with significance at P ≤ 0.05. Results: The age of the sample population ranged from 19 to 60 years. No significant difference was observed in oral health status among expats of different nationalities. Age and education were significantly related to OHRQoL as well as oral health status. The mean cumulative scores of OHIP-14 showed that expats from different nationalities had statistically significant differences. Conclusion: Overall the impact of OHRQoL was less among working expat population in Al Zulfi. Physical pain was the common dimension seen among all nationalities. Psychological discomfort and handicap dimensions of OHIP-14 were significant among the study sample.
  292 70 -
Assessment of structural changes in translucency and opacity of tooth enamel against a direct demineralization process: An in vitro study
Santiago Ruiz, Ana Díaz-Soriano, Walter Gallo, Fernando Perez-Vargas, Arnaldo Munive-Degregori, Frank Mayta-Tovalino
July-August 2020, 10(4):473-480
DOI:10.4103/jispcd.JISPCD_158_20  
Objective: The objective of this study was to assess in vitro the structural changes in translucency and opacity of tooth enamel following a direct demineralization process. Materials and Methods: This experimental in vitro study evaluated 45 thirds (cervical, middle, and occlusal) of the tooth enamel surface of premolar teeth extracted from young adults divided into three groups of 15 specimens each: Group 1 (solution based on calcium, phosphorus, and fluorine), Group 2 (orthophosphoric acid 37%), and control group (distilled water). All underwent optical macroscopic examination with ×3 magnification to determine the initial translucency according to the variation of the medium in their intercrystalline spaces, and Thylstrup and Fejerskov Index was used. The experimental groups were then subjected to an artificial caries process during which the specimens were placed in an inorganic and organic solution of calcium, phosphorus, and fluorine at 37°C for 90 days with the acidic solution at pH 5 and the neutral solution at pH 7. The control specimens were placed in distilled water. Finally, all the specimens were assessed by polarization microscopy. Results: In relation to the occlusal third, the highest proportion in Groups 1 and 2 was in Grades 2 and 3 (80%). A significant association was only observed between the experimental groups in the degree of translucency in the occlusal third (P = 0.002), whereas no association was found in relation to the degree of opacity in the middle and cervical thirds in either study group (P > 0.05). Conclusion: The resistance of enamel hydroxyapatite crystals increases from occlusal to cervical due to the greater presence of aprismatic enamel in the cervical horizontal third.
  244 39 -
Reliability of caries assessment spectrum and treatment tool in the Indian subcontinent
Sreenivas Voruganti, Praveen B Haricharan, Durga P Mudrakola, Neeraja Turagam
July-August 2020, 10(4):410-414
DOI:10.4103/jispcd.JISPCD_217_19  
Background: Accurate diagnosis, reporting of caries and its consequences, is absolute mandate for planning an efficient, effective community health-care program. Literature reports indicate shortcomings of existing caries assessment tools. Caries assessment spectrum and treatment (CAST) is novice caries quantification tool, which quantifies the entire spectrum of carious lesions. This tool records give an insight into the status of restorations along with various progressive developmental stages of dental caries. This instrument has been validated for face, content, and construct by an expert group, and currently, its usage is on the rise. Aim: The aim of this study was to report the reliability of this assessment tool with regard to the primary and permanent dentition of school children and adults belonging to a south Indian district. Materials and Methods: A cross-sectional study was carried out by two trained and calibrated examiners by examining 192 school children in the age-group between 4 and 6 years and 262 adults between 19 and 69 years. The study sample was reexamined by the same examiners after a gap of 4 weeks. The κ coefficient values and percent of agreement were calculated for the data recorded from the study subjects. Results: The analyzed data showed moderate intra-examiner and inter-examiner reproducibility for either of the dentition as revealed by κ coefficient values (0.80–0.89). Inter- or intra-examiner agreement was found to be substantial to almost perfect (percent agreement above 90%) with respect to both the age-groups. Conclusion: The CAST tool seems quite promising to be the future for quantifying caries spectrum for a community or an individual.
  192 60 -
Evaluation of International Caries Detection and Assessment System (ICDAS)-related caries severity among caries risk groups in Pendul district: An observational study
Arya Adiningrat, Harum Annisa Kusmaharani, Sri Utami, Novitasari Ratna Astuti
July-August 2020, 10(4):498-503
DOI:10.4103/jispcd.JISPCD_46_20  
Aim: The aim of this study was to evaluate the difference in severity of caries code 5 or 6 according to the International Caries Detection and Assessment System (ICDAS) among caries risk groups in Pendul district. Materials and Methods: This was an observational study with a cross-sectional design. A total of 730 people who were residing in Pendul district belonged to population of this study. One of the inclusion criteria of this study was the people who were ≥5 years old according to World Health Organization. On the basis of our preliminary survey, we confirmed 660 people who fulfilled the inclusion criteria. The subjects were selected using the accidental simple random sampling. Slovin’s formula was used with margin of error 8% to obtain the 138 subjected people. Of the 138 subjects studied, there were only 87 people who could be included in the further inclusion criteria by having dental caries code 5 or 6 according to ICDAS. The Kruskal–Wallis statistical test was used to analyze the differences as the data belong to nonparametric and there were three variable groups. Next, the Mann–Whitney U was used to test the differences between these variables. Results: The results of this study showed that there was a significant difference in the severity of caries among caries risk groups (P < 0.05). Conclusion: The higher the caries risk the higher the caries severity that was observed. This result supported the potential use of caries risk assessment as a predictive and supportive tool to prevent the increasing caries severity in the community.
  201 48 -
Influence of an 810-nm diode laser on the temperature changes of the external root surface: An in vitro study
Njwan F Shehab, Nawal A Al-Sabawi, Emad F Alkhalidi
July-August 2020, 10(4):445-451
DOI:10.4103/jispcd.JISPCD_216_20  
Background and Aims: Rising effects of temperature due to laser use during root canal disinfection may harm periodontium and alveolar bone. Therefore, the aim of this study was to estimate the surface root temperature of lower incisors throughout the application of different power levels and times of an 810-nm diode laser. Materials and Methods: Sixty single-rooted extracted human lower incisor teeth were selected and chemomechanical preparation was performed. Specimens were irradiated using 810-nm diode laser at 1.05, 1.5, and 1.95 W power settings and two periods of time 20 and 60s, in a continuous wave (CW) mode, without water spray. Specimens were divided into three main groups (n = 20). Each group was subdivided into two subgroups (n = 10). Then, the peak temperatures at the middle and apical regions of the root surface were registered using a thermocouple. Results: Temperature rise of root surface at all the selected output powers was below 7°C. The highest temperature value was obtained in the apical region at 60s when the root canal irradiated at 1.95 W output power. Conclusion: Diode laser is safe for use as a root canal disinfectant. Time of exposure to laser irradiation has an effect on the temperature difference at different output powers.
  191 52 -
Clinical and microbiological profiles of aggressive and chronic periodontitis in Congolese patients: A cross-sectional study
Em Kalala-Kazadi, Selena Toma, Jérôme F Lasserre, Fidèle Nyimi-Bushabu, Hubert Ntumba-Mulumba, Michel C Brecx
July-August 2020, 10(4):491-497
DOI:10.4103/jispcd.JISPCD_501_19  
Background: Chronic and aggressive periodontitis were the main forms of periodontitis according to the 1999 classification of periodontal diseases and conditions. Their profile in Congolese patients is still undescribed. Aim: The aim of this study was to compare the profile of chronic periodontitis (ChP) with that of aggressive periodontitis (AgP) in Congolese patients. Materials and Methods: Thirty-two patients with ChP and 20 with AgP who consulted the dental services at any of the four medical centers in Kinshasa, from April 2017 to April 2018, were enrolled in the cross-sectional study. All patients underwent a full mouth examination, including assessment of the probing pocket depth and clinical attachment level at six sites per tooth. Microbial samples were collected in the deepest pocket in the maxilla and the deepest pocket in the mandible. A deoxyribonucleic acid (DNA) analysis was performed using DNA strip technology. Fisher exact test, the chi-square test, the t test, and the Mann–Whitney test were used for the statistical analysis. Results: Patients with AgP were significantly younger than those with ChP (P < 0.001). There was no significant difference in the prevalence of Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, or Prevotella intermedia between the AgP and ChP groups (P > 0.05). Aggregatibacter actinomycetemcomitans was detected in 10% of cases in the AgP group and in none of those in the ChP group (P = 0.143). Conclusion: This study shows that the clinical profiles of ChP and AgP are similar in Congolese patients. There were no microbiological differences between these two forms of periodontitis.
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Bond strength to microtraction and nanofiltration using ethanol wet bonding technique in fresh extracted teeth: An ex vivo study
Sheyla Caceres, Gerardo Ayala, Daniel Alvítez-Temoche, Daniel Suarez, Romel Watanabe, Frank Mayta-Tovalino
July-August 2020, 10(4):466-472
DOI:10.4103/jispcd.JISPCD_378_19  
Objective: The objective of this study was to evaluate the bond strength to microtraction and nanofiltration using ethanol wet bonding technique in fresh extracted teeth. Materials and Methods: This quasi-experimental ex vivo study evaluated 48 teeth that had an indication of premolar extraction due to orthodontic reasons. The protocol of dental preparation and restorative procedure was carried out to evaluate the adhesion resistance by means of the universal testing machine at a loading speed of 0.5 mm/min and 500MPa. To evaluate the nanofiltration, matches were made that were immersed in ammoniac silver nitrate for 24h, and then the specimens impregnated with silver were washed thoroughly in distilled water and placed in a photo-developer solution for 8h under a fluorescent light. All statistical analyses were statistically evaluated with a level of significance P < 0.05. Results: The ethanol technique without premature failure (PF) group had an average of 31.26 ± 10.26MPa, whereas the lowest value was found in the water technique group with PF, which had 22.59 ± 12.27MPa. When performing inferential statistics, it was evidenced that there were statistically significant differences between both techniques with a value of P < 0.05. Conclusion: According to the results in both cases, the adhesive strength showed superiority in the ethanol wash group. It determines that this technique presents greater tolerance to the residual presence of water. Finally, in relation to nanofiltration we found that there were no significant differences between the groups evaluated.
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A three-year audit of dental services at primary health care facilities in Gauteng, South Africa: 2017 to 2019
Ahmed Bhayat, Thomas K Madiba, Ntombizodwa R Nkambule
July-August 2020, 10(4):452-457
DOI:10.4103/jispcd.JISPCD_72_20  
Aim: The aim of this study was to determine the types and trends of dental services offered over 3 months (April, May, and June) every year from 2017 till 2019 at all full-time primary oral health care facilities (POHCFs) in Gauteng Province, South Africa. Materials and Methods: This was a record-based retrospective study. Data were collected from April, May, and June in 2017, 2018, and 2019, from all full-time POHCFs in Gauteng. The data were obtained from the attendance registers at each facility and included the number of patients and personnel and the type and number of procedures performed. Results: A total of 90 POHCFs were included. The number of clinicians remained stable, whereas the mean number of patients per month increased from 587 (2017) to 654 (2019). This resulted in an increase in the mean monthly patient-to-clinician ratio from 376 (2017) to 428 (2019). On average, 459 extractions, 64 restorations, and 43 fissure sealants were performed monthly per district. Clinicians treated on average 19 patients per day and on average 15 extractions for every restoration. The mean operator-to-dental assistant ratio was 1.3:1. Conclusion: Although there were differences in the types of services rendered and the workloads of clinicians across the province, a significant increase was observed in the number of patients over the study period. The most common services rendered were extractions and the extraction-to-restoration ratio was fairly high. Managers need to carry out regular audits to ensure that the facilities are operating optimally.
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