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   Table of Contents - Current issue
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May 2019
Volume 11 | Issue 6 (Supplement)
Page Nos. 81-506

Online since Tuesday, May 28, 2019

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EDITORIAL  

From the Editorial Desk Highly accessed article p. 81
Gobichettipalayam Jegatheeswaran Anbuselvan, Thuckanickenpalayam Ragunathan Yoithapprabhunath, Thangavelu Arthiie
DOI:10.4103/0975-7406.258977  
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REVIEW ARTICLES Top

Stem cells and their application in dentistry: A review Highly accessed article p. 82
Muraleedhara Bhat, Praveen Shetty, Subramanya Shetty, Faizan A Khan, Shabeeb Rahman, Mallikarjuna Ragher
DOI:10.4103/JPBS.JPBS_288_18  
The use of the term “stem cells” dates back to the 1800s; however, the application of the same is still not completely understood. Recent advances have indicated the harvesting of postnatal stem cells from sources such as the dental pulp and fat. The pluripotent nature of these cells allows for use in various aspects of treatment and patient care such as organ and tissue transplantation, bony defects repair, distraction osteogenesis, cell therapies, gene therapy, and toxicology testing of new drugs. This article explores the various aspects involved, the current status, and future challenges of stem cell therapy in patient care and management.
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Application of finite element model in implant dentistry: A systematic review Highly accessed article p. 85
M Sesha Reddy, Rajasekar Sundram, Hossam Abdelatty Eid Abdemagyd
DOI:10.4103/JPBS.JPBS_296_18  
FEM was technologically innovated which initially aimed at answering structural analysis difficulties involving Mechanics, Civil and Aeronautical Engineering. FEM basically stands for a numerical model of analyzing stresses as well as distortions in the form of any agreed geometry. There for the shape is discretized into the so-called ‘finite elements’ coupled through nodes. Accuracy of the results is determined by type, planning and total number of elements used for a particular study model. 3-D FE model was designed for in-depth qualitative examination of the relations amongst implant, tooth, periodontal ligament, and bone. Scholarly work equating work reliability, validated with a 3-D modeling suggested that meticulous data can be acquired with respect to stress distribution in bone. Comparative results from 3-D FEA studies showed that 3D FEA, when matched with in-vivo strain gauge measurements were corresponding with clinical outcomes. The aim of this review of literature is to provide an overview to show the application of FEM in (Short) implant dentistry.
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Embracing personalized medicine in dentistry Highly accessed article p. 92
Manchala Sesha Reddy, Shishir Ram Shetty, Venkataramana Vannala
DOI:10.4103/JPBS.JPBS_297_18  
Aim: The aim of this systematic review was to evaluate the number of articles in the area of personalized medicine specific to dentistry. Materials and Methods: Electronic search using three databases was performed using PubMed, Embase, and Scopus search. Results: Results suggest that there is a definite need for more awareness and research pertaining to this specific area. Conclusion: With this background, the authors have written a comprehensive review on applications of personalized medicine in various branches of dentistry.
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Periodontal accelerated osteogenic orthodontics technique for rapid orthodontic tooth movement: A systematic review Highly accessed article p. 97
Venkataramana Vannala, Anilkumar Katta, Manchala S Reddy, Shishir R Shetty, Raghavendra M Shetty, Shakeel S Khazi
DOI:10.4103/JPBS.JPBS_298_18  
Aim: The aim of this review was to analyze the data in the available literature regarding aspects of periodontally accelerated orthodontic therapy such as reduction in treatment time, variation in surgical techniques, and patient satisfaction. Materials and Methods: An internet-based search was performed for the articles published between January 2008 and August 2018 using keywords periodontal accelerated orthodontic tooth movement, corticotomy, bone grafting, tooth movement, and treatment duration. A total of 84 articles were obtained from MEDLINE and Embase search engines, of which 31 articles were eligible to be included for the systematic review. Results: On analysis, it was observed that the earlier studies were predominantly pertaining to case reports. In the later part of the decade considered in this review, it was observed that the emphasis was given to clinical and animal studies. Conclusions: Most of the studies included in the review concluded that there was a significant reduction in orthodontic treatment duration using periodontal accelerated techniques compared to conventional orthodontic treatment.
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Immunotherapy in oral cancer Highly accessed article p. 107
Sunil Paramel Mohan, Manoj K Bhaskaran, Ashford L George, Abhilash Thirutheri, Maya Somasundaran, Anegh Pavithran
DOI:10.4103/JPBS.JPBS_31_19  
Immunotherapy is one of the newer entities which is promising, at least can be very much helpful as an adjuvant therapy. This newer modality of the treatment in the field of cancer treatment may be the fourth pillar supporting surgery, chemotherapy, and radiotherapy. Careful selection of patient is the key for success of immunotherapy, which is based on patient’s immunological contexture. This review aimed to present the fundamental aspects of tumor immunity and immunotherapy, focused on oral squamous cell carcinoma.
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Monomer modifications of denture base acrylic resin: A systematic review and meta-analysis p. 112
R Ajay, K Suma, Seyed Asharaf Ali
DOI:10.4103/JPBS.JPBS_34_19  
Background: Methyl methacrylate monomer of denture base resins was modified with several monomers to achieve better physico-mechanical properties without compromising the biocompatibility. However, there are no consensuses on the best strategy to achieve best modified monomer. Purpose: To identify and evaluate the differences in the properties between conventional and modified monomers and to verify the influence of several variables on the properties of denture base acrylic resin. Materials and Methods: This study was executed by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. In-vitro studies that investigated the properties of conventional and modified monomers were selected. Searches were carried out in the Ebscohost, PubMed, Semantic scholar and J-stage databases. The search commenced from the year 1995 and the last search was done till November 2018. A comparison was performed between modified and unmodified monomers. The analyses were carried out using fixed-effect models. Results: The meta-analysis results showed high heterogeneity in all aspects, and higher flexural strength for monomers modified with 20% methacrylic acid. Conclusion: Although the articles included in this meta-analysis showed high heterogeneity and high risk of bias, the in-vitro literature seems to suggest that use of modified monomers could improve the properties of denture base resins. Other variants of monomer modifications and their tested parameters were discussed in this systematic review as well. Dimensional accuracy is an unexplored variable to be evaluated extensively in the future researches.
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Platelet-rich plasma and platelet-rich fibrin in periodontal regeneration: A review Highly accessed article p. 126
Sunil Paramel Mohan, Nallusamy Jaishangar, Sandha Devy, Anjhana Narayanan, Deepthi Cherian, Sanupa Sethu Madhavan
DOI:10.4103/JPBS.JPBS_41_19  
Platelet concentrates (PCs; platelet-rich plasma and platelet-rich fibrin) are autologous bioactive substances that have found varied application in medical and dental fields, particularly in oral and maxillofacial surgery, plastic surgery, and sports medicine. The rationale of these technologies is to extract all the elements from patient’s own blood sample, which could be used to improve healing by promoting tissue regeneration. PCs have evolved a long way since its introduction in 1954. PCs have been used successfully in periodontics and implant dentistry. However, the preparation protocol, processing time, transfer of concentrates, centrifugation temperature, vibration, etc., being not standardized are various factors for the mixed results reported in the literature. This review intends to discuss evolution of PCs, their preparation techniques, and their clinical and technical aspects and applications.
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Surface modification techniques for zirconia-based bioceramics: A review p. 131
Suma Karthigeyan, Arun Jaikumar Ravindran, Ramesh T R Bhat, Madhulika Naidu Nageshwarao, Sree Varun Murugesan, Vignesswary Angamuthu
DOI:10.4103/JPBS.JPBS_45_19  
Zirconia is gaining interest as a ceramic biomaterial for implant applications due to its biocompatibility and desirable mechanical properties. At present, zirconia-based bioceramics is often seen in the applications of hip replacement and dental implants. This article briefly reviews different surface modification techniques that have been applied to zirconia such as polishing, sandblasting, acid etching, biofunctionalization, coating, laser treatment, and ultraviolet light treatment. The potential of surface modification to make zirconia a successful implant material in the future is highly dependent on the establishment of successful in vitro and in vivo studies. Hence, further effort should be made in order to deepen the understanding of tissue response to implant and tissue regeneration process.
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Gingival crevicular fluid: An overview p. 135
Krishnan Chandragiri Subbarao, Gowri Shankar Nattuthurai, Satheesh Khannaa Sundararajan, Indhu Sujith, Jennifer Joseph, Yasmin Parvin Syedshah
DOI:10.4103/JPBS.JPBS_56_19  
Gingival crevicular fluid is an inflammatory exudate derived from the periodontal tissues. It is composed of serum and locally generated materials such as tissue breakdown products, inflammatory mediators, and antibodies directed against dental plaque bacteria. It plays a special part in maintaining the structure of junctional epithelium and the antimicrobial defense of periodontium. Some of the suspected periodontal pathogens such as Porphyromonas gingivalis and Treponema denticola produce broad-spectrum neutral proteinases as part of their virulence arsenal. These proteinases may be detected in plaque and gingival crevicular fluid samples of patients with periodontitis. The potential diagnostic importance of gingival fluid was recognized more than six decades ago. The fluid component of gingival crevicular fluid is derived primarily from microvascular (postcapillary venule) leakage. There are number of distinct advantages and challenges of using gingival crevicular fluid as a diagnostic test for periodontal disease.
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Meta-terminology of Ameloblastoma p. 140
Thuckanickenpalayam Ragunathan Yoithapprabhunath, Ramadas Madhavan Nirmal, Nalliappan Ganapathy, Shanmugam Mohanapriya, Seeni Renugadevi, Ravi Aravindhan, Kenniyan Kumar Srichinthu
DOI:10.4103/JPBS.JPBS_57_19  
One of the primary tasks of systematic biology is the development of our biological nomenclature and classifications. The key purpose for the development of a standard nomenclature for a disease is the need for a common language for the statement of diagnostic terms and for a means or system whereby diagnosis could be suitably recorded without chaos. Odontogenic tumor nomenclature and classification have confused physicians over the years. Ameloblastoma is one such entity among odontogenic tumors, which has continuously changed to be an evolution of the terms and taxonomy used in literature. In this review, we aim to provide a fundamental basis for the understanding of how the etymology and the position of ameloblastoma in odontogenic tumor classification have evolved over the years.
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ORIGINAL ARTICLES Top

Evaluation of the efficacy of visual, tactile method, caries detector dye, and laser fluorescence in removal of dental caries and confirmation by culture and polymerase chain reaction: An in vivo study p. 146
Kadandale Sadasiva, Kumarappan Senthil Kumar, Sreeram Rayar, Sai Shamini, Manu Unnikrishnan, Deivanayagam Kandaswamy
DOI:10.4103/JPBS.JPBS_279_18  
Aim: To determine the degree of association between visual and tactile methods of caries removal compared with caries detector dye and laser fluorescence device (DIAGNOdent), which detects the degree of demineralization; to determine the presence of Streptococcus mutans via culture and polymerase chain reaction (PCR) techniques; and to find a suitable method for caries removal. Materials and Methods: A total of 75 patients were divided into three groups: visual and tactile (Group A), visual and tactile with caries detector dye (Group B), and visual and tactile with caries detector dye along with laser florescence readings (Group C). Caries removal was carried out using visual and tactile methods, caries detector dye, and laser fluorescence, and the samples obtained were subjected to culture and PCR. The data obtained were statistically analyzed using Pearson’s chi-square test, analysis of variance (ANOVA), and Tukey’s post hoc test. Results: Visual and tactile along with caries detector dye and laser florescence (Group C) is the most efficient method for caries removal. Conclusion: Caries detector dye along with visual, tactile examination and laser fluorescence is a valuable and superior tool for clinicians that aids in better caries removal and can prevent the overzealous removal of tooth structure.
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Management and disposal of mercury and amalgam in the dental clinics of South India: A cross-sectional study p. 151
Karthik Krishna Ramesh, Maya Ramesh, Ramesh Krishnan
DOI:10.4103/JPBS.JPBS_280_18  
Context: Dental offices are known to be one of the largest users of inorganic mercury in the preparation of amalgam—a restorative material which, if not handled and disposed through scientific methods, can pose grave threats to the biosphere. Aims: The objective of this study was to assess and record the mercury management and disposal strategies of dental practitioners belonging to the two South Indian states, Kerala and Tamil Nadu. Subjects and Methods: A questionnaire regarding the usage and disposal of a filling material containing mercury (amalgam) was designed and distributed online. The 150 dental practitioners partaking in this study responded anonymously. Results: The results were statistically analyzed using chi-square test and the P value was evaluated. The usage of amalgam was correlated with the age of the practitioner and the nature of practice and it was found to be statistically significant. The number of fillings was correlated with the years of practice and locality of the clinic, which were found to be statistically significant. Conclusions: This study showed that mercury was widely preferred and utilized even today as a restorative material by dentists and dental specialists, despite the availability of other alternative strategies. Only a minor section of practitioners were found to be aware of the global changes in the guidelines pertaining to the handling and disposal of amalgam. We feel that Safe Mercury Amalgam Removal Technique, amalgam safety rules, and amalgam-free practice should be a part of the academic curriculum and continuing dental education.
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The evaluation of dentin microhardness after use of 17% EDTA, 17% EGTA, 10% citric acid, MTAD used as chelating agents combined with 2.5% sodium hypochlorite after rotary instrumentation: An in vitro SEM study p. 156
Manu Unnikrishnan, Vijay Mathai, Kadandale Sadasiva, Ravi Sanker Madhavankutty Santakumari, Sabari Girish, Arya Karunakaran Shailajakumari
DOI:10.4103/JPBS.JPBS_282_18  
Introduction: The smear layer removed during root canal instrumentation enables penetration of irrigant solution and adhesion of root canal sealants providing a fluid tight seal of obturated root canals, necessitating its removal. The aim of the study was to compare the effect of smear layer removal by 17% Ethylene diamine tetraacetic acid (EDTA), 17% Ethylene glycol tetraacetic acid (EGTA),10% Citric acid and (MTAD solution) a Mixture of tetracycline isomer, an acid and a detergent applied as final rinse , when used along with 2.5% (NaOCl) Sodium hypochlorite and its effect on dentin microhardness. Materials and Methods: Sixty single-rooted human mandibular premolars with minimum curvature (<5°) were instrumented using rotary instrumentation till apical enlargement size 35 RaCe file 0.04 taper. During instrumentation, the canals were irrigated with 2-mL 2.5% NaOCl. After instrumentation, teeth were rinsed with distilled water and were divided into 5 groups (n = 12) according to final rinse for 1min with 5-mL 17% EDTA followed by 5-mL 2.5% NaOCl (group 1, control group), 17% EGTA (group 2), MTAD solution (group 3), 10% citric acid (group 4), and 17% EDTA (group 5). Teeth were split through the groove prepared, and one-half of specimen were evaluated for smear layer removal using scanning electron microscopy. A score system was followed to evaluate the images and comparisons among groups were performed using Kruskal–Wallis one-way analysis. Multiple comparisons were performed using Mann–Whitney U test. The other half was evaluated for dentin microhardness using Vickers microhardness testing machine. Microhardness values were statistically analyzed using parametric one-way analysis of variance test. Conclusion: Irrigation regimen following the use of 2.5% NaOCl during instrumentation followed by application of 5-mL 17% EDTA solution for 1min resulted in efficient smear layer removal and less decrease in dentin microhardness compared with 17% EGTA, 10% citric acid, and MTAD solution.
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In vitro antibacterial efficacy of sutures coated with Aloe vera and ciprofloxacin: A comparative evaluation p. 164
Potluri Leela Ravishankar, Vandana Vijayan, Sunanda K Rao, Saravanan A Vadivelu, Damodaran Narayanaswamy, Surya Teja
DOI:10.4103/JPBS.JPBS_284_18  
Background: Sutures which are used for wound approximation can act as a reservoir of microbes at the surgical site leading to increased chances of surgical site infection (SSI). Sutures used in oral cavity are continuously bathed in saliva which results in wicking. Several studies on sutures treated with nanoparticles, antibacterial agent and various drugs to advance the therapeutical value of surgical sutures are in consideration, drug-eluting sutures has been notable in research to deliver localized effect on the site of incision. Ciprofloxacin and Aloe vera are routinely used agents in coating sutures. Aim: This study is to evaluate the antibacterial efficacy and oral biofilm inhibition of Ciprofloxacin and Aloe vera coated 3-0 silk sutures in comparison to uncoated sutures against E.coli. Material and Methods: Equal segments of ciprofloxacin and aloe vera coated 3-0 silk sutures are to be incubated in E.coli culture media (blood agar) at 37°C for 24 hours in aerobic atmosphere. Plain uncoated suture served as control. Assessment was done using Total Colony Forming Units and biofilm inhibition potential of sutures. Results awaited. Results: The zone of inhibition around ciprofloxacin coated suture is nearly double than that of with Aloe vera indicted that antibacterial efficacy of ciprofloxacin is more comparatively. No inhibition zone around uncoated plain 3-0 braided silk shows that it has no significant antibacterial activity. Conclusion: Within limitation of our study, it can be concluded that both ciprofloxacin and Aloe vera coated sutures have antibacterial property against gram negative E. coli and can have a promising role in prevention of SSI although it would require further in vivo validation.
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Oral health–related quality of life and dental caries status in children with orofacial cleft: An Indian outlook p. 169
Nagappan Nagappan, Rajmohan Madhanmohan, Nithin Manchery Gopinathan, Sujith Raj Stephen, Dinesh Dhamodhar Mathevan Pillai, Nagaland Tirupati
DOI:10.4103/JPBS.JPBS_285_18  
Aim: To assess the dental caries status and oral health–related quality of life (OHRQOL) among children with orofacial cleft reporting to a hospital in India. Materials and Methods: Subjects were divided into two groups. Group 1 cleft children (n = 80) and group 2 noncleft children (n = 80). Decayed, missing, and filled teeth (DMFT) Index, deft Index, and Children Oral Health Impact Profile questionnaire were recorded. Results: The mean DMFT was high in noncleft (3.51±2.45) children than in cleft children (2.75±2.68). The mean deft was high in noncleft (1.11±0.96) children than in cleft children (0.86±3.07). Conclusion: Cleft children have negative impact on OHRQOL than noncleft children.
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Assessment of periodontal disease among the dental prosthetic and nonprosthetic wearers in an adult rural population in Mangalore taluk, South India p. 175
Mallika Sadanand Shetty, Saurabh Jain, Uma M Prabhu, Akshata G Kamath, Savitha Dandekeri, Mallikarjuna Ragher, Sanath K Shetty
DOI:10.4103/JPBS.JPBS_286_18  
Background: Oral health as an integral part of general health. Rural population neglect oral health as they lack awareness on oral diseases and also due to inadequate availability of dental services. There is a very high prevalence of chronic inflammatory periodontal disease in the rural Indian population, which is left untreated. Hence, this cross-sectional survey was taken up in the rural area of Mangalore taluk, Karnataka, India. Materials and Methods: A cross-sectional survey was carried out on 1312 participants aged 18 years and older. The prevalence of periodontal disease among the dental prosthetic and nonprosthetic wearers was assessed. The World Health Organization format was used to record the periodontal status and loss of attachment. Data collected were analyzed using chi-square test. P < 0.05 was considered as significant. Result: Of the 1312 included subjects, 520 were males (39.6%) and 792 were females (60.3%). Periodontal status showed that calculus was found to be high among all age groups. When the prevalence of periodontal disease was assessed among the prosthetic wearers, it was found that subjects wearing removable partial denture showed increased prevalence of periodontal pocket depth and attachment loss irrespective of age group, gender, and educational qualification. Conclusion: Lack of awareness among the individuals regarding periodontal diseases has been associated with consistently higher prevalence of periodontal diseases and treatment needs. Demographical studies need to be carried out at regular intervals, thus helping in planning the treatment needs nationwide for better oral health care in rural population.
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Oral health status of sports university students in Chennai p. 180
Nagappan Nagappan, Nagaland Tirupati, Nithin Manchery Gopinath, Duraiselvi Panneer Selvam, Gayathri Ponnusamy Subramani, Gireesh Kumar Subbiah
DOI:10.4103/JPBS.JPBS_287_18  
Background: The field of sports in India has its renowned importance. Oral health is mirror to general health. Thus, oral assessment to sports players by a dentist is important. The commonly faced oral health problems among sports players are oral and facial trauma, leading to fracture of facial bones and teeth. Hence, it compromises the function of chewing, loss of muscle balance, and temporomandibular joint problems. The mean of facial trauma experienced by sports players in Mysuru and Chennai was 21% and 17%, respectively. Objectives: This study aimed to assess the oral health status among sports university students in India. Clinical examination was conducted using the World Health Organization’s oral health pro forma in 2013. Materials and Methods: A cross-sectional descriptive study was conducted among sports university students, Melakottaiyur, Chennai. Results: A total of 94 athletes comprising 64 (68%) males and 30 (32%) females in the age group of 18–30 years, with a mean age of 24±5.04 years, were included. The mean decayed, missing, filled (Teeth) value was 2.23±3.01 and 1.87±2.62 for male and female, respectively. Around 64% of sports persons are affected with gingival inflammation, 36% with periodontal condition, and 15% with dental fluorosis. Conclusion: This study concludes that sports persons have poor gingival, dental caries, and periodontal status.
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Evaluation of patient and parent satisfaction after orthodontic treatment/orthognathic surgery for cleft lip and palate deformity p. 184
Muraleedhara Bhat, Subramanya Shetty, Praveen Shetty, Faizan A Khan, Akhtar Husain, Mallikarjuna Ragher
DOI:10.4103/JPBS.JPBS_289_18  
Objectives: The objectives of this study were to evaluate the satisfaction of patients, parents, and individuals other than health professionals (neighbors or relatives), regarding the quality of care, and to evaluate the patients general care, facial appearance, dental changes, and psychological assessment by social outlook and emotional quotient. Materials and Methods: Sixty patients with cleft lip and palate reporting to a dental institution were divided into two age groups, 0–15 years (G1) and 15–30 years (G2), their parents (P1 and P2) and a group comprising their neighbour’s or relatives (T1 and T2) were also divided according to G1 and G2. To evaluate their satisfaction toward the treatment received, three separate questionnaires were given to the three groups and their responses were subjected to statistical analysis. Results: The results showed that majority of patients (74%) and their parents (60%) were satisfied with the orthodontic treatment they received to align the teeth. But they were not satisfied with the appearance of lip (61.6% and 56.6%), nose (60% and 53.3%), and speech (62%). This study showed that cleft-affected individuals were teased mainly for speech (60%) followed by lip and teeth. Sixty percent of the patients admitted that their self-confidence was quite affected because of cleft and 36.6% expressed that their school/college results have been affected. Conclusion: Majority of cleft lip and palate patients as well as their parents were satisfied with their child’s dental appearance; they were unsatisfied with the appearance of nose, lip, smile, and speech.
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Assessment of periodontal health and necessity of dental treatment in the institutionalized elderly population of East Godavari district, Andhra Pradesh p. 188
Shaik K Sha, Ayub Khan, Karteek Eswara, Deepa Lakshmi Parchuri Venkata Suvarna, Karthik Kannaiyan, Nagarjuna Pottem
DOI:10.4103/JPBS.JPBS_291_18  
Aim: To assess the periodontal health condition and treatment needs among elderly people aged 60–85 years residing as inmates in the eight old age homes in East Godavari district, Andhra Pradesh, India. Settings and Design: A cross-sectional descriptive study was conducted to verify the oral health condition and treatment needs among elderly people aged 60–85 years. Materials and Methods: Modified World Health Organization (WHO) 2013 oral health assessment pro forma for adults was used to assess the oral health status and treatment needs, the clinical assessment of oral mucosa, loss of attachment (LOA) , community periodontal index, dentition status, and treatment need. Prosthetic status and prosthetic needs and related oral health information were obtained from WHO Oral Health Assessment Questionnaire. Statistical Analysis Used: SPSS 23 was used for statistical analysis. Chi-square test was used for age- and gender-wise comparison. P < 0.05 was considered statistically significant. Results: Among the study subjects aged 60–74 years, there were 28.1% males and 25.9% females, and in 75–85 years, 30.6% were males 15.3% were females. In terms of periodontal status (pocket scores), 66.2% of elderly people have pocket scores 6mm or more and presence of gingival bleeding in 75.9% of study subjects. Almost 24.4% had LOA scores of 12mm or more. Comparison of LOA scores based on age and gender was statistically significant (P < 0.001). Of the study participants, 50.3% need prompt treatment (including scaling). Almost more than half of the study participants require one or multiunit prosthesis as only 10.93% of elderly population has ≥20 or more natural teeth present. Conclusion: The study showed poor periodontal health among institutionalized elderly inmates. Oral mucosal lesions were found to be higher and oral health status was very deprived among the study population.
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Effect of dental health education on the knowledge and attitude among expectant mothers: A questionnaire study p. 194
Nandhini B Selvarajan, Ramesh Krishnan, Suresh Kumar
DOI:10.4103/JPBS.JPBS_293_18  
Background: Although dental caries levels have declined and stabilized the world over, the problem of early childhood caries has remained persistent in many areas of the world affecting certain segments of society, especially the socially deprived, who remain at high risk to this disease. Parents have an essential role in mediating between their children and environment for which prenatal period is the best time for health interventions. This mediation is done through preventive services they provide to their children such as dietary habits supervision, oral hygiene performance, and other practices that can be enhanced by prenatal dental health education. Purpose: The purpose of the study was to evaluate, by means of a questionnaire, the expectant mother’s knowledge and attitude toward dental health and to test the effectiveness of the health education tool. Materials and Methods: The baseline questionnaire consisted of 27 questions, which was distributed to 138 participants. Subsequently, provision for dental health education was made in batches of 20. After 3 weeks, 10 questions were randomly selected from the first questionnaire for reassessment session. Paired t test was used for statistical analysis. Results: The mean overall knowledge improved from 67.4% to 97.32% and attitude improved from 75.83% to 99.22%. Conclusion: Knowledge and attitude of mothers was found to increase on provision of dental health education, which were retained even after a period of 3 weeks.
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Preparation of mouthwash and gel from Rosa damascena Mill and evaluating its effectiveness—An in vivo analysis p. 198
Nazargi Mahabob, Jayashree Mohan
DOI:10.4103/JPBS.JPBS_294_18  
Background: Rosa damascena Mill, commonly known as Damascus rose and garland rose, belongs to Rosaceae family, which has around 200 different types of rose species. R. damascena Mill is famous for its fragrance and beauty, and hence it is highly cultivated all over the world. In addition, this plant is also used for its medicinal properties. Objectives: The objectives of this study are to prepare mouth wash and gel from the oil of R. damacena Mill, to evaluate the effectiveness of the medicinal properties of prepared mouth wash and gel, to evaluate its anti-inflammatory and analgesic properties, and to evaluate the adverse effects. Materials and Methods: At the JSS College of Pharmacy, Ooty, the oil of R. damacena Mill was converted into mouth wash and gel. To evaluate the effectiveness of the prepared rose gel and mouthwash, 24 Wister and 24 Albino rats were subjected to acetic acid induced writhing, hot plate method, and Carragennin induced paw edema test. Results: Acetic acid induced writhing in mice and hot plate method were carried out. Both methods proved presence of analgesic activity, and Carragennin induced paw edema test showed the anti-inflammatory property of R. damascena mill. Conclusion: These two in vivo studies proved that the presence of analgesic and anti-inflammatory properties in prepared R. Damascena mill mouth wash and gel.
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Antimicrobial activity of Curcuma longa L. extract on periodontal pathogens p. 203
Mohammad Jalaluddin, Ipsita Jayanti, Inderjit Murugendrappa Gowdar, Rincy Roshan, Roshan Rajan Varkey, Abhilash Thirutheri
DOI:10.4103/JPBS.JPBS_295_18  
Aim: The aim of this study was to evaluate the antimicrobial activity of Curcuma longa L. extract (CLE) on periodontal pathogens. Materials and Methods: Sixty patients were divided into three groups: Group I (n = 20) patients treated with scaling and root planning (SRP) only, Group II (n = 20) patients treated with SRP followed by subgingival irrigation with 1% CLE solution, and Group III (n = 20) patients treated with SRP followed by subgingival irrigation with 0.2% chlorhexidine (CHX) solution. The clinical parameters (plaque index [PI], gingival index [GI] scores, probing pocket depths) were recorded at baseline, 4 weeks, and 8 weeks. The antimicrobial efficacy of 1% CLE and 0.2% CHX solutions against Porphyromonas gingivalis, Prevotella intermedia, and Aggregatibacter actinomycetemcomitans were evaluated by disk diffusion method. Results: There was no significant difference in the mean values of zone of inhibition exhibited by both CLE and CHX solutions. All the groups showed significant improvement in the clinical parameters when compared to baseline values. The improvement in the PI and GI scores in the CLE group was lesser than that in CHX group by the end of the study period. Conclusion: CLE possess antimicrobial efficacy against the common periodontopathic bacteria. However, further large-scale studies evaluating the substantivity of C. longa are required to support its beneficial use in the treatment of periodontal diseases.
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Evaluation of sagittal changes in Class II Div 2 patients with decelerating phase of growth by PowerScope appliance: A retrospective cephalometric investigation p. 208
Gowri Sankar Singaraju, Venkataramana Vannala, Srikanth A Ankisetti, Prasad Mandava, Vivek Reddy Ganugapanta, Deepthi Unnam
DOI:10.4103/JPBS.JPBS_299_18  
Background: Restricted mandibular growth is observed in Class II Div 2 malocclusions. The fixed functional appliances are used to effect the skeletal changes in patients with end stages of skeletal maturity. Aim: This cephalometric study aimed to distinguish the skeletal and dental corrections done in the mandible on skeletal Class II Div 2 subjects when treated with PowerScope appliance (American Orthodontics, Sheboygan, WI). Materials and Methods: This is a cephalometric study based on the retrospective data. The patients selected for this study were with Class II Div 2 malocclusion and assessed to be in decelerating phase of skeletal growth. A total of 12 patients were selected after applying inclusion and exclusion criteria. A PowerScope was placed after incisor correction and followed up till Class I molar relation was achieved. The initial values (T1) at the time of placement of the appliance and the final values at the end of the molar correction (T2) were noted. The cephalometric parameters at T1 and T2 were assessed using sagittal occlusal (SO) analysis by Pancherz. The paired Student’s t-test was used to analyze pre- and posttreatment changes. Results: There was sufficient lengthening of the mandible (4.38mm). Both the dental and skeletal alterations were observed in the mandible. These changes were marked compared to the maxilla. The pre- and posttreatment changes were statistically significant for the mandibular skeletal changes (P < 0.001) as well as mandibular incisor proclination (P < 0.001). Conclusion: The PowerScope can be used as a propeller for sagittal mandibular correction in Class II Div 2 patients.
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Comparative evaluation of depth of penetration of root canal irrigant after using manual, passive ultrasonic, and diode laser–assisted irrigant activation technique p. 216
Arasappan Rajakumaran, Arathi Ganesh
DOI:10.4103/JPBS.JPBS_300_18  
AIM: The aim of this study was to compare and evaluate the penetration depth of irrigant after using manual, passive ultrasonic, and diode laser–assisted irrigant activation technique. Materials and Methods: Ninety extracted single-rooted human mandibular premolars were selected (N = 90). Teeth were decoronated and working length was standardized for 12mm. Root canals were shaped using ProTaper Universal F3. Saline was used as an irrigant in between every successful instrumentation. After completion of chemomechanical preparation, root canals were filled with Rhodamine-B-labeled sodium hypochlorite (3%). Teeth samples were divided into three experimental groups. In Group 1 (n = 30), manual irrigant activation was performed for 30 seconds with master cone gutta-percha (F3) in gentle up and down motion. In Group 2 (n = 30), ultrasonic irrigant activation was performed using passive ultrasonic endo tips for 30 seconds. In Group 3 (n = 30), laser activation was performed using diode laser for 30 seconds with 200-µm tips. Transverse sections were made at 2, 5, and 8mm from the root apex and were observed under confocal laser scanning microscopy. Maximum penetration depth of irrigant was recorded and statistically analyzed. Result: In the all three groups, coronal third (sections at 8mm from root apex) showed the highest penetration depth of irrigant. Laser activation (Group 3) showed the highest penetration depth in all the three sections when compared with manual and passive ultrasonic irrigant activation. One-way analysis of variance and post hoc test showed there were significantly high differences among all the three groups and also at all three levels (P < 0.05). Conclusion: Diode laser–assisted irrigant activation technique had better penetration depth in all the three aspects of root dentin.
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Evaluation of resin penetration depth in enamel surface for orthodontic bonding exposed to five types of enamel conditioning methods: A scanning electron microscopic study p. 221
D Pawan Kumar Bhandari, Gobichettipalayam J Anbuselvan, Muthukumar Karthi
DOI:10.4103/JPBS.JPBS_301_18  
Aims and Objectives: To evaluate the enamel surface depth of resin penetration for orthodontic bonding when exposed to five types of enamel conditioning methods using scanning electron microscope. Materials and Methods: The sample comprised of 25 human extracted premolar teeth for orthodontic reasons. The samples are divided into 5 groups with each 5 teeth based on the enamel conditioning methods such as group A with 37% Phosphoric acid, group B with 10% Polyacrylic acid, group C with Self etch primer, group D with Laser etching and group E with air abrasion etching. All the samples in each group are bonded with metal brackets using Transbond XT Adhesive. After bonding, the teeth are sectioned mesiodistally using hard-tissue microtome and observed under scanning electron microscope at 500x and 3000x for the calculation of depth of resin penetration. Results: The teeth etched with 37%phosphoric acid exhibited significantly greater depth of resin penetration (15.1µm) than do self-etch and polyacrylic acid. Laser etching has comparable penetration depth with that of acid etching. Air abrasion has got the least penetration of all groups. Conclusion: Comparing the enamel treated with these conditioning methods, the penetration of resin material into enamel are greater when it is treated with 37% Phosphoric acid than self-etch or laser etching.
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Low-level laser therapy: A noninvasive method of relieving postactivation orthodontic pain—A randomized controlled clinical trial p. 228
Subramaniam Murugesan Vignesh Prasad, Turuvekere Ramaiah Prasanna, Vijayarangan Kumaran, Nagaraj Venkatachalam, Mohamed Ramees, Esther A Abraham
DOI:10.4103/JPBS.JPBS_303_18  
Introduction: Pain is an unavoidable squeal of orthodontic treatment and it is known to decrease patient compliance and eventually affects treatment results. Numerous methods are available in literature to manage orthodontic pain after activation but they have their own limitations. This has led to exploring further options for management of pain. Aim: The aim of this study was to evaluate the effectiveness of low-level laser therapy (LLLT) in alleviating orthodontic pain after activation. Materials and Methods: 20 subjects were randomly divided into an experimental and a control group. Each participant was given a retraction force of 200gm/cm2/side. Subjects in the experimental group were exposed to low-level laser light at 980nm and those in the control group were exposed to red LED light as placebo. The pain perceived after 0 hour, 1 hour, 3 hours, 48 hours, and 1 week of activation was recorded by patient using Visual Analog Scale. Statistical analysis was done using Mann–Whitney test. Results: Results of the study showed that pain experienced by the subjects after orthodontic activation was higher in experimental group at T0 than in placebo group. At T1, T2, T4, and T5, the pain experienced by the subjects was less in the experimental group compared to the placebo group. Pain experienced by the subjects in the experimental group at T3 was significantly less as compared to those in the placebo group. Conclusion: A single dose of LLLT at 980nm, 2.5 W/cm2, and 600 J is effective in relieving orthodontic pain after activation.
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Analysis of Ki-67 expression in oral premalignant lesions and normal oral mucosa: An immunohistochemical study p. 232
Basheer H Beevi, Suhas Ramananda Nayak, Celestina D Peter, Ajay K Haridas, Lin Jacob, Asaf Aboobakker
DOI:10.4103/JPBS.JPBS_305_18  
Aim: This study aimed to evaluate the Ki-67 expression in oral premalignant lesions and normal oral mucosa. Materials and Methods: The cases were selected on the basis of the details obtained from the patients. A total of 45 specimens were divided into three groups: Group 1 (normal mucosa), Group 2 (clinically and histologically diagnosed as oral lichen planus), and Group 3 (clinically and histologically diagnosed as leukoplakia). Specimens were prepared and the slides for Ki-67 were observed under light microscope with a magnification of ×400. The tissue samples were thoroughly examined, and the pattern of expression was analyzed semiquantitatively by counting the number of positive cells. Results: The mean positive cell count of normal mucosa was 23.20±2.89, of oral lichen planus was 42.82±2.65, and of leukoplakia was 82.14±3.10. There was a statistically significant difference of expression observed between the groups (P < 0.001). On multiple comparisons using Tukey post hoc test, a statistical difference was found between all the three groups. Conclusion: Ki-67 is an easily applicable marker of cell proliferation whose expression correlates well with the disease progression.
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An in vitro evaluation of fracture resistance strength of different post systems in endodontically treated teeth p. 236
Shabna Moyin, Saurabh Chaturvedi, Nasser M Alqahtani, Mansoor Shariff, Adel M Abdelmonem, Mohammed A Alfarsi
DOI:10.4103/JPBS.JPBS_306_18  
Aim: This study aimed to evaluate the fracture resistance strength of different post systems in endodontically treated teeth. Materials and Methods: Freshly extracted 60 single-rooted first premolars were selected for this study. Conventional step-back technique was used to prepare a canal for all the teeth. Obturation was carried out and post space was created using a Peeso reamer. All teeth were randomly divided into three groups of 20 samples in each group: Group I, teeth inserted with prefabricated carbon posts; Group II, teeth inserted with prefabricated zirconia posts; and Group III, teeth inserted with prefabricated everStick posts. Core buildup was performed using light-cured composite resin. Compressive load required to fracture the tooth was measured using a universal testing machine. Results: The compressive strength of zirconia posts was highest with a mean of 796.10±20.78 followed by carbon posts (628.22±18.11) and lower compressive strength was exhibited by everStick posts (534.13±19.98). An analysis of variance revealed a statistically highly significant difference (P < 0.005) among the different posts used, and a statistically significant difference between carbon posts vs. zirconia posts, carbon posts vs. everStick posts, and zirconia posts vs. everStick posts (P < 0.05). Conclusion: Zirconia posts show the maximum fracture resistance than the carbon posts and everStick posts.
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Correlation of ICDAS-LAA and ORA test for caries risk assessment: A cross-sectional study p. 240
Pradeep Daniel Gainneos, Mallika Selvam, Suresh Kumar Vasaviah, Ramesh Krishnan
DOI:10.4103/JPBS.JPBS_307_18  
Background: Dental caries is the most common chronic disease of children aged 6–11 years. The International Caries Detection and Assessment System—Lesion Activity Assessment (ICDAS-LAA) is a precise tool for the clinical assessment of dental caries by visual appearance, tactile feeling, and potential for plaque accumulation. Ora test is a chairside tool to estimate the ability of acid produced by bacteria to cause demineralization, in a suitable environment. Aim of this study is to correlate ICDAS-LAA and Ora test in assessing the caries risk of a patient on the dental chair. Materials and Methods: A total of 60 school children aged between 6 and 9 years were included in the study. Of 60 children, 30 (Group A) were caries free and 30 (Group B) had decayed missing extraction, filled (DMF) score of 1–3. All the children were initially subjected to ICDAS-LAA scoring, which was assessed by one examiner followed by chairside Ora test performed by another examiner. Results: Statistical analysis was done using Pearson correlation test, and a negative linear relation was found between the time taken for color change in Ora test and ICDAS-LAA scores. Conclusion: A direct correlation exists between ICDAS-LAA scores and Ora test, which shows that microbial activity correlates well with lesion activity.
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Efficacy of three types of plaque control methods during fixed orthodontic treatment: A randomized controlled trial p. 246
M Shilpa, Jithesh Jain, Fazal Shahid, Khalid Gufran, George Sam, Mohammed S Khan
DOI:10.4103/JPBS.JPBS_1_19  
Aim: The aim of this study was to evaluate and compare the efficacy of three types of plaque control methods among 13- to 35-year-old subjects receiving fixed orthodontic treatment in Coorg Institute of Dental Sciences, Virajpet, Coorg district, Karnataka, India. Materials and Methods: A total of 111 subjects who fulfilled the inclusion and exclusion criteria were randomly included in the study. The subjects were recalled after 1 month of the commencement of fixed orthodontic treatment for the recording of baseline data including plaque index (PI), gingival index (GI), and modified papillary bleeding index (MPBI). After recording of the baseline data, the subjects were randomly allocated into each of the intervention groups, i.e., group A (manual tooth brush), group B (powered tooth brush), and group C (manual tooth brush combined with mouthwash) by lottery method. Further, all the subjects were recalled after 1 and 2 months for recording the data. Results: Regarding plaque levels, it was seen that there was a highly statistically significant difference between the three groups (P = 0.001), with the manual tooth brush combined with chlorhexidine mouthwash group recording the lowest mean PI score of 0.5±0.39. A comparison of the mean GI scores among the groups at the end of 2 months shows a highly statistically significant difference (P = 0.001). The mean MPBI scores at the end of 2 months were highly statistically significant among the three groups (P = 0.001), with the group C recording the lowest mean MPBI score of 0.3±0.3. Conclusion: The powered tooth brush group subjects exhibited significantly lesser PI, GI, and MPBI scores than the manual tooth brush group at the end of 2 months, whereas the manual tooth brush combined with chlorhexidine mouth wash group subjects showed maximum improvement, having significantly lesser PI and GI scores than the powered tooth brush group.
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Prevalence of dental caries and periodontal status among Down’s syndrome population in Riyadh City p. 252
Khalid Gufran, Omar Saud Alqutaym, Abdul Aziz Maree Alqahtani, Ahmed Mohammed Alqarni, Essa Ali Essa Hattan, Refdan Obeid Alqahtani
DOI:10.4103/JPBS.JPBS_2_19  
Aim: Aim of the present study was to evaluate the prevalence of dental caries and periodontal status among Down’s syndrome population in Riyadh City. Materials and Methods: A total of 81 male Down’s syndrome subjects were examined in this study. All subjects were recruited from the Saudi Center for Down Syndrome, Riyadh. Clinical examination was carried out by a single precalibrated examiner. Dental caries experience was counted according to the DMFT (decayed, missing, and filled teeth) indexes. Periodontal status was evaluated by using plaque and gingival indexes. Statistical analysis was performed using SPSS 19 version. Consequently, Pearson chi-square test and Fisher exact test was used to calculate p-value for parametric variables. Results: In this study 11.1% of the subjects were not having any decayed teeth, 39.5% were not having any missing teeth, and 55.6% were not having any filled teeth. In plaque index, maximum number of subjects in all the age group were in the fair group, and there was a highly significant (P value <0.001) association between the age group and the plaque index groups. In gingival index, maximum number of subjects in all the age group was in the poor group. No significant (P value = 0.697) association between the age group and the gingival index groups was found. Conclusion: The present study concluded that the prevalence of dental caries was high and periodontal status of Down’s syndrome subjects was poor.
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Antimicrobial efficacy of Aloe vera, lemon, Ricinus communis, and calcium hydroxide as intracanal medicament against Enterococcus faecalis: A confocal microscopic study p. 256
Ramamurthy Varshini, Anirudhan Subha, Vasanthakumar Prabhakar, Pon Mathini, Sriman Narayanan, Koshy Minu
DOI:10.4103/JPBS.JPBS_5_19  
Introduction: The aim of this study was to evaluate the antimicrobial efficacy of different intracanal medicaments against Enterococcus faecalis using confocal microscopy. Materials and Methods: Eighty extracted single-rooted mandibular premolar teeth were used in this study, which were decoronated and instrumented with K-files following which biomechanical preparation was performed up to ProTaper F3. The teeth were inoculated with E. faecalis and incubated for 21 days. The specimens were divided into five groups according to the medicaments used: saline, calcium hydroxide, Aloe vera, Ricinus communis, and lemon extract. After 7 days of placement of intracanal medicament, the efficacy of the intracanal medicament against E. faecalis was assessed using confocal microscopy. The data were analyzed using one-way analysis of variance and the Tukey HSD (post hoc) test for multiple comparisons. Results: Calcium hydroxide showed significantly greater antimicrobial efficacy than A. vera, lemon, and R. communis (P < 0.05). Conclusion: Complete elimination of E. faecalis was not achieved in any of the experimental groups. Calcium hydroxide was more effective than the other herbal medicaments used.
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Comparison of efficacy of lycopene and lycopene–hyaluronidase combination in the treatment of oral submucous fibrosis p. 260
Joseph Johny, Sudeep C Bhagvandas, Sunil Paramel Mohan, Sameer Punathil, Shabna Moyin, Manoj K Bhaskaran
DOI:10.4103/JPBS.JPBS_6_19  
Background: Oral submucous fibrosis (OSMF) is a chronic progressively scarring disease of the oral cavity. Lycopene is a powerful antioxidant obtained from tomatoes and has the highest singlet oxygen quenching capacity and a high capacity of quenching other free radicals in vitro among dietary carotenoids. Hyaluronidase is a substance prepared from the testes and semen of mammals that modifies the permeability of connective tissue through the hydrolysis of hyaluronic acid. Objective: To evaluate the efficacy of lycopene and lycopene−hyaluronidase combination, and to compare the efficacy of lycopene and lycopene−hyaluronidase combination in the treatment of OSMF. Study Design: The study consisted of 45 patients with OSMF divided into three equal groups. Patients in Group A were given Lycored 16mg daily in two equally divided doses for 3 months. Patients in Group B were given LycoRed along with hyaluronidase intralesional injection of 1500 IU twice weekly for 3 months. Patients in Group C were given placebo capsules. Patients were evaluated after 3 months. The following parameters were recorded: mouth opening, visual inspection, palpatory findings, and burning sensation. Results: There was statistically significant change in mouth opening and burning sensation for lycopene and lycopene–hyaluronidase combination than in the placebo group in the treatment of OSMF, but the lycopene–hyaluronidase combination did not show any statistically significant change when compared with lycopene alone. Conclusion: Lycopene appears to be a very promising antioxidant in the management of oral submucous fibrosis, both in clinical and symptomatic improvement.
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Estimation of serum cortisol levels in oral lichen planus patients with electrochemiluminescence p. 265
Sam Jose, Jayasree Vijayalakshmi Mukundan, Joseph Johny, Arun Tom, Sunil Paramel Mohan, Anjali Sreenivasan
DOI:10.4103/JPBS.JPBS_7_19  
Objectives: The objectives of this study were to compare the serum cortisol level in oral lichen planus (OLP) patients with normal healthy individuals and to compare the serum cortisol level in patients with erosive and nonerosive forms of OLP. Materials and Methods: A case–control study involving 60 patients within the age group of 20–50 years was carried out. Group A included 15 subjects with nonerosive lichen planus, without skin involvement; Group B included 15 subjects with erosive lichen planus, without skin; and Group C included 30 subjects with no apparent lesions of the oral mucosa and the skin. From the cases and controls, 7mL venous blood was taken from median cubital vein two times (between 8 and 10 am,and 4 and 6 pm) by using a 10mL syringe from which 5mL was taken for estimation of serum cortisol. Results: The serum cortisol levels of the erosive OLP patients were significantly higher than those of nonerosive OLP patients and controls. There was no significant difference in the serum cortisol levels between nonerosive OLP in comparison with controls.
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Comparative assessment of force decay of the elastomeric chain with the use of various mouth rinses in simulated oral environment—An in vitro study p. 269
Vineetha Venugopal Menon, Sankar Madhavan, Tojan Chacko, Supriya Gopalakrishnan, Jose Jacob, Anuradha Parayancode
DOI:10.4103/JPBS.JPBS_9_19  
Aim: This study is aimed to assess the effect of different mouth rinses and its active components on the force decay of elastomeric chains. Listerine, Colgate Phos-Flur, Clohex Plus mouth rinses, 26.9% alcohol, 0.04% sodium fluoride (NaF), and 0.2% chlorhexidine were used for this study to determine its effects on force decay of elastomeric chains. Materials and Methods: Seven custom-made jigs were constructed on which 120 short module elastomeric chains were stretched to predetermined lengths between the pins. Using calibrated digital force tester, measurements of force exerted by the elastomeric chains while stretched on the framework were recorded at the time of attachment to the frame and after 24 hours, 7 days, 14 days, 21 days, and 28 days. The custom-made jigs and the elastomeric chains were allowed for complete submersion in artificial saliva throughout the test period, as well as in respective control solution and mouth rinses for 60 seconds, twice daily. Results: All test groups showed significantly more force decay than the control group. Statistically significant differences were observed when comparing force decay among the test groups except between a few. Interpretation and Conclusion: Mouth rinses cause an increase in force decay of elastomeric chain over the time. Listerine and 26.9% alcohol solution caused maximum force decay by the end of 28 days. Least force degradation of elastomeric chain was seen with the use of 0.2% chlorhexidine.
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Assessment of oral mucosal integrity status in patients with recurrent aphthous stomatitis p. 274
Sriram Kaliamoorthy, Ramalingam Sathishmuthukumar, Keerthanasri Chidambaram, Paranthaman Srinivasan, Mahendirakumar Nagarajan, Rajkumar Selvakumar, Vikneshan Murugaboopathy
DOI:10.4103/JPBS.JPBS_10_19  
Background: Recurrent aphthous stomatitis represents one of the most common oral pathoses with multifactorial etiology. Decrease in mucosal barrier resistance is believed to be one of the etiologies in its pathogenesis. This study was conducted to assess the oral mucosal integrity status by evaluating the salivary albumin level in patients with aphthous stomatitis. Materials and Methods: Thirty patients diagnosed with aphthous stomatitis were selected as case group. Equal number of age- and sex-matched healthy individuals formed the control group. Salivary albumin level was estimated during active and quiescent stage of the disease in both case group and control group. Result: Mean salivary albumin level for the case group during the active and quiescent stage was 0.070g/dL (SD = 0.037) and 0.004g/dL (SD = 0.007) (SPSS, version 7.0), respectively, and that for the control group was 0.027g/dL (SD =0.042). Statistically significant difference was found on comparison of the mean salivary albumin level between the case group during active and quiescent stage and the normal controls using Mann–Whitney U test. No statistically significant difference in salivary albumin level was seen between the quiescent stage in case group and the normal controls. Conclusion: Increase in salivary albumin level at the time of disease presentation could be attributed to the leakage of albumin through the ulcerated mucosa. Absence of significant elevation in the salivary albumin level after the resolution of the aphthous ulcer apparently indicates inherently a healthy mucosal barrier in majority of the patients.
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Clinical and radiological evaluation of delayed and early loading of single-tooth implant placement: A 6-month, prospective, randomized, follow-up clinical study p. 278
Santhosh Sekar, Thangakumaran Suthanthiran, Arthiie Thangavelu, Sasi Kumar Karupannan, Fairlin Prem, Dhivya Rajendran
DOI:10.4103/JPBS.JPBS_12_19  
Purpose: The purpose of the study was to compare delayed and early loaded single-tooth implant technique. Materials and Methods: A randomized, prospective clinical trial was conducted to evaluate the clinical and radiological parameters of delayed and early loading of single-tooth implant placement. Fourteen male or female patients were selected randomly, who had single tooth missing in mandibular posterior region. A delayed implant placement technique was followed in these regions. A Hi-Tech implant (Life Care Implants) was performed. The patients were divided into two groups: delayed loading group and early loading group. In delayed loading groups, implants were loaded after 3 months, and in early loading groups, implants were loaded within 7 days to 2 months. Soft tissue and radiological bone loss were assessed at baseline, 3 months, and 6 months. The parameters assessed were plaque index, gingival index, probing pocket depth, thickness of peri-implant mucosa, and bone loss (radiographically). Results: The results show that there was no statistical difference in indexes taken between delayed loading and early loading groups. Conclusion: In this study, after first 6 months there was no difference in success rate between delayed loading or early loading of implants. This study also showed that more bone loss occurred around delayed loading implants. So it can be concluded that early loading technique can be successfully practiced instead of delayed loading of implants.
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Dermatoglyphics and their relationship with blood group: An exploration p. 285
Saranya Manikandan, Leka Devishamani, Saranya Vijayakumar, Gowri Shankar Palanisamy, Priyadharsana Ponnusamy, Sai Lakshmi Lalpettai Jayakar
DOI:10.4103/JPBS.JPBS_13_19  
Introduction: Dermatoglyphics means the study of skin markings or patterns on fingers, hands, and feet. Dermatoglyphics is a heritable trait that is considered as a usual phenotype in criminology. Dermatoglyphics acts as a scientific method for identification of an individual and it is constant till demise. Objectives: This study was conducted to correlate the dermatoglyphics and blood grouping of 150 dental students. Materials and Methods: A pro forma was prepared on a durable white paper, rubber stamp ink pads were used for smearing each finger, imprints were taken, and each pattern of fingerprint was observed by powerful hand lens and recorded. Note was made of the sex, age, and ABO and Rh blood group for studying the relationship between types of fingerprints and relation to ABO and Rh blood type. Fingerprint was taken using the INK method as illustrated by Cummins and Mildo. Fingerprint patterns (loops, whorls, and arches) and blood data were collected. Results: In this study, 38% of subjects belonged to O blood group followed by A, B, and AB, and 96.77% of subjects were Rh-positive and 3.23% were Rh-negative. Conclusions: This study shows the association between distribution of dermatoglyphics, ABO, Rh blood group, and gender.
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Relationship between dental archform and dermtoglyphics p. 289
Saravana Kumar Subramanian, Annamalai Periyakaruppiah, Yamini Jeyaraj, Thailavathy Vaidyalingam, Prema Anbarasu, Indra Annamalai
DOI:10.4103/JPBS.JPBS_15_19  
Aim: To study the associations of dermatoglyphic pattern and the dental archform among the young adult population. Materials and Methods: The sample consisted of 150 randomly selected patients, within the age ranging from 15 to 25 years. The fingerprint patterns of the study subjects were recorded with a rolling impression technique using blue printer ink and the archform was assessed from the cast prepared from the impression of their lower dental arches. The data obtained were subjected to statistical analysis using SPSS software. The fingerprint patterns for each digit were analyzed and correlated with archform using appropriate statistical tests (chi-square test). Results: Although no fingerprint pattern was found to be specific for a particular dental archform, increased frequencies of whorls in subjects with square or ovoid archform, high frequencies of ulnar loop pattern with ovoid or tapered archform, and radial loop finger ridge pattern in those with tapered archform were observed. Conclusion: Dermatoglyphic analysis can be used as an indicator for determining the dental archform at an early stage, thereby aiding in the orthodontic treatment of malocclusion aiming to establish favorable occlusion and long-term stability.
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Antimicrobial efficacy of two mouthrinses against Candida albicans: An in vitro study p. 293
Nagappan Nagappan, Bharath Champakesan, Nagaland Tirupati, Thomson Maridasan D'cruz, Palanivel Pandian Ramasubramanian, Parvathy Premnath
DOI:10.4103/JPBS.JPBS_16_19  
Background: Mouthrinses have been used for centuries with the objective of reducing the amount of microorganisms in the oral cavity. Mouthrinses are used as adjuncts to mechanical oral hygiene. Therapeutic mouthwashes are often recommended as an adjunct to mechanical plaque control for prevention of plaque accumulation and to maintain gingival and periodontal health. Mechanical control alone for reducing recalcitrant biofilms in the oral cavity has been challenged because it is considered to be rather time-consuming and most importantly insufficient for effective oral hygiene. The aim of this study was to evaluate the antimicrobial efficacy of herbal and 0.2% chlorhexidine gluconate mouthrinse against Candida albicans. Materials and Methods: The minimum inhibitory concentration and antimicrobial effectiveness (zone of inhibition) of a herbal mouthrinse and 0.2% chlorhexidine mouthrinse were determined by broth macro-dilution and agar well diffusion method, respectively. Results: The zone of inhibition of C. albicans was 26mm for the 0.2% chlorhexidine mouthrinse, whereas it was 12mm for the Arowash liquid mouthrinse. Conclusion: Chlorhexidine mouthrinse (0.2%) has a better antimicrobial efficacy against the C. albicans when compared to herbal mouthrinse (Arowash liquid).
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Malondialdehyde as a marker of oxidative stress in periodontitis patients p. 297
Deepthi A Cherian, Tim Peter, Anjhana Narayanan, Sanupa S Madhavan, Sylvana Achammada, Gopinath Parakkat Vynat
DOI:10.4103/JPBS.JPBS_17_19  
Background: Periodontology is a fast-evolving field with newer insights into traditional periodontal diagnosis. Advances in periodontal disease diagnostic research are moving toward methods whereby periodontal risk can be identified and quantified by objective measures such as biomarkers. Objectives: The aim of this study was to evaluate malondialdehyde (MDA) levels in whole saliva of patients with chronic periodontitis. Materials and Methods: Whole saliva samples were collected from 85 patients: 30 patients with chronic periodontitis, 25 with gingivitis, and 30 periodontally healthy controls. To determine the clinical condition of each subject, the gingival index and clinical attachment level were measured. The salivary MDA levels were determined spectrophotometrically. Results: Higher salivary MDA levels (P < 0.005) were detected in patients with periodontitis compared to the healthy controls. There was no statistically significant difference in the salivary MDA levels between patients with gingivitis and healthy controls. Conclusions: Higher salivary MDA levels seem to reflect increased oxygen radical activity during periodontal inflammation. Thus, MDA can be used as a marker of oxidative stress in patients with periodontitis.
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Gingival crevicular fluid levels of RANKL and OPG after placement of collagen membrane with simvastatin in the treatment of intrabony defects in chronic periodontitis p. 301
Thangakumaran Suthanthiran, Sivakumar Annamalai, Sugirtha Chellapandi, Sreelakshmi Puthenveetil, Syed Dhasthaheer, Srinivasan Narasimhan
DOI:10.4103/JPBS.JPBS_18_19  
Purpose: The aim of this study was to estimate the Receptor activator of nuclear factor kappa-B ligand (RANKL) and Osteoprotegrin (OPG) levels in gingival crevicular fluid (GCF) after placement of collagen membrane with simvastatin in intrabony defects. Materials and Methods: Sixty subjects were grouped according to the treatment plan as Group I and Group II. Group I included patients with intrabony defects treated with collagen membrane. Group II included patients with intrabony defects treated with simvastatin of 1.5mg concentration incorporated into the collagen membrane. A split-mouth design was planned, in which two contralateral sites with >5mm probing pocket depth and radiographic evidence of bone loss at baseline were chosen. Probing pocket depth was standardized with acrylic stent in all the selected areas. GCF samples were collected at baseline and 21 days. The amount of RANKL and OPG in the samples was determined by commercial ELISA kits (Biomedica Medizinprodukte, Austria). Results: When comparing both the groups, Group II had more statistically significant (P < 0.001**) decrease in the levels of RANKL than Group I. In contrast to RANKL, the OPG levels were significantly increased in patients (Group II) having intrabony defects treated with collagen membrane along with simvastatin. Conclusion: Simvastatin-loaded collagen membrane expressed increased OPG and decreased RANKL levels, which could have a potential role in periodontal regeneration.
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An ex vivo evaluation of antimicrobial efficacy of root canal preparation with hand K-files, hand Pro Taper, and Pro Taper rotary files p. 305
Shabna Moyin, Sameer Punathil, Manoj Kumar Pulyodan, Shamsheer Thayil, Akshay Mohan, Dhanya Valsan
DOI:10.4103/JPBS.JPBS_19_19  
Background: Microorganisms are considered to be the primary cause behind persistent pulpoperiapical pathologies as well as endodontic failures. It has been found that Enterococcus faecalis is one of the most commonly isolated organisms in failed endodontic treatment. Proper and appropriate mechanical instrumentation is necessary to eradicate these microorganisms. Aims and Objectives: The aim of this study was to compare antimicrobial efficacy of various root canal instrumentation techniques. This study was designed to compare antimicrobial efficacy of root canal preparation using hand K-files, hand Pro Taper files, and Pro Taper rotary files. Materials and Methods: Forty intact maxillary premolars extracted for orthodontic reasons were used. After extirpation of pulp, teeth are decoronated and autoclaved. Then the root canals were infected with E. faecalis suspension and the teeth were incubated at 37°C for 24h. Thereafter the teeth were divided into five groups and were prepared using the following instruments: group 1 (hand K-files), group 2 (hand Pro Taper files), group 3 (Pro Taper rotary files), group 4 (Control I; treatment consists of irrigation with 1mL of sterile physiological saline with no instrumentation), and group 5 (Control II; teeth received no treatment at all). Before and after treatments, samples were taken from the root canals for culture and were transferred to physiological saline. Results were evaluated after 24-h incubation in selective culture medium. Results: The results showed that the teeth prepared with Pro Taper rotary files showed significant reduction in number of bacteria from the root canals.
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Ultrastructural changes of collagen in different histopathological grades of oral submucous fibrosis p. 309
Arun Tom, Venkat Baghirath, Bhargavi Krishna, Ashalata Ganepalli, Jogishetty Vijay Kumar, Sunil Paramel Mohan
DOI:10.4103/JPBS.JPBS_20_19  
Background and Objectives: Oral submucous fibrosis (OSMF) is a potentially malignant disorder and a crippling condition of oral mucosa. It is usually seen in adults with areca nut chewing habit, which is characterized by changes in the connective tissue fibers leading to stiffness of the mucosa and restricted mouth opening. Patients with severe cases have distinct difficulties in chewing, swallowing, and speaking. It predominantly occurs in Indians and other population of the Indian subcontinent with a prevalence of 0.2%–0.5%. The potentiality of malignant transformation associated with OSMF is much higher with a range of 4.5%–7.6%. This article is about the ultrastructural changes pertaining to collagen and with respect to the histopathological grades of OSMF. Materials and Methods: A total of 20 biopsy samples from clinically diagnosed OSMF subjects and 5 healthy controls were collected. After obtaining the biopsy, the specimens were divided into two halves, of which one was studied under light microscope and the other half was observed under transmission electron microscope. Results: Of the 20 subjects in the study group, most of the subjects were in the 20–29 years age group with an overall male predilection (19 subjects). Four subjects were in grade 1, nine were in grade 2, and seven were in grade 3. Collagen showed sparse to dense fibrosis and normal to thick collagen bundles, and some subjects showed encroachment of collagen into the blood vessels. Conclusion: This study showed definitive changes with respect to collagen in the OSMF samples compared to the controls. The changes were found to be increasing with the progression of the disease to the higher grades. The changes were pertaining to the collagen and were drawing toward an increased fibrosis of the connective tissue, which compresses the blood vessels. Hence, the state of hypoperfusion and subsequent epithelial atrophy can be considered in the progression of disease to the higher grades.
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Knowledge and awareness toward cervical cancer screening and prevention among the professional college female students p. 314
Saranya Manikandan, Subasish Behera, Nageswarao Madhulika Naidu, Vignesswary Angamuthu, Omar Farooq Burhanuddin Mohammed, Abhitosh Debata
DOI:10.4103/JPBS.JPBS_21_19  
Background: Worldwide, cervical cancer is the fourth most common cancer affecting women. The five most frequent cancers affecting women in India are breast, cervical, oral cavity, lung, and colorectal cancer. More women die from cervical cancer in India than in any other country. Cancers of major public health relevance such as breast, oral, cervical, gastric, lung, and colorectal cancer can be cured if detected early and treated adequately. The objective of this study was to assess the knowledge and attitudes toward cervical cancer screening and prevention. Materials and Methods: A cross-sectional study was conducted among 100 professional college female students to obtain information about their knowledge and attitudes on cervical cancer screening and prevention. Results: In this study, we intended to assess the knowledge and attitudes toward cervical cancer screening and prevention among 100 professional college female students with a mean age of 18 years. All the respondents were single. Majority of the respondents were not aware about the cervical cancer, PAP smear testing, and human papillomavirus vaccine. Conclusion: These results indicate that most of the students participated in our study were not aware about the cervical cancer screening and prevention. Deaths resulting from cervical cancer are tragic as this type of cancer develops slowly, which is treatable and can be prevented through screening. Therefore, it is important that negative attitudes and gaps in knowledge should be addressed early before the women reach suitable ages for screening and vaccination.
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Prevalence of dental anxiety level in 6- to 12-year-old South Indian children p. 321
Vinod Kumar, E V Soma Sekhar Goud, Neeraja Turagam, Durga Prasad Mudrakola, Kranti Kiran Reddy Ealla, Praveen Haricharan Bhoopathi
DOI:10.4103/JPBS.JPBS_22_19  
Background: Dental anxiety is one of the prime reasons for discouraging children to receive dental treatment. Measurement of the dental anxiety is very useful to know the prevalence level among 6- to 12-year-old children. Thus, the aim of the study was to determine the dental anxiety among 6- to 12-year-old children using Modified Dental Anxiety Scale (MDAS) score. Materials and Methods: A total of 400 south Indian children in the age group of 6-12 years who had visited Dental College and Hospital were recruited in the study. Dental anxiety was measured before dental treatment using MDAS. Statistical analysis was performed using Wilcoxon signed rank test. Results: Of the 400 children, 240 (61.5%) had severe dental anxiety, 92 (23%) had mild anxiety, and 78 (17%) had no anxiety. Females had higher anxiety level compared to males. Many study subjects answered that local anesthesia (LA) injection was considered most fearful. Dental anxiety was highest in smaller age groups. Conclusion: In our research, high percentage of children had dental anxiety, so counseling before dental visits is very important to reduce the dental anxiety among these 6- to 12-year-old children.
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Effect of 2% chlorhexidine on resin bond strength and mode of failure using two different adhesives on dentin: An in vitro study p. 325
Sreeram Rayar, Kadandale Sadasiva, Prabath Singh, Preethee Thomas, Kumarappan Senthilkumar, Udayakumar Jayasimharaj
DOI:10.4103/JPBS.JPBS_23_19  
Aim: To evaluate the shear bond strength and failure mode of total-etch and self-etch bonding agents on human dentin with and without application of 2% chlorhexidine gluconate (CHX). Materials and Methods: Eighty extracted premolars were chosen and stored in 10% formalin until use. Samples were mounted in cold cure acrylic resin and the occlusal enamel perpendicular to long axis of each tooth was removed using a low-speed diamond saw under water coolant. The prepared teeth were randomly divided into four groups of 20 samples each according to the adhesive system used. Groups 1 and 2 were the control group in which total-etch and self-etch adhesives were applied as per manufacturer’s instructions, Groups 3 and 4 were the experimental groups in which 2% CHX was applied and blot dried prior to the application of total-etch and self-etch adhesives. A custom-designed rig was fabricated to place composite on samples. The customized rig comprised a cylindrical mold with height of 3mm and internal diameter of 2.5mm. Resin was placed in increments of 1mm and was cured after each increments. After the composite placements, samples were placed in distilled water at 37°C for 24h. The samples were then thermocycled between 5°C and 55°C in water with a dwell time of 30s in each temperature to a total of 10,000 cycles. The shear test was performed using universal testing machine and fracture modes were evaluated using stereomicroscope. Results: Both the experimental total-etch and self-etch groups showed better shear bond strength than the control groups, which was statistically significant, and also the least mode of failure at the adhesive interface was observed in both the experimental groups. Conclusion: 2% Chlorhexidine gluconate effectively improved the shear bond strength and helped maintaining the durability of adhesive interface in both total-etch and self-etch adhesives.
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Evaluation of gynecologists’ awareness about oral health condition during pregnancy in Chennai city p. 331
Silambarasan Paneer, Narasimman Muthusamy, Rathinavel Pandian Manickavel, Cakku Jalliah Venkatakrishnan, Pradeep Rathnavelu, Muthuvignesh Jayaram
DOI:10.4103/JPBS.JPBS_24_19  
Background/Objectives: A cross-sectional study was conducted to evaluate the knowledge and practiced behaviors of gynecologists regarding oral health during pregnancy and association of periodontal disease with adverse pregnancy outcomes. Materials and Methods: This study was conducted among 200 gynecologists. A self-structured, close-ended questionnaire containing 22 questions was prepared. The principal investigator approached the gynecologists personally and distributed the questionnaire after obtaining their informed consent. Results: Of the 200 gynecologists approached, 200 filled the questionnaire, yielding a response rate of 100%. The majority (87%) acknowledged a connection between oral health and pregnancy and 63% agreed that periodontal disease can affect the outcome of pregnancy. However, only 60% gynecologists advise major/minor surgery during pregnancy, and many of them (74%) said that second trimester is the safe period for dental treatment. Almost three-quarters of the participants (79%) regarded dental radiograph and more than half (74%) considered administration of local anesthesia to be unsafe during pregnancy. Conclusion: This study demonstrated that gynecologists have a relatively certain level of knowledge regarding oral health status during pregnancy and the relationship of periodontal disease to pregnancy outcomes. However, there clearly exist misconceptions regarding the provision of dental treatment during pregnancy. To provide better oral health care, more knowledge needs to be made available to the pregnant women and medical community, mainly to the gynecologists who are primary health-care providers for pregnant women, and misconception regarding the types of dental treatments during pregnancy should be clarified.
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Prevalence of ocular injuries, conjunctivitis and musculoskeletal disorder–related issues as occupational hazards among dental practitioners in the city of Salem: A randomized cross-sectional study p. 335
Vanita D Revankar, Yadav Chakravarthy, Selvam Naveen, Ganapathy Aarthi, Dharmapuri Yadhavakrishnan Mallikarjunan, Assmee Mohammed Noon
DOI:10.4103/JPBS.JPBS_25_19  
Background: Similar to several other occupations, dentists are also stricken by bounteous occupational health hazards (OHHs) such as musculoskeletal disorders (MSDs) and ocular health–related issues. Aims: The aim of this study was to evaluate the diffusion of MSDs and ocular health–related issues among dental surgeons in Salem city, Tamil Nadu, India, according to age, sex, and number of practicing hours per week. Objectives: A survey was conducted to examine the rate of prevalence of these OHHs amidst the dental surgeons in Salem city. Materials and Methods: The study was performed through a questionnaire amidst 150 dentists practicing in Salem City, Tamil Nadu, India. Dental surgeons were questioned about any occupational disorder that they had experienced related to a musculoskeletal pain and its location whether in the back, upper limbs, or lower limbs. In extension to this, dental surgeons were asked about any ocular injury that they had. Results: MSD showed higher rate of occurrence correlated to ocular health–related issues. Conclusion: The practice of protective measures is crucial, in perspective of the high rate of these disorders in the community of dental surgeons.
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Differentiation between benign and metastatic cervical lymph nodes using ultrasound p. 338
Namitha Jayapal, Shashi Kiran Mohan Ram, Vidya Sreenivasa Murthy, Sulphi A Basheer, Shaheen V Shamsuddin, Anas Bismillah Khan
DOI:10.4103/JPBS.JPBS_26_19  
Purpose: The oral cavity is the most common site for squamous cell carcinoma, which has a distinct predilection for lymphatic spread before distant systemic metastasis. The cervical lymph node status is a very important consideration in the assessment of squamous cell carcinoma. Ultrasound is a noninvasive and inexpensive technique that can be used to differentiate between the benign and metastatic nodes. So the aim of this study was to evaluate reliability of ultrasound for such differentiation and to correlate them with histopathological finding. Materials and Methods: A total of 200 lymph nodes from 38 patients histopathologically proven for oral squamous cell carcinoma who underwent surgical neck dissection were considered. The patients underwent ultrasound examination of cervical lymph nodes prior to surgical neck dissection. The lymph nodes were differentiated into benign and metastatic based on the assessment of size, shape, shortest diameter/longest diameter (S/L ratio), margin, and internal architecture, and also the internal echo structure of the lymph nodes and histopathological findings were analyzed. Results: On correlation of ultrasonographic diagnosis with histopathological evaluation for metastatic lymph nodes, the overall accuracy of ultrasonographic analyses was 77.83%, and the sonographic criterion of irregular margin showed the highest predictability followed by the size. The correlation of internal echo structure with histopathological findings was highly variable. Conclusion: The ultrasound parameters such as size, shape, margin, S/L ratio, and internal echo structure might assist in differentiation between benign and metastatic lymph nodes. Combining these findings should raise the accuracy, as each sonographic parameter has some limitation as a sole criterion.
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Comparative evaluation of implant designs: Influence of diameter, length, and taper on stress and strain in the mandibular segment—A three-dimensional finite element analysis p. 347
Gowthama Raaj, Pulliappan Manimaran, Chandran Dhinesh Kumar, Duraisamy Sai Sadan, Mathivanan Abirami
DOI:10.4103/JPBS.JPBS_29_19  
Introduction: Success or failure of dental implants depends on the amount of stress transferred to the surrounding bone. Increased amount of loading to the bone through implant cause failure, whereas decrease in the amount of loading to the bone causes improved success rate of implants. Biomechanical interaction between implant and bone decides the long-term function or prognosis of dental implant system. Aim and Objectives: The aims of this study were to evaluate the influence of implant length and diameter on stress distribution, to understand the stress distribution around bone–implant interface, and to understand the response of bone under axial and non-axial loading conditions. Materials and Methods: Finite element three-dimensional mandibular model was made using cone beam computed tomography of patient with completely edentulous mandible, and in that model five posterior bone segments were selected. NobelReplace Select Tapered implants with diameters and lengths 3.5×10mm, 4.3×10mm, 3.5×11.5mm, and 4.3×11.5mm, respectively were selected and three dimensionally modeled using Creo 2.0 Parametric Pro/E software. Bone and implant models were assembled as 20 models and finite element analysis was performed using ANSYS Workbench v17.0 under axial and non-axial loads. Result: Under axial and non-axial loads, 3.5×10mm implant showed maximum von Mises stress and strain in both cortical and cancellous bone whereas implant with diameter and length 4.3×11.5mm showed minimum von Mises stress and strain in both cortical and cancellous bone. Conclusion: In axial and non-axial loads, amount of stress distribution around implant–bone interface is influenced by diameter and length of implant in cortical and cancellous bone, respectively. Increased diameter of the implant produces the minimum stress in cortical bone. Increased length of the implant produces the minimum stress in cancellous bone.
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Attitude and awareness of dentists practicing in Southern India toward non-steroidal anti inflammatory drugs p. 355
Maria Monisha, Tatu Joy Elengickal, Shashi Kiran Mohan Ram, Malu L Madhu, Maneesha Raghuveeran, Rahul Raveendran Pillai
DOI:10.4103/JPBS.JPBS_33_19  
Background: Pain management is an everyday challenge in dentistry. Analgesics are the group of drugs prescribed for effective pain management, of which nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly prescribed drugs. Selection of NSAIDs must be judiciously made considering their pharmacological properties and adverse effects. Aim: This study aimed to analyze the attitude toward analgesic prescription among practicing dentists and the awareness to update their knowledge about them. Materials and Methods: The study was carried out among 100 dental practitioners, where a questionnaire consisting of 16 questions was formulated based on the awareness of indication and contraindication, actual practice, and required future trends for updating the knowledge. The questionnaire was distributed among the practitioners; the answered questionnaire was collected and tabulated. Statistical analysis included χ2 test to evaluate the significance. Results: Of 100 dental practitioners, 63% prescribed drugs based on the diagnosis. Aceclofenac was found to be the effective drug in postoperative pain management, whereas paracetamol was considered to be the safest among NSAIDs in clinical conditions such as bleeding disorders, gastric irritation, chronic kidney disease, and during pregnancy. All practicing dentists showed their willingness to participate in awareness programs in updating their knowledge. Conclusion: This study showed that dental clinical practitioners are well aware of the drugs to be prescribed in different clinical conditions but pitfalls have been observed in areas of systemic complication, where continuous educational programs are needed to overcome the same.
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Effect of implant abutment acid etching on the retention of crowns luted with different cements: An in vitro comparative evaluation p. 360
R Ajay, V Rakshagan, M Kamatchi, A SelvaBalaji, Jambai Sampath Kumar Sivakumar, M SenthilKumar
DOI:10.4103/JPBS.JPBS_35_19  
Background: Air abrasion of the implant abutment surface improves the bond strength of luting agents. However, the effect of acid etching and combination of air abrasion and acid etching on the bond strength of various luting agents under masticatory load is yet to be documented. Purpose: The purpose of this study was to evaluate the effect of implant abutment surface modifications on the tensile bond strength (TBS) of cast metal copings (CMCs) luted with different luting agents, subjected to cyclic fatigue loads. Materials and Methods: A total of 150 Ni-Cr CMCs were made on commercially pure titanium (Cp-Ti) laboratory analogues. The samples were categorized into three groups based on surface modifications and five subgroups for luting agents. The CMCs were cemented to the respective surface-modified groups, stored in distilled water at 37°C for 24 hours, and then subjected to load cycling, followed by tensile loading. One-way analysis of variance (ANOVA) was used to compare the mean bond strength between luting agents. Results: Self-adhesive resin cement showed the highest TBS followed by resin-modified glass ionomer cement, zinc polycarboxylate, and zinc phosphate cement. Non-eugenol temporary cement showed least TBS values on all modified abutment surfaces. Conclusion: Air abrasion + acid etching (HY) provided the greatest TBS followed by acid-etched (AE) surface only. Air-abraded (AA) surface yielded the least TBS for luting agents.
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Impact strength and dimensional accuracy of heat-cure denture base resin reinforced with ZrO2 nanoparticles: An in vitro study p. 365
S Sajida Begum, R Ajay, V Devaki, Krishnamoorthi Divya, K Balu, P Arun Kumar
DOI:10.4103/JPBS.JPBS_36_19  
Background: Polymerization shrinkage and fracture are the two common trouble shoots with denture base resins. Polymerization shrinkage affects the dimensional accuracy and fit of the prosthesis. The effect of zirconia (ZrO2) nanoparticles on polymerization shrinkage is not documented yet. Purpose: The aim and objective of this study were to evaluate the impact strength and dimensional accuracy of heat-cured poly methyl methacrylate (PMMA) on reinforcement with ZrO2 nanoparticles. Materials and Methods: Conventional heat-cure denture base resin (control) and the polymer reinforced with 3, 5, and 7 wt% of ZrO2 nanoparticles were prepared and used in this study. Forty bar-shaped specimens were prepared and tested for impact strength using Charpy’s type impact tester. Forty denture bases were fabricated and checked for dimensional accuracy by measuring the distance between the denture base and the cast in two different sections using the travelling microscope. Results: The impact strength decreased with increased concentration of ZrO2 and found to be least at 7 wt% concentration (2.01±0.26 J/mm2). The distance between the denture base and the cast significantly decreased both in the posterior palatal seal region (0.060±0.007cm) and mid-palatine section region (0.057±0.006cm) with ZrO2 nanoparticles reinforcement and was found to be least at 7 wt% concentration. Conclusion: Reinforcement of heat-cured PMMA with ZrO2 nanoparticles significantly increased the dimensional accuracy and decreased the impact strength.
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Correlation of vertical dimension of occlusion in parents and their offspring: A cephalometric study p. 371
R Ajay, PS Manoharan, V Rakshagan, BM OmarFarooq, P Arunkumar, R Sasikala
DOI:10.4103/JPBS.JPBS_37_19  
Background: Establishment of optimal vertical dimension of occlusion (VDO) for prosthetic patients, either complete denture or fixed full mouth rehabilitation, is a vital step to discern at a pleasing esthetics and harmonious function. None of the experiments in the literature studied the hopeful inheritance of the VDO from a parent to offspring. Purpose: The aim of this study was to establish the dominant mode of inheritance of VDO from parents to offspring using cephalometric landmarks. Materials and Methods: Following the inclusion criteria, 20 families were selected and explained about the study design. Individual cephalograph of father, mother, and offspring were traced out of bony landmarks. The reference planes were delineated for the measurements from maxillary incisal (I) tip and mesio-palatal cusp tip of maxillary first molar (M) to palatal (PP) and inter-foramina (IFP) planes. Results: In all the distances measured, there exists a statistically significant difference between both father and son and mother and son. For the measured IPP, MPP, and IIFP distances, there is no statistically significant difference existed between father and daughter. However, in MIFP distance, there is a significant difference between father and daughter. Except for the IIFP distance between mother and daughter (P = 0.08), in all other measured distances, there existed a statistically significant difference. Conclusion: There is no dominant mode of inheritance from the parent to the son with respect to the measured parameters. Inheritance was observed to be stronger between father and daughter than between mother and daughter.
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Kerosene as an alternative to xylene in histopathological tissue processing and staining: An experimental study p. 376
Janardhanam Dineshshankar, Manikandan Saranya, Periyasamy Tamilthangam, Jeyaraman Swathiraman, Kumaravel Shanmathee, Ravichandran Preethi
DOI:10.4103/JPBS.JPBS_38_19  
Background: Conventional tissue processing is as old as 100 years and still remains the gold standard. Tissue processing involves many steps, of which one of the important steps is clearing. Xylene is one of the common clearing agents used in laboratory, but it is carcinogenic and teratogenic. Aim: The aim of this study was to substitute conventionally used xylene with kerosene in tissue processing and staining. Materials and Methods: Thirty bits of chicken tissue samples were collected; each was randomly separated into two groups: tissue processing and staining. Instead of conventional xylene, we used kerosene. The tissue blocks were subjected to sectioning and staining, and finally, they were observed under light microscope. Results: Tissue samples that were processed and cleared with kerosene showed equal clearing and staining without any alterations of the tissue morphology and cellular details with that of xylene. Conclusion: Kerosene can be used as a substitute to xylene without posing any health risk or compromising the cellular integrity.
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The effect of surface treatments on the shear bond strength of acrylic resin denture base with different repair acrylic resin: An in vitro study p. 380
P Arun Kumar, K Iniyan, R Balasubramaniam, M Viswanathan, P Allen Jim Hines, V Monnica
DOI:10.4103/JPBS.JPBS_40_19  
Background: Fracture of the denture base is a common problem associated with dental prostheses. Fractured denture base surfaces treated with chemical agents and mechanical features have the potential for improved bond strength. Aim: The aim of this study was to evaluate the effect of surface treatment on the shear bond strength of heat-cured denture base with different repair acrylic resins. Materials and Methods: A total of 100 circular specimens (2-cm diameter × 3.3-mm thickness) were fabricated from heat-cured denture resins (DPI) according to the manufacturer’s instructions. The heat-cured denture base acrylic resin specimens were divided into two groups: In group 1, auto-polymerizing acrylic resin (DPI) was used as a repair resin, and in group 2, light-cured acrylic resin (VLC) was used as the repair resin. Further, the heat-cured denture base acrylic resin specimens were subdivided into five subgroups. The shear bond strength (in megapascal) was measured in a universal testing machine at a crosshead speed of 1mm/min. The results were subjected for statistical analysis. Result: Comparison of mean and standard deviation of shear bond strength between DPI and VLC group using one-way analysis of variance showed that the mean shear bond strength of DPI group is higher than that of VLC group. Conclusion: From the study, heat-cured denture base specimens repaired with auto-polymerizing repair resin showed higher mean shear bond strength than the visible light cure resin material.
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Assessment of oral health status and dental treatment needs among 12- and 15-year-old school-going children of fisherman community residing at east coast road, Chennai: A cross-sectional study p. 385
Raj Mohan, Bharathwaj Venkatanarasu, Boinapelli Vengal Rao, Karteek Eswara, Satyam Martha, Harinipriya Hemasundar
DOI:10.4103/JPBS.JPBS_42_19  
Aims and Objectives: This study was conducted to assess the dental treatment needs of 12- and 15-year-old school-going children of fishermen community residing at East Coast Road, Chennai. Materials and Methods: Of 35 schools, 2 schools of private and government each were chosen to a final sample size of 650 students. Ethical clearance to conduct the research was obtained. A pilot study was undertaken during February 2012 at St. Joseph school, Kovalam to determine the feasibility of the study and also to determine the sample size. Examination was carried out by a single examiner to assess the treatment needs using World Health Organization Oral Health Surveys: Basic Methods pro forma (1997) excluding prosthetic treatment needs. The Chi-square test (χ2) was used to find out whether there existed a significant difference in the oral health status between 12- and 15-year-old school children and private and government school children. Results: 12-year-old children and 15-year-old children had a mean decayed-missing-filled teeth value of 2.14 and 2.72, respectively. Majority of the study population 454 (241[68.8%] 12-year-old children and 213[71%] 15-year-old children) need one surface restoration. Majority of the study population 623 (95.8%) had community periodontal index (CPI) score of 2 (i.e., calculus), whereas only 27 (4.1%) of the study population had CPI score of 0 (i.e., healthy gums). Conclusion: This study revealed that the oral health status of these children was poor with high caries prevalence and high Malocclusion.
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Role of Orthopantamograph in Forensic Identification: A Retrospective Study Among Chennai Population p. 393
Sriraman Rajkumari, Kotha Nikitha, Sekar Monisha, Sekar Nishagrade, Balakrishnan Thayumanavan, Balasubramaniam Arunachala Murali
DOI:10.4103/JPBS.JPBS_43_19  
Context: Identification of unknown corpse can be established by their body features and belongings; when the features are distorted, it becomes a challenge for the forensic experts. Orthopantamograph (OPG) analysis is a simple, noninvasive, economic, and reliable method to sort for identification of the unidentified. Aim and Objective: The aim of this study was to assess the efficacy of OPG in age and sex determination. The objective of our study was to evaluate various measurements on the mandibular ramus and to correlate them with the age and sex of an individual. Settings and Design: A retrospective study was conducted using 150 OPGs that were taken in the Department of Oral Medicine and Radiology using Orthophos XG3 OPG machine. The mandibular ramus measurements were carried out using WebPlot Digitizer v 4.1. The measurement was statistically assessed. Statistical Analysis Used: SPSS version 20 was used for discriminate analysis, correlation, and regression analysis. Results: The male population showed higher values of ramus measurements compared to the female population. A regression equation was positively drawn to estimate the age of the unknown individual. Conclusions: Coronoid height is the main predictive factor in age estimation of an individual irrespective of the gender whereas gonial angle is the extrapolative tool in gender prediction.
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Levels of mercury in fish-eating children, with and without amalgam restoration p. 397
Vinayak Padmakumar, Kavya Premkala Raveendran, Anshad Mohamed Abdulla, Sivadas Ganapathy, Shan Sainudeen, VS Nasim, Vaishnavi Vedam
DOI:10.4103/JPBS.JPBS_44_19  
Background: Mercury is a naturally occurring metal that exists in three forms: elemental (metallic), inorganic, and organic mercury. Amalgam, which is an alloy of inorganic mercury, is used as a restorative material in dentistry. Organic mercury gets ingested in the body mainly by the consumption of seafood. Mercury is also stated to cause various adverse health effects such as gastrointestinal disturbances, dermatitis, muscle weakness, and neurological disorders. In recent years, the use of amalgam has become a controversy stating the various adverse effects of mercury. Hence, the study was conducted to determine and compare the variation in levels of organic and inorganic mercury in fish-eating children before and after placement of amalgam restoration. Materials and Methods: Seventy-five subjects, 42 males (56%) and 35 females (44%) of age group ranging 7–13 years, living in South Canara district of Karnataka, India, were selected as a part of the study. Hair and urine samples were collected for estimation of organic and inorganic levels of mercury, respectively. Informed consent was collected from all the participating subjects. Results: On comparison between organic and inorganic mercury levels during the study period, the concentration of organic mercury in hair samples was greater irrespective of amalgam restorations present (1.172 and 0.085, respectively; P < 0.001). Conclusion: Thus inorganic levels of mercury do not seem to pose a threat as much as the organic levels observed in hair, which remain fairly constant for a longer period of time. Hence in a coastal region where this study was undertaken and fish being a staple food, the risk could probably be attributed to more of an organic toxicity than an inorganic one. Thus amalgam is relatively safe to be practiced and the controversy against it should be reevaluated.
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Body Mass Index and Tooth Loss: An Epidemiological Study in a Sample of Suburban South Indian Population p. 402
Parthasarathy Natarajan, Minati Choudhury, Madhan Kumar Seenivasan, Karthigeyan Jeyapalan, Shanmuganathan Natarajan, Anand Kumar Vaidhyanathan
DOI:10.4103/JPBS.JPBS_48_19  
Aim: This study evaluated the relationship between missing posterior teeth and body mass index with regard to age and socioeconomic state in a sample of the suburban south Indian population. Materials and Methods: The 500 individuals of both males and females aged 40 years and older with missing posterior teeth and not rehabilitated with any prosthesis were gone through a clinical history, intraoral examination, and anthropometric measurement to get information regarding age, sex, socioeconomic status, missing posterior teeth, and body mass index (BMI). Subjects were divided into five groups according to BMI (underweight > 18.5kg/m2, normal weight 18.5–23kg/m2, overweight 23–25kg/m2, obese without surgery 25–32.5kg/m2, obese with surgery < 32.5kg/m2). Multivariate logistic regression was used to adjust data according to age, sex, number of missing posterior teeth, and socioeconomic status. Results: People with a higher number of tooth loss were more obese. Females with high tooth loss were found to be more obese than male. Low socioeconomic group obese female had significantly higher tooth loss than any other group. No significant relation between age and obesity was found with regard to tooth loss. Conclusion: The BMI and tooth loss are interrelated. Management of obesity and tooth loss can help to maintain the overall health status.
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An in vitro evaluation of fracture resistance of endodontically treated maxillary central incisor restored with custom-made cast post and core with uniform and nonuniform core ferrule heights p. 407
Premkumar Elavarasu, Chellaswamy Savarimalai Karumaran, Rajamani Indira, Ramachandran Anilkumar, Rekha Mani, Raghunathan Natarajan
DOI:10.4103/JPBS.JPBS_50_19  
Aim: The aim of this study was to evaluate in vitro fracture resistance of endodontically treated teeth restored with custom-made cast post and core having uniform and nonuniform core ferrule heights. Materials and Methods: Thirty-five freshly extracted human maxillary central incisors were included in this study. All teeth were subjected to standard root canal treatment. The teeth were randomly divided into five groups—Group 1: uniform ferrule (2mm buccal, lingual, and proximal), Group 2: uniform ferrule (3mm buccal, lingual, and proximal), Group 3: nonuniform ferrule (2mm buccal, 3mm lingual), Group 4: nonuniform ferrule (2mm buccal, 4mm lingual), and Group 5: no ferrule. The teeth were sectioned horizontally 4mm above cementoenamel junction and post space preparation was performed maintaining 4mm of apical gutta-percha. Ferrule was prepared according to dimension designated for each group. Custom-made cast post and core were fabricated and luted using zinc phosphate cement. Testing was conducted using universal testing machine with application of static load (Newton), and failure load was recorded. Data were analyzed by one-way analysis of variance and Tukey test. The mode of fracture was noted by visual inspection for all specimens. Result: Significant differences (P < 0.001) were found among mean fracture forces of test groups. Group 1: 1181.66±68.29, Group 2: 1455.58±173.11, Group 3: 1019.00±52.55, Group 4: 971.58±66.52, and Group 5: 888.00±60.56. The presence of nonuniform ferrule height resulted in a significant decrease (P < 0.0001) in mean fracture strength compared to uniform 2- and 3-mm core ferrule height. Conclusion: The central incisors restored with cast post and core and crowns with 3-mm uniform core ferrule were more fracture resistant compared to central incisors with nonuniform core ferrule height. Both the uniform and nonuniform core ferrule groups were more fracture resistant than the group that lacked ferrule.
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Age and reasons for first dental visit and knowledge and attitude of parents toward dental procedures for Puducherry children aged 0–9 years p. 413
Adimoulame Sanguida, Venkatachalamoorthi Vinothini, Gajula Shivashankarappa Prathima, Arumugam Santhadevy, Kulandairaj Premlal, Muthukrishnan Kavitha
DOI:10.4103/JPBS.JPBS_54_19  
Background: The first dental visit provides the dentist an opportunity to advise parents on prevention of oral diseases and also allows for early detection of caries and arrest of its progression. The first dental visit should occur no later than 12 months of age. However, parents fail to give importance to primary dentition as they feel that they are temporary. Aim: The aim of this study was to determine the age of first dental visit and most common reasons for the visit among children aged 0–9 years and to examine the knowledge and attitude of their parents toward treatment procedures for children, taking into account their socioeconomic and educational status. Materials and Methods: After obtaining informed consent from parents, sociodemographic data that included age and gender of the child, educational status, occupation of parents, and annual family income were collected. A validated questionnaire was given to the parents. Statistical Analysis Used: Descriptive statistics (proportion) was used to report the data. To examine differences in knowledge and attitudes among different socioeconomic and educational groups, chi-square test was used with P value <0.05. Results: A total of 300 completed questionnaires were analyzed. Age of first dental visit was 6–9 years (57%) and the most common reason for the visit was decayed teeth (33%). The overall attitude of parents toward treatment procedures for children was good in spite of low levels of knowledge about primary teeth and role of the pedodontist. Conclusions: It is necessary to promote early dental visits by providing education on perinatal and infant oral healthcare to the healthcare professionals dealing with children. It is also important to promote awareness regarding the maintenance of primary dentition.
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Intraradicular Smear Removal Efficacy of Triphala as a Final Rinse Solution in Curved Canals: A Scanning Electron Microscope Study p. 420
Abraham Chris Susan, Alamelu Ragunath Bharathraj, Muthuvel Praveen, Nallakapalayam Somasundaram Mohan Kumar, Jeyaraman Venkataraman Karunakaran
DOI:10.4103/JPBS.JPBS_55_19  
Aim: This study aimed to compare smear layer removal ability of different solutions of Triphala (TA) when used in specific irrigant protocols in curved canals. Materials and Methods: Seventy-four mandibular first molars with 25–35degrees of curvature of mesial roots were selected and standardized, and canals were prepared. As the initial rinse solution (8mL), 5% sodium hypochlorite was used. Samples were divided into control (Group I—normal saline, Group II—17% ethylenediaminetetraacetic acid) and experimental (Group III, IV, V, VI, VII, VIII, and IX) groups based on the type of final rinse solution (5mL) used, that is, TA-premixed (P), TA-(P)-sonic, TA-(P)-ultrasonic, 3% TA solution, 5% TA solution, 10% TA solution, and 10% citric acid. Samples were dehydrated, split buccolingually, splutter coated, and examined in field emission scanning electron microscope. Results: Among the experimental groups, Group V presented the least amounts of smear and debris in all thirds of the root canal with mean values of 1.6±0.63 and 1.6±0.62, respectively, and on comparison with Group II the results were comparable, and no significant difference was found statistically (P > 0.05). Group V presented with the highest amount of erosion with loss of peritubular and intertubular dentin at all levels with mean values of 1.60±0.51. Conclusion: The use of TA as a final rinse solution during biomechanical preparation seems promising.
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Evaluation of the effect of extraction and restorative procedures on blood pressure and pulse rate due to anxiety in 6- to 12-year-old children: An in vivo study p. 429
Nanditha Hegde, Sundeep K Hegde, Sham S Bhat, Gobichettipalayam Jegatheeswaran Anbuselvan, Dhanraj Pawan Kumar Bhandari, Senthilnathan Radhakrishnan
DOI:10.4103/JPBS.JPBS_61_19  
Background: The objective of this study was to determine the changes in the cardiovascular parameters, blood pressure, and pulse rate due to anxiety in children undergoing dental extraction and restorative treatment. Materials and Methods: A total of 150 children were included in the study based on inclusion and exclusion criteria. The parameters were measured at four and three intervals for the extraction and restorative group, respectively. The obtained data were analyzed using repeated measures analysis of variance test. Results: In the extraction group, the change in blood pressure in female children (144mm Hg) was significant compare to male children (141mm Hg). In the restoration group, the change in blood pressure in male children (140/84mm Hg) was found to be statistically more significant when compared to female children (139/85mm Hg).The pulse rate change in both sexes was equally significant in restorative and extraction group. Conclusion: It can be inferred that pain and fear anxiety play important roles in the cardiovascular changes during dental treatment because there was significant change in blood pressure and pulse rate over time during dental treatment.
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Implications of Overprescription of Antibiotics: A Cross-Sectional Study p. 434
Punithavathy Ramachandran, Narendra Kumar Rachuri, Satyam Martha, Rekha Shakthivel, Anusha Gundala, Thilak Sravan Battu
DOI:10.4103/JPBS.JPBS_62_19  
Introduction: The use of antibiotics in recent years has become more aggressive and more common. The inappropriate use, to be more precise, the abuse of these prescriptions, is the root cause for increasing bacterial resistance and adverse outcomes. Antisepsis can be suggested as an appropriate alternative to antibiotics, to control the increasing antibiotic resistance among individuals. Objective: The objective of this study was to compare the awareness of antibiotic prescription and resistance among BDS and MDS practitioners and students. Materials and Methods: A total of 361 dental professionals were included in this study. Each of them was given a questionnaire containing questions pertaining to antibiotic prescription and awareness. Results: Most of the participants prescribed antibiotics as pre and post treatment management of all the oral diseases during their routine interaction with the patients. Overprescription of antibiotics, amoxicillin being the most common, was significantly more among the BDS practitioners than the MDS practitioners. BDS practitioners (78%) preferred a 3-day antibiotic prescription whereas MDS practitioners (80%) prescribed a 5-day course, which was statistically significant. Mindfulness with respect to antimicrobial prophylaxis and antibiotic resistance was observed to be satisfactory in both the groups. However, there was a general absence of mindfulness with respect to the rules for antibiotic prescription recommendations in both the groups. Conclusion: Antibiotic prescription should be given with care to prevent its resistance, an upcoming iatrogenic health hazard.
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An in vitro comparative evaluation of distribution of three different sealers by single-cone obturation technique p. 438
Chandrika Ramanathan Palanivelu, Vaiyapuri Ravi, Arthanarieswaran Andamuthu Sivakumar, Jambai Sampathkumar Sivakumar, Anjaneya Shiva Prasad, Kaneesh Karthik Arthanari
DOI:10.4103/JPBS.JPBS_64_19  
Aim: The aim of this study was to evaluate the distribution of sealer at different levels of the root canal using three different sealers in a single-cone obturation technique. Materials and Methods: Thirty freshly extracted mandibular premolar teeth were selected and access opening was performed. Working length was determined. Cleaning and shaping were done till 25 size K file followed by ProTaper till F2 size. Teeth were then obturated with matching gutta-percha points with the following sealers: Group I, 10 teeth with zinc oxide eugenol sealer; Group II, 10 teeth with AH plus sealer; and Group III, 10 teeth with NanoSeal-S sealer. Teeth were cross sectioned at 3 and 6mm from the apex. Color photographs of sections were taken at a magnification of ×40 using a camera connected to a stereo-operating microscope and the images were transferred to a computer. Sealer distribution was observed and the canal perimeters coated or uncoated with the sealer can be calculated using a computer digital imaging system. Results: Of the three groups, zinc oxide eugenol showed least sealer distribution. AH Plus and Nanoseal-S showed no significant difference between the distribution at the 3- and 6-mm levels. Conclusion: Both AH Plus and Nanoseal-S showed excellent sealer distribution when compared to zinc oxide eugenol.
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A comparative evaluation of intracanal calcium hydroxide removal with hand file, rotary file, and passive ultrasonic irrigation: An in vitro study p. 442
Sowmiya Tamil, Sivakumar A Andamuthu, Ravi Vaiyapuri, AS Prasad, Sampathkumar Sivakumar Jambai, Mathimaraiselvan Chittrarasu
DOI:10.4103/JPBS.JPBS_65_19  
Aim: The aim of this study was to compare the effectiveness of hand file (K-file), rotary file (HERO shaper), and passive ultrasonic irrigation (PUI; U-file) in removing Ca(OH)2 from the root canal. Materials and Methods: Thirty single-rooted teeth were collected and decoronated to standardize the length to 14mm. Cleaning and shaping were conducted using HERO shaper rotary files (up to no. 25, 4% taper). Ca(OH)2 powder was mixed with normal saline and filled into the canals using lentulo spiral and the orifice was sealed with zinc oxide eugenol. After 7 days of incubation, samples were divided into three groups of 10 samples each: Group I (hand files)—no. 20 K-file; Group II (rotary files)—no. 25, 4% HERO shaper; Group III (PUI)—no. 20 U-file. Ca(OH)2 paste was removed using 2mL of 3% sodium hypochlorite solution followed by 1-minute activation of the respective file system. All the samples were finally irrigated with 17% ethylenediaminetetraacetic acid and flushed with distilled water. Results: Ultrasonic group was more effective in removing Ca(OH)2 followed by HERO shaper and hand file. Conclusion: It was concluded that PUI had the highest ability to remove Ca(OH)2 from the root canal walls.
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Comparison of bite force after administration of midazolam and dexmedetomidine for conscious sedation in minor oral surgery p. 446
Suryahanth Mihiran Sivasubramani, Deepak Abraham Pandyan, Ravindran Chinnasamy, Santhosh Kumar Kuppusamy
DOI:10.4103/JPBS.JPBS_67_19  
Aim: The aim of this study was to compare the bite force and sedation score in moderate/conscious sedation for minor oral surgical procedure. Materials and Methods: A sample size of 30 was selected in each group (group M [midazolam] and group D [dexmedetomidine]). Results: Dexmedetomidine group had a statistically significant sedation score than midazolam. A statistically significant increase in the bite force was observed in both midazolam and dexmedetomidine groups, but there was no significant difference between the two groups. Conclusion: Dexmedetomidine and midazolam significantly increased the bite force because of the loss of proprioceptive function of periodontal ligament, but there was no significant difference between the drugs regarding bite force.
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A comparative evaluation of five obturation techniques in the management of simulated internal resorptive cavities: An ex vivo study p. 450
Mathew J Elenjikal, Abhilash A Latheef, Mohammed A M Kader, Sivadas Ganapathy, Ahmed B Mohamed, Shan S Sainudeen, Anshad M Abdulla, Shahabe S Saquib
DOI:10.4103/JPBS.JPBS_75_19  
Background: Root resorption is the loss of dental hard tissues as a result of clastic activities. It might be broadly classified into external or internal resorption by the location of the resorption in relation to the root surface. the various techniques used these days for filling internal resorption include warm condensation, vertical condensation, core techniques, thermoplasticized gutta-percha, warm vertical compaction, and cold lateral condensation. Objectives: The aims and objectives of this study were to compare the quality of root fillings in artificially created internal resorption cavities filled with warm vertical compaction, lateral condensation, Obtura II along with System B, E and Q plus along with System B, and Thermafil, and to calculate the percentage of gutta-percha, sealer, and voids using an ImageJ software. Results: Results between the warm vertical compaction (group I), lateral condensation (group II), Obtura II with System B (group III), E and Q plus with System B (group IV), and Thermafil (group V), group III showed the highest percentage of gutta-percha plus sealer and gutta-percha, and least number of voids, which was statistically significant (P < 0.000). Conclusion: It can be concluded that Obtura II along with System B was found to be the most suitable obturation technique for the management of teeth exhibiting internal resorption. Thermafil was found to give the poorest obturation quality when used to fill the teeth with internal resorption. Similarly, lateral condensation technique was observed to show maximum sealer and hence was not ideal for the management of internal resorptive cavities.
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Assessment of correlation of growth hormone receptor gene with tooth dimensions: A CBCT and genotyping study p. 457
Gaurav Ramdhan Shinde, Rujuta Deelip Mhaisekar, Shashwati Hargovind Chaube, Anuradha Narayanrao Barad, Shivkanya Bhadange, Hiralkumar J Patel
DOI:10.4103/JPBS.JPBS_76_19  
Aim: Assessment of root morphology, size, and amount of bone around tooth is essential before starting the orthodontic treatment. The present study aimed to assess the relationship between tooth dimensions with two gene variants of growth hormone (GH), namely rs6184 and rs6180. Materials and Methods: This study was conducted on 218 subjects (males: 104, females: 114) requiring orthodontic treatment. All underwent cone beam computed tomography (CBCT) scan for orthodontic treatment planning with Kodak CBCT machine. In all teeth, crown height (CH), root length (RL), and crown–root ratio were evaluated. Two growth hormone receptor (GHR) variants (rs6184 and rs6180) were genotyped using the TaqMan genotyping assay. Results: The mean CH and RL of all teeth, that is, maxillary and mandibular central incisors, lateral incisor, canine, first premolar, second premolar, first molar, and second molar, were measured. There was no significant difference in males and females (P > 0.05). Allele frequencies of GHR variants for rs6180 and rs6184 were 48.1% and 8.92%, respectively. Multiple regression analysis showed GHR rs6184 association with maxillary central incisor CH, maxillary canine RL, mandibular canine CH, and mandibular first premolar RL (P < 0.05). Conclusion: There was correlation of CH of maxillary and mandibular canine and RL of maxillary canine and mandibular first premolar with GHR rs6184.
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Comparative evaluation of erosive potential of various frozen and unfrozen fruit juices on primary teeth enamel: An in vitro study p. 463
Sunil T Philip, Anshad M Abdulla, Sivadas Ganapathy, Vaishnavi Vedam, Vini Rajeev
DOI:10.4103/JPBS.JPBS_78_19  
Background: Changing lifestyle pattern and food habits has a deteriorating effect on dental tissues. Dental erosion is a pathological wear of hard tissues of teeth with increased consumption of acidic and carbonated drinks. Susceptibility to erosion in primary dentition is more compared to permanent dentition due to softer and disordered crystal structure of enamel. Objectives: The main aim of the study was to determine and compare the erosive potential of different fruit juices in frozen/unfrozen forms on primary teeth by studying the calcium dissolution. Materials and methods: pH of four different juices (pure) - apple, orange, citrus limetta (musumbi) and grapes were determined using a digital pH meter. The titratable acidity of these in frozen and unfrozen forms were determined by adding 0.2 ml of 1M NaOH to these to raise to pH=5.5(critical pH) and pH =7(neutral pH). Forty eight caries free deciduous anterior teeth specimens were prepared to study the calcium dissolution by atomic absorption spectrophotometer. The results were analysed for statistical significance using One-way Repeated Measures ANOVA and pair wise multiple comparison with Bonferroni correction. Results: Total titratable acidity and calcium dissolution were found to be significantly more in the initial thawed fruit juices. Conclusion: Frozen fruit juices had more buffering capacity and erosive potential than unfrozen forms. The study concluded that sucking on frozen fruit juices is more damaging to teeth than unfrozen forms because more of erosion is expected to occur in a frozen state.
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Isthmus incidence in human permanent mandibular first molars of a South Indian population: A cone-beam computerized tomographic study p. 468
Jeyaraman Venkataraman Karunakaran, Modachur Muruganathan Premkumar, Ganapathy Aarthi, Nachimuthu Jayaprakash, Swaminathan Senthil Kumar
DOI:10.4103/JPBS.JPBS_80_19  
Aim: This study aimed to analyze incidence of isthmus in human permanent mandibular first molar teeth using cone-beam computed tomographic imaging techniques in a South Indian population. Materials and Methods: Three hundred permanent mandibular first molar teeth were collected, cleaned, and stored in normal saline. They were divided into groups (GPs) I and II based on number of roots, and were further subdivided (right and left [RL] subgroups A and B for GP I; and RL subgroups C and D for GP-II). Samples were processed and isthmus incidence was evaluated by cone-beam tomography, compared, and statistically analyzed. Results: Overall in mandibular first molars, the isthmus incidence in mesial root was 97.2%, distal root was 39%, and distolingual root was 0%. There was no statistically significant difference between the right and left mandibular first molar teeth with regard to incidence of isthmus (P > 0.05). There was an incidence of type I (38.67%), type II (56.33%), type III (3%), and type IV (2%) isthmuses in mesial root and type I (12.33%), type II (16%), and type III (10.67%) in distal root. Conclusion: Incidence of isthmus was very high in the mesial root of the mandibular first molar and should be factored during nonsurgical and surgical endodontic treatment procedures to achieve successful treatment outcomes.
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Maxillary permanent first premolars with three canals: Incidence analysis using cone beam computerized tomographic techniques p. 474
Jeyaraman Venkataraman Karunakaran, Thiyagarajan Ganeshamoorthy, Kaliayaperumal Anbarasi, Nagappan Ragavendran, Arthanari Kaneesh Karthick
DOI:10.4103/JPBS.JPBS_89_19  
Aim: This study aimed to analyze incidence of three canals in human permanent maxillary first premolar teeth using cone beam tomographic techniques. Materials and Methods: The samples were divided into three groups namely Group (GP) I (single rooted [n = 255]), GP II (two rooted [n = 326]), and GP III (three rooted [n = 8)]. The teeth were processed, mounted in arches, coded, and subjected to cone beam tomographic scanning. Incidence of three canals was evaluated by cone beam tomography, compared, and statistically analyzed. Results: The percentage of incidence of three canals in human permanent maxillary first premolar teeth was 1.7% and there was no statistically significant difference of incidence of three canals between studies using cone beam and non-cone beam methodologies. Conclusion: Clinicians should be aware of the variations they may encounter when endodontically treating a maxillary first permanent premolar and should apply this knowledge in a clinical scenario systematically.
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CASE REPORTS Top

Management of traumatized immature vital tooth: A case report p. 481
Jeswin M Thomas, Esai Amutha Prabha Arumugam, Anoop Harris, Vijil Vimala Ravi
DOI:10.4103/JPBS.JPBS_283_18  
Trauma to front tooth is one of the disturbing conditions for children and parents. The treatment strategies used to treat the immature young dentition are important for the long-term prognosis of teeth and should aim at preserving pulp vitality to secure tooth maturation and root development. This article describes a case of trauma to upper front tooth with open apex. The patient was treated with vital pulp therapy with mineral trioxide aggregate to induce apexogenesis.
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A three-rooted permanent maxillary canine: A rare anatomical variant p. 485
Saravanan Kandasamy, Naveen Balakrishnan, Manoj Chandrasekar
DOI:10.4103/JPBS.JPBS_292_18  
Maxillary canines are usually found to be the single-rooted, single-canaled teeth1. Two roots with two root canals are a very rare condition2. Here we report a rare case of anatomic variation of permanent maxillary canine with three roots and three root canals which is first of its kind in the literature.
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Impacted upper lateral incisor in a 16-year-old female—“Compound odontome” the culprit—A case report p. 488
Kayarohanan Janarthanan, Annamalai Thangavelu, Subramanian Adalarasan, Rajkumar Selvakumar, Ranganathan Murugan, Sudhakar Venkata Reddy
DOI:10.4103/JPBS.JPBS_3_19  
Odontoma is the most commonly found odontogenic tumor. Odontomas are an abnormal mass of calcified dental tissue, usually representing a developmental anomaly. They are benign and originate from an alteration of differentiated mesenchymal and epithelial odontogenic cells. They have the capacity of forming enamel, dentin, and cementum. Etiology in still unknown, but different theories have been postulated. Because these tumors are asymptomatic, 75% of all cases are diagnosed before the second decade of life, due to a delay in eruption of permanent teeth. Treatment of choice for these tumors is enucleation. The authors describe one such case of compound odontome obstructing the eruption of a permanent lateral incisor.
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A clinical report of solitary gingival overgrowth in a young female patient p. 491
Hemalatha Ramakrishnan, Anisa Noorullah, Leelarani Venugopal
DOI:10.4103/JPBS.JPBS_8_19  
Pyogenic granuloma is a type of inflammatory hyperplasia. The term “inflammatory hyperplasia” is used to describe nodular growths of oral mucosa that histologically contain inflamed fibrous and granulation tissues. It is nonneoplastic. It is predominant in second decade of life in young adult females. Oral pyogenic granuloma is the most common gingival tumor with a striking predilection to gingiva. About one-third of the lesions occur following trauma. Poor oral hygiene may be a precipitating factor as 75% of all cases show calculus or foreign material in gingival sulcus. Lesions are more common in maxillary than mandibular gingiva; lesions are more common on the facial aspect of gingiva than gingival aspect. Clinically, pyogenic granuloma is a smooth, lobulated, exophytic lesion seen as small, red, and erythematous papules on a pedunculated or sessile base that is usually hemorrhagic. Clinical development of the lesion is slow, asymptomatic, and painless but may also grow rapidly; surface is characteristically ulcerated and friable, covered by yellow, fibrinous membrane with its color ranging from pink to red to purple depending on the age of the lesion. Pyogenic granuloma develops in about 5% of pregnancy, called as “pregnancy tumor’’ or “granuloma gravidarum.” Hormonal imbalance in pregnancy exaggerates the body’s response to bacterial irritation. Sometimes, pregnancy gingivitis may show a tendency for localized hyperplasia, which is called “pregnancy granuloma.” Generally, it appears in about second-to-third month of pregnancy. Although pyogenic granuloma is a nonneoplastic growth in the oral cavity, proper diagnosis, prevention, management, and treatment of the lesion is very important. Excisional surgery is the treatment of choice whereas cryosurgery, excision by Nd:YAG laser, and sclerotherapy are alternative therapies. Though pyogenic granuloma in pregnancy is because of the effect of sex hormonal imbalances, taking careful oral hygiene measures is important to avoid recurrence of the lesion. This article is a case report of a 22-year-old female patient with pyogenic granuloma in the buccal aspect of maxillary gingiva managed by surgical excision.
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Socket-shield technique of mandibular anterior teeth: A case report p. 495
Vadivelu Saravanan, Potluri Leela Ravishankar, Maharshi Malakar, Sunanda Rao Karkala, Vandana Vijayan
DOI:10.4103/JPBS.JPBS_11_19  
With the aim of achieving an optimal aesthetic result, implant dentistry has become a prosthetically driven procedure. Special care is being taken to focus on the details that would lead to this objective. These details may include imitating the natural teeth by harmonizing the structures around the placed implant. The prosthetic and/or surgical parts of the procedure should be performed to reach an optimal outcome. In order to minimize the resorption of hard and soft tissue, which exists around the newly extracted tooth—to create a natural emergence profile of implant born prosthesis—socket preservation procedures were introduced; however, in case of ridge deficiencies, hard and soft tissue augmentation procedures are indicated. In this article, we present a case report using a new approach in socket ridge preservation, which is the socket-shield technique (partial root retention).
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Bullous lichen planus: Case report and review p. 499
Abhilesh Babu, Sreeja Chellaswamy, Sathish Muthukumar, Bhavna Pandey, Merlin Jayaraj, Serena Francis
DOI:10.4103/JPBS.JPBS_58_19  
Lichen planus is a chronic inflammatory mucocutaneous disorder that is seen in skin and oral mucosa. Definitive etiology for oral lichen planus remains unknown. It may or may not be associated with skin lesions. Different clinical patterns such as reticular, plaque, erosive, bullous, and atrophic are seen in oral mucosa of which bullous lichen planus is a rare entity. We present a unique case of bullous lichen planus in a 20-year-old male without skin manifestations along with the review of literature comprising various case reports of bullous lichen planus.
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