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   Table of Contents - Current issue
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July-September 2022
Volume 33 | Issue 3
Page Nos. 229-347

Online since Tuesday, January 17, 2023

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EDITORIAL  

Improving trans-disciplinary knowledge to provide oral health for all p. 229
SM Balaji
DOI:10.4103/ijdr.ijdr_870_22  
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ORIGINAL RESEARCH: EVALUATIVE STUDY Top

Knowledge, attitudes, and beliefs among dental students and faculty members regarding COVID-19 Vaccines in Dental Colleges of Haryana, India - A cross-sectional study p. 230
Neha Chauhan, BC Manjunath, Jadhav Sachin Kumar, Vipul Yadav, Bhavna Sabbarwal, Adarsh Kumar
DOI:10.4103/ijdr.ijdr_193_22  
Aim: To assess knowledge, attitudes, and beliefs among dental students and faculty members regarding COVID-19 vaccines in dental colleges in Haryana, India. Objectives: To assess knowledge level, attitudes, and beliefs differences among BDS, MDS students and faculty members and find association between knowledge and COVID-19 vaccine inoculation among study participants. Materials and Methods: A cross-sectional study was carried out among students and faculty members of dental colleges in Haryana, India. Data collection was done via an online questionnaire based on questions to assess the knowledge, attitude and beliefs regarding COVID-19 vaccines. Results: The present study comprised of 270 study participants, where majority, i.e., 81.5% have reported COVID-19 vaccine inoculation. The mean knowledge score of the participants was reported to be 5.54 ± 2.19. A significant difference was found in the mean knowledge score of faculty members (7.81 ± 1.69), MDS (6.72 ± 1.49), and BDS (4.39 ± 1.68) students. COVID-19 vaccine inoculation was found to be significantly associated with average knowledge score of participants (OR = 6.1, P < 0.01). Conclusion: Dental professionals have an adequate degree of knowledge and attitude level regarding COVID-19 vaccines and are generally optimistic about resolving the pandemic situation with the immunization.
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Secular trends in prevalence of overweight and obesity over a decade in urban and rural South Indian children integrated with geographic information system p. 235
HP Chanchala, B Madhu, Manjunatha S Nagaraja, Raghavendra Shanbhog
DOI:10.4103/ijdr.ijdr_939_21  
Context: The globalization in the process most of the rural sectors are also upgrading technically with digitalization with more availability of smart phones and gaming along with the refined food influences on the present-day children is causing a trend of overweight among the children. Aims: To arrive at the prevalence of overweight and obesity considering the Indian Academy of Pediatrics (IAP) cut-offs for growth standards among children aged 12 years from the rural and urban areas of Mysuru District. Methods and Material: The present program was the third large scale community intervention project carried out including the 7 talukas of Mysuru District which focused on the measurement of the Body mass index (BMI). In this phase between the year 2019 and 2020 anthropometric measurements were undertaken in 1602 urban and rural children aged 12 years from government-funded and privately-funded schools of Mysuru District. Statistical Analysis Used: The results were analysed statistically using SPSS for Windows (version 23.0) and the t-test, Chi-square test and proportion tests, P value were reported. Results: As per the IAP reference ranges the prevalence of obesity was 5.5% and overweight was 7.1% among children of Mysuru District. Conclusions: We report that this increase was significantly higher in girls than boys. There was an increasing trend in rural sectors; however, the obese children were more predominantly distributed among the urban sectors. This calls for a precise preventive measure to fulfil the goal of the World Health Organization (WHO) to control prevalence of childhood obesity by the year 2022.
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Advanced virtual mentoring of dentists in oral cancer screening and tobacco cessation - An interventional study p. 241
Suzanne T Nethan, Amrita John, Priyanka Ravi, Kavitha Dhanasekaran, Roshni Babu, Roopa Hariprasad
DOI:10.4103/ijdr.ijdr_8_21  
Context: Oral cancer is the third common cancer in India. Its mortality can be reduced through early detection and tobacco cessation ideally by dentists owing to their forte of work. Aim: This study was conducted to discuss effectiveness of an advanced tele-mentoring programme in oral cancer screening and tobacco cessation for dentists across India. Settings and Design: Online, interventional study. Methods and Material: The 14-week long training programme with 52 participants/spokes from across India had weekly hour-long online sessions comprising of an expert-led didactic and case discussions by spokes. Online evaluation (pre- and post-training, post-session), weekly and post-one-year feedback were conducted. Successful spokes attended a hands-on workshop subsequently. Statistical Analysis Used: One and independent sample t-tests determined the significance of the evaluation scores of the participants. Findings on attitudes and practice-related questions are presented as simple percentages. Results: A notable increase in the overall and per-session mean knowledge score, and confidence in oral cancer screening was observed. Many participants started these services at their clinics, thereby reducing further referrals, and were also motivated to spread community awareness about the same. Conclusion: This tele-mentoring programme, based on the novel Extension for Community Healthcare Outcomes model, is the first oral cancer screening training programme for dentists. This model—comprising of expert didacts, case discussions, and significant spoke-expert interaction—is a promising best-practices tool for reducing the disparity in knowledge and skills regarding oral cancer prevention among dentists across different locations. This would enable these most appropriate healthcare providers to contribute toward the overall goal of oral cancer prevention.
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Knowledge, attitude, and practice of autotransplantation among the practicing pediatric dentists in Chennai – A questionnaire study p. 247
JA Amilia Elizabeth, Shankar Paulindraraj, R Hemalatha, Trophimus Gnanabagyan Jayakaran, Senthil Dakshinamurthy
DOI:10.4103/ijdr.ijdr_571_21  
Background: Autotransplantation is a minor surgical procedure which involves transplantation of teeth within the same oral cavity. For children, autotransplantation may be considered as a provisional measure with good survival probability. It offers a viable biological approach for replacing the missing teeth and also for orthodontic treatments in children. Aim: The aim of this study is to assess the knowledge, attitude, and practice of autotransplantation among pediatric dentists in Chennai, India. Methods: An 18-item questionnaire was developed, piloted, and distributed among 100 practicing pediatric dentists in Chennai, India. Descriptive statistical analysis was done using Chi-square test. Results: Seventy valid responses from the practicing pediatric dentists were obtained. Among them, 39.7% had an experience of 5–10 years, 47.1% practiced less than 5 years, and 13.2% had experience more than 10 years. Analysis of the responses showed that 76.5% of the pediatric dentists were aware of the procedure but have not observed autotransplantation being done. Among the respondents, 95.6% have not performed this technique and 40.6% of them were not sure of the prognosis. Atraumatic extraction of donor tooth was considered to be a major limitation in autotransplantation by 41.8% of the pediatric dentists. From the responses received, 95.6% were interested in gaining more information with majority opting for more hands on workshops on the technique of autotransplantation. Conclusion: Though most of the respondents were aware of autotransplantation procedure, they have not practiced it due to inadequate training.
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Burden of oral precancer and cancer among an indigenous tribal population of South India – An evaluative study p. 253
Sivaramakrishnan Muthanandam, Bontha V Babu, Jananni Muthu, Suganya Rajaram, B Sivapatha Sundharam, M Kishore
DOI:10.4103/ijdr.ijdr_552_21  
Context: Oral cancer is of major concern in the Indian subcontinent and is found to be high among low socioeconomic groups. One such high-risk group is considered to be the tribal people, who are economically and socially marginalised. Aims: The aim of the present study is to assess the prevalence of oral cancer and precancer lesions among the Narikurava population in Puducherry state, India. Methods and Material: A total of 329 Narikurava tribal people were included in this study. Data was collected by clinical examination of the oral cavity by door-to-door screening. The oral cavity was examined for white/red lesions, ulcerative changes, leathery changes and tissue growths. Statistical Analysis Used: Prevalence was calculated in terms of percentages. Descriptive statistics included the calculation of percentages, mean, and standard deviation. Results: The prevalence of precancer in the population is 48.3%. The majority of the lesions were observed in the buccal mucosa: 41.6% had white lesions, 9.1% had red lesions, 0.3% had ulcerations or growth, and 28.3% had leathery changes followed by the labial mucosa: 0.6% had white lesions, 0.6% had red lesions, 0.3% had ulcerations or growth and 16.4% had leathery changes. Conclusions: The present study observed a high prevalence of precancerous lesions among the Narikurava tribe. The main reason for the high prevalence is attributed to tobacco and tobacco-related habits. Hence, cancer control activities should be prioritised. Designing a model to detect precancer and cancer early and to constantly monitor the detected cases in such populations is of utmost importance.
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The effect of metallic dental restorations and implants in causing patient discomfort and artefacts during magnetic resonance imaging of the head and neck p. 258
Aiswarya Ashok, Pramodkumar Ayyadanveettil, Ellezhuthil Devarajan, Vinni Thavakkara, Neethu Latha, Arya Saraswathy
DOI:10.4103/ijdr.ijdr_430_21  
Context: Patients with metallic dental objects in their oral cavity are often associated with discomfort or artefacts during magnetic resonance imaging (MRI) of the head and neck. Aim: This study was conducted to evaluate the effects of metallic dental objects in causing patient discomfort and artefacts during MRI of the head and neck region. Design: This is an observational study including 538 participants from various specialized MRI centres in Kozhikode. Methods and Material: MRI records of 538 participants who underwent head and neck MRI as a part of their medical treatment were collected. With the help of questionnaire and clinical examination, the type of metallic dental object in the patient's oral cavity was identified. After examining the MRI images, four categories of artefacts were established. In MRI brain, artefacts in three different sequences were also studied. Statistical Analysis Used: The significance of the difference between proportions was analysed by the Chi-square test. Results: Artefacts were found in 65 cases with metallic dental objects but none of the participants had experienced any kind of discomfort. The artefact formation significantly depended on the type of metallic dental restoration in the patient's oral cavity. Orthodontic braces and titanium bone plate created severe artefacts in head and neck MRI making interpretation almost impossible. In the MRI brain, diffusion-weighted imaging is most sensitive to artefact followed by fluid-attenuated inversion recovery. Conclusions: Artefacts were found in 65 cases with metallic dental restorations but none of the participants had experienced any kind of discomfort.
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Evaluation of stress among dental undergraduates and postgraduates using salivary cortisol as a biomarker p. 263
V Vasanthi, Rooban Thavarajah, Elizabeth Joshua, Umadevi K Rao, Kannan Ranganathan
DOI:10.4103/ijdr.ijdr_498_21  
Background: Stress is a non-specific response of the body to any demand. Professional education has a certain level of stress inherent in it. Dental students have been reported in the literature to experience more stress than medical students. Objective: To evaluate the stress levels of dental students: first-year undergraduates, house surgeons, and final-year postgraduates, using salivary cortisol as a stress biomarker. Materials and Methods: Dental students above 18 years of age and without any systemic illness were included in the study. Those students with a drug history of corticosteroids, anti-depressants, and oral contraceptives were excluded from the study. Female participants experiencing pre-menstrual symptoms, pregnancy, and familial stressor issues were excluded from the study. First-year undergraduates, house surgeons, and final-year postgraduates were enrolled in the study. Unstimulated whole saliva was collected in the morning and evening between 9:00 and 10:00 am and between 3:00 and 4:00 pm. Salivary cortisol levels were assessed by chemiluminescence immuno-assay (CLIA). Results: Paired sample t-test was used to compare the diurnal variation among morning and afternoon samples within the groups. The salivary cortisol levels were found to be significant within the groups. One-way ANOVA was used to compare the salivary cortisol levels between the groups. The salivary cortisol levels within the groups were not statistically significant. Conclusion: Salivary cortisol is a non-invasive biomarker of stress. Postgraduates had higher salivary cortisol levels than other study groups.
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ORIGINAL RESEARCH: PROSPECTIVE STUDY Top

Assessment of biological risk among dentists during the COVID-19 Pandemic—A cross-sectional study p. 267
Divya K Devaraj, Syed Khaja Hussain Alikunju, Mohandoss Murugesan
DOI:10.4103/ijdr.ijdr_227_22  
Background: The health and life of a healthcare worker are repeatedly under threat due to the rising number of epidemics and pandemics. The COVID-19 pandemic is said to be fatal in people with a risky biological, demographic profile and working environment. This study is the first of its kind carried out on the dentist population from India, who were most affected during the COVID-19 pandemic. Aims and Objective: The present study aims to assess the biological risk of dentists based on the objective risk stratification (ORS) tool developed by Strain et al. Materials and Methods: This was a cross-sectional study of dentists in government dental colleges of Kerala using the online form of the ORS tool consisting of questions which included certain demographic characteristics and comorbid conditions of the individual. An additional question was added to the tool, to categorise the work of the dentist depending on the exposure to aerosol (non-aerosol, minimal aerosol and aerosol). Results: Out of the 74 dentists, 48.6% reported high aerosol and 31% with minimal aerosol. The median score of the study participants was 2 (ranging from 1 to 12). Using the ORS tool, 16.2% had medium risk and only 2.7% had high risk. When the ORS tool was stratified with the aerosol generation, 5.4% had minimal and 6.7% had significant with medium-risk scores. Also, 2.7% with a high-risk score had minimal aerosol generation. Conclusion: Identifying the high-risk category to allocate duties accordingly and decrease the morbidity and mortality among dentists has to be kept a top priority in the event of a pandemic.
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Expression of Ki67 as potential biomarker in oral submucous fibrosis: An immunohistochemical study p. 272
KA Kamala, Sujata R Kanetkar, Kailash D Datkhile, S Sankethguddad
DOI:10.4103/ijdr.ijdr_551_21  
Background: Oral submucous fibrosis (OSMF) is a potentially malignant disorder (PMD) known to transform into oral cancer. One of the important hallmarks of malignant transformation is the uncontrolled growth rate, commonly reflected as increased cell proliferation which can be significantly detected by proliferative markers such as a high Ki-67 index. Aim: The aim of this study is to evaluate the degree and pattern of expression of Ki67 in OSMF, oral squamous cell carcinoma (OSCC) and in normal mucosal (NOM) patients and to correlate the Ki67 expression with clinical and histological grading of OSMF and OSCC patient. Materials and Methods: A prospective cross-sectional study was conducted over a duration of two years. An immunohistochemical study was performed for Ki76 expression on 35 cases of OSMF, 10 cases of OSCC and 10 normal mucosal patients. Statistical Analysis: Data were analysed using SPSS version 21. Chi-squared test was used to analyse the differences between the intensity levels in OSMF, OSCC and NOM. Results: Expression of Ki67 was significantly higher in OSMF than that of NOM samples but less than that of OSCC samples. Expression of Ki67 increased with increasing grade of clinical and histological stages. Conclusion: The study demonstrated a high incidence of Ki67 overexpression in OSMF and OSCC and showed a correlation between clinical and histological grading of OSMF and OSCC. Identification of high-risk oral PMDs and intervention at premalignant stages could constitute one of the key steps in reducing the mortality, morbidity and cost of treatment associated with malignant transformation of these diseases.
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ORIGINAL RESEARCH: COMPARATIVE STUDY Top

Comparison of mandibular buccal shelf bone characteristics between two facial types using cone beam computed tomography p. 277
Padmanathan Ramasamy, Sharanya Sabrish, Vinod Pattabiraman, Prashantha Govinakovi Shivamurthy, Roshan Sagarkar, Silju Mathew
DOI:10.4103/ijdr.ijdr_1201_21  
Background: Mandibular buccal shelf (MBS) offers good quality and quantity of bone for orthodontic bone screw (OBS) insertion. Despite several reports of treated patients, there are numerous variables in selecting the exact placement site for OBS placement in the MBS. There are also anatomical variations in this area which must be considered. Objectives: This study aims to measure and compare the MBS bone characteristics for OBS placement using cone beam computed tomography (CBCT) between two different facial types. Materials and Methods: Eighty CBCT samples were collected (40 samples of group A horizontal growers and 40 of group B vertical growers). Each CBCT image was reconstructed and oriented with CS 3D CBCT software. The cortical bone thickness, the slope of the MBS, and buccolingual inclination of mandibular second molar were measured and analysed. Result: Cortical bone thickness among horizontal growers was 5.23 ± 0.58 mm and among vertical growers was 4.85 ± 0.37 mm. The slope of MBS among horizontal growers was 60.83 ± 6.15 degrees and among vertical growers was 66.75 ± 6.27 degrees. In both the parameters there was a statistically significant difference between the groups. There was no significant difference between the groups for the buccolingual inclination of 2nd molar. Conclusion: Increased cortical bone thickness and the flatter slope of MBS at the 2nd molar region allows for easier placement of OBS in horizontal growers than in vertical growers.
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Immunohistochemical evaluation of galectin-3 expression in oral squamous cell carcinoma, oral leukoplakia and normal mucosa p. 282
Freeda M Selvaraj, Anna P Joseph, BR Varun, Vinod Mony, TT Siva Kumar
DOI:10.4103/ijdr.ijdr_157_22  
Background: Galectin 3 (Gal-3) has diverse functions critical in cancer biology including cell proliferation, apoptosis, evasion of immune responses and angiogenesis. The expression of Gal-3 is heterogeneous in normal and neoplastic tissues. In oral squamous cell carcinoma (OSCC) and oral leukoplakia (OL), both increased and decreased expressions of Gal-3 were elicited in numerous studies. Aims: To evaluate, compare and correlate the immunohistochemical expression of Gal-3 in OSCC, OL and normal oral mucosa. Settings and Design: The study was conducted at the Department of Oral Pathology and Microbiology at PMS College of Dental Science and Research, Vattapara, Thiruvananthapuram. This is a retrospective analytical study. Methods and Material: Clinically diagnosed and histopathologically confirmed cases of OSCC (n = 21), OL (n = 21), and normal oral mucosa (n = 21) were included in the study. Paraffin-embedded tissues were subjected to immunohistochemical analysis for Gal-3 expression. Gal-3 staining expression, staining distribution and cellular localisation were evaluated. All sampled categories were compared using immunohistochemical scoring analysis such as the H-score, labelling index (LI), immunoreactive score (IRS) and staining intensity (SI). Statistical Analysis: The results were statistically analysed using multivariate analysis of variance (MANOVA) within and among the groups. Results and Conclusion: The statistical inferences obtained found that the H-score could be used as a guideline for better differentiation between the groups and among the groups. The P value obtained was < 0.0125 and was found to be significant. The observation in our study shows that the immunohistochemical expression of Gal-3 gradually decreased from normal oral mucosa to OL to OSCC.
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A comparative investigation of the activity of superoxide dismutase in patients with leukoplakia and healthy controls p. 287
Jobin Mathew Kuthoor, Esther Anuradha Sunil, Sindhu Edakkadath Raghavan, Binitha Ponnamparambil Purushothaman
DOI:10.4103/ijdr.ijdr_1009_21  
Context and Aim: Oral leukoplakia has recently been re-defined as “a predominantly white lesion of the oral mucosa that cannot be characterised as any other definable lesion”. Superoxide dismutase (SOD) is one of the enzymatic anti-oxidants which form the first line of defence in the cell. There are very limited data available on the analysis of SOD in leukoplakia patients. Therefore, the present study was planned to analyse anti-oxidant SOD levels in leukoplakia patients. Methods and Material: The study group consisted of 29 subjects of oral leukoplakia, and the control group consisted of 25 healthy individuals. All the subjects were evaluated for SOD enzyme in plasma. Statistical Analysis Used: The results for each determinant were calculated using one-way ANOVA test, Student 't' test, Pearson Chi square test, and 't' test for equality of means wherever applicable. Results: The study revealed that among the different clinical entities of oral leukoplakia, the enzymatic anti-oxidant SOD is shown to have decreased in all forms of oral leukoplakia, but without any statistical significance. A statistically highly significant decrease (at P < 0.0001) of SOD in oral leukoplakia patients compared to normal healthy patients was observed in the present study. Conclusions: The study revealed a difference in the free-radical activity and oxidative stress in blood of leukoplakia patients compared to healthy patients, which is reflected by the variation in the levels of blood SOD, thus showing vulnerability to cellular damage and tendency towards further malignant changes.
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Effectiveness of laser fluorescence–based device in detecting the extent of re-mineralisation in primary teeth compared to the conventional method: An In vitro study p. 292
Megha J Nair, Arathi Rao, K Jayaprakash, Srikant Natarajan, Vasavi Kumblekar, BS Suprabha
DOI:10.4103/ijdr.ijdr_546_21  
Background: Laser fluorescence (LF)–based clinical device DIAGNOdent™ is at present being used to detect caries. Can the same be used to detect therapeutic remineralisation of early white spot lesions? Aims: To explore the feasibility of using LF-based device in monitoring the changes following remineralisation of demineralised primary teeth. Materials and Method: The sample number for the present experimental in vitro study was 10. The LF based device readings were correlated with surface microhardness (SMH) test values to evaluate its efficiency. SMH analysis was performed using a microhardness tester (Tescol-HT1000AD). All the samples were demineralised, followed by remineralisation using fluoride varnish and pH cycling. The data was analysed using the Statistical Package for the Social Sciences (SPSS) version 17.0 (IBM SPSS®) software. Paired t-test was performed to compare laser fluorescence readings and SMH test result values at baseline, after demineralisation, and after remineralisation. Pearson's correlation was used to compare the relation between the laser fluorescence and SMH test. Results: A good negative correlation was seen between the two methods at the baseline readings even though it was not statistically significant (P = 0.069). A positive correlation between the methods existed following demineralisation which was not significant (P = 0.074). The correlation between the parameters following remineralisation showed a moderate negative correlation but was not significant (P = 0.55). Conclusion: DIAGNOdent™ values at baseline, after demineralisation, and after remineralisation was consistent with SMH values. Thus, DIAGNOdent™ can be explored to provide chairside assistance in identifying remineralisation of white spot lesions.
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Prevalence and determinants of early childhood caries among children enrolled in anganwadi centres in Bhilai of Central India: A cross-sectional study p. 297
Ramakrishna Chevvuri, Hunny Sharma, Ravi Gupta, Abhilasha Tiwari, Gangesh Bahadur Singh, Anjali Singh
DOI:10.4103/ijdr.ijdr_128_21  
Introduction: Early childhood caries (ECC), which results in rapid involvement and progression of several teeth, is a growing concern in preschool children. It directly affects a child's overall health and quality of life. Aim: To assess the prevalence and determinants of ECC among children enrolled in Anganwadi centres in Bhilai city of Chhattisgarh. Methodology: This descriptive cross-sectional study was conducted among 360 children enrolled in Anganwadi of Bhilai. An oral examination and findings were recorded in 'dmft' using the WHO oral health assessment form for children 2013. The mothers' knowledge, attitude, and practice were determined by a professionally administered 10-item pre-tested short questionnaire with Cronbach's alpha of 0.86. The data were compiled and analysed using Microsoft Excel vs. 2013 and Statistical Package of Social Science (IBM SPSS version 23; Chicago Inc., USA). Results: The prevalence of ECC was 25.83%, out of which 13.33% in boys and 12.50% in girls. Children of middle school-educated mothers have 35.48% ECC, followed by high school and primary school, that is, 24.73 and 23.66, respectively. Mothers who assisted the children in tooth brushing have less prevalence of ECC (8.15%) as compared to non-assisted (17.8%) (P = 0.044). Conclusion: Although mothers' knowledge was appreciable regarding reasons for tooth decay, still 1/4th of the children were found to be affected by ECC. This necessitates the importance of regular/periodic screening campaigns for the children, implementing institutional preventive programmes, and referral for children to secondary/tertiary healthcare centres.
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Evaluation of serum and gingival crevicular fluid levels of Vitamin D binding protein in subjects with clinically healthy periodontium and chronic periodontitis: A clinico bio-chemical study p. 301
Yashaswini Chakravarthy, Ashank Mishra, Preeti Krishnan, Krishnajaneya Reddy Pathakota, V Vijaya, Shanthi Naidu Kamatham
DOI:10.4103/ijdr.ijdr_646_21  
Background: Advances in oral and periodontal disease diagnostic research are moving towards methods wherein periodontal risk can be identified and quantified by objective measures such as bio-markers. Given the roles of vitamin D binding protein (DBP) in modulating the immune response and in the transport of vitamin D, it is hypothesised that quantitative changes of vitamin DBP are associated with periodontal disease. Aim: The aim of the current study is to measure DBP levels in serum and gingival crevicular fluid (GCF) of patients with generalised chronic periodontitis, in comparison to healthy controls. Materials and Methods: The present cross-sectional clinico-bio-chemical study includes 30 systemically healthy subjects with 15 periodontally healthy and 15 chronic periodontitis subjects who were recruited from the out-patient Department of Periodontics. GCF and blood samples were collected from all the patients. DBP estimation was performed in both the samples using a commercially available ELISA kit. Results: Serum and GCF DBP levels in chronic periodontitis subjects were significantly higher when compared to the periodontally healthy group. There were no significant correlations found among serum and GCF DBP levels with gender and increasing age in both the groups. An increase in disease severity measured by the increase in probing pocket depth and clinical attachment loss did not show correlation with the GCF and serum DBP levels in the chronic periodontitis group. Conclusion: Based on the findings of the present study, increased serum and GCF DBP levels in chronic periodontitis seem to be a probable marker for identifying ongoing periodontal destruction.
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Correlation of COVID-19 with severity of periodontitis-A clinical and biochemical study p. 307
Rupali Kalsi, Zoya Ahmad, Mallapragada Siddharth, Kharidhi Laxman Vandana, Sachit Anand Arora, Kumar Saurav
DOI:10.4103/ijdr.ijdr_1168_21  
Background: Various conceptual hypotheses have been put forth to link association of COVID-19 with various chronic diseases such as periodontitis. Empirical evidence is still lacking to correlate the severity of COVID-19 with periodontal diseases. Objectives: This study was undertaken with an objective to correlate COVID severity in systemically healthy patients suffering from periodontal diseases. Materials and Methods: 44 systemically healthy patients of both genders with minimum of 20 teeth in their oral cavity in age range of 20 to 50 years suffering from periodontitis were recruited and categorised into four stages as per American Academy of Periodontology (AAP) 2017 classification for periodontitis. Serum C-reactive protein (CRP) levels and periodontal disease parameters of all the patients were measured. Because of COVID-19 and the nationwide lockdown, the dental practice was highly affected. With the help of self-designed online questionnaire information regarding COVID-19 infection and associated symptoms were recorded. Cases were categorized into five groups based on the World Health Organization clinical progression scale of COVID severity. Results: All the patients suffering from COVID disease in moderate and severe forms had increased probing pocket depth, clinical attachment level, and raised serum C-reactive protein levels as compared to patients who were uninfected or suffering from mild COVID disease and the results were statistically significant. Conclusion: Prioritisation and Implementation of periodontal treatment as a preventive measure for COVID-19 should be done. A positive correlation is observed between the severity of periodontitis and COVID-19.
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Comparative evaluation of push-out bond strength of AH-Plus, MTA-Fillapex and Epiphany SE root canal sealers: An Ex-Vivo study p. 313
Sagolsem Chandarani, Mohan Gundappa, Zoya Chowdhary, Deepika Singh, Neeti Swarup, Shalabh Mehrotra
DOI:10.4103/ijdr.ijdr_1052_21  
Background: A successful root canal (RC) treatment depends upon creation of a fluid impervious seal that is commonly built by using a RC sealer along with gutta-percha. The bond strength of the RC sealer is a hallmark as it will minimize the risk of treatment failure by reducing the possibility of filling detachment from dentin. Aim: To evaluate and compare the push-out bond strength of AH-Plus and MTA-Fillapex with Gutta-Percha and Epiphany Self Etch/Resilon system using the Universal Testing Machine. Materials and Method: About 60 mandibular premolars with single canals were prepared apically with Hyflex CM files upto size #30. Out of total, 20 teeth were obturated with AH-Plus/GP (group 1), 20 with MTA-Fillapex/GP (group 2), and other 20 with Epiphany Self Etch/Resilon system (group 3). Teeth were sectioned into three slices of 2 mm each and were subjected to Universal Testing Machine. Statistical Analysis: The data obtained were tabulated and statistically evaluated using SPSS version 21.0 statistical analysis software (IBM, Chicago, Illinois, USA). Results: The mean push-out bond strength was highest for AH–Plus (14.32 MPa) followed by MTA-Fillapex (12.18 MPa) and then Epiphany SE (8.44 MPa). The results were statistically significant. Conclusion: Significantly, higher push out bond strength was displayed by AH-Plus sealer than MTA-Fillapex and least being Epiphany SE sealer. The push out bond strength was significantly highest at apical third and lowest at coronal third.
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ORIGINAL RESEARCH: IN VITRO STUDY Top

Comparison of sealing ability of MTA and retroplast as root end filling materials evaluated under a stereomicroscope using rhodamine B dye: An In vitro study p. 318
Nitin Kararia, Anushka Yadav, BR Adyanthaya, Vandana Kararia, Suman Poonia, Sachin Jain
DOI:10.4103/ijdr.ijdr_357_22  
Aim: The aim of the study was to compare the sealing ability of Mineral Trioxide Aggregate (MTA) and Retroplast as root end filling materials using the Rhodamine B dye penetration method in vitro. Methodology: Forty freshly extracted human single-rooted teeth were randomly divided into two groups of 20 teeth each, and standard root-end cavities were prepared in all teeth. The cavities were filled with MTA and Retroplast in groups 1 and 2, respectively. The specimens were then stored in 1% Rhodamine B dye for a week, following which the dye penetration with all samples was analysed under a stereomicroscope and scored according to Tronstad's criteria. The observations were compared with Chi square test at a 0.220 level of significance. Results: 5% of the samples in both the groups showed no significant leakage. The leakage was deeper with the Retroplast group than with the MTA group; however, there was no statistically significant difference between the two groups. Conclusion: Both MTA and Retroplast are similar in their sealing potential as root-end cavity fillings with Retroplast reporting slightly deeper microleakage than MTA within the limits of the present study.
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SYSTEMATIC REVIEWS AND META-ANALYSIS Top

Effectiveness of molecular-targeted chemotherapy in ameloblastomas: A systematic review p. 323
Thuckanaickenpalayam R Yoithapprabhunath, Kenniyan K Srichinthu, Deepak Gupta, Diksha Singh, Swetha Pasupuleti, Ramdas M Nirmal
DOI:10.4103/ijdr.ijdr_456_22  
Ameloblastoma is a benign, locally aggressive neoplasm that needs extensive surgical resection. The goal of this article is to obtain an in-depth review of benign ameloblastomas to determine the available level of evidence and the possible benefit of targeted therapeutics for the treatment of ameloblastoma and BRAF V600E mutation in ameloblastoma. An electronic literature search was conducted according to PRISMA guidelines in PubMed/MEDLINE, EBSCO, and Web of Science for eligible studies published between 1975 and 2021. The systematic review is registered with INPLASY (INPLASY202260018). The review included 2 case series and 17 case reports. The histopathological type, anatomic location, expression of BRAF mutation, additional mutations, and molecular-targeted therapies of the 19 reviewed articles were summarized and tabulated. Interestingly, the majority of the primary site of ameloblastoma was located in the mandible (80.9%) compared to the maxilla (17%). The tumour size was reported in nine of the included studies. Most of the included studies in the review exhibited ameloblastoma with BRAF V600E mutations and responded to molecular-targeted therapies. Molecular therapies employing BRAF and/or MEK inhibitors in ameloblastoma with BRAF V600E mutations proved to be an appropriate treatment based on the limited available evidence. It is essential further to deepen our understanding at the clinical and molecular level to enhance the precision of management of ameloblastoma.
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Comparative effectiveness of herbal and conventional toothpaste on prevention of dental caries: systematic review and meta-analysis p. 332
Shivashankar Kengadaran, Divvi Anusha, Kavya Baskar, Kavitha Muthukrishnan, J Pooraninagalakshmi, Jayashri Prabakar
DOI:10.4103/ijdr.ijdr_404_21  
Dental caries is a global oral health problem caused due to localized demineralization of the enamel. Chemical plaque control is used as an adjuvant to mechanical plaque control in removing biofilm, thereby preventing dental caries. In recent times, there has been a renewed interest in nature-based products. This systematic review aimed to analyse the existing literature to compare the effectiveness of herbal and conventional dentifrices on prevention of dental caries. A search was done in the databases of PubMed and Google Scholar in July 2020 for the related topic. A hand search was done from the references of primary studies and other clinical trial registry sites. Randomized control trials, comparative clinical trials, and in vitro studies in which the effectiveness of herbal and conventional dentifrices on prevention of dental caries were included after review by the reviewers. The systematic search revealed a total of thirty-two publications from which ten publications were included. Five studies were clinical studies and five were in vitro studies. All the studies used microbiological analysis for the determination of cariogenic microorganisms in plaque and saliva, whereas one study used pH of plaque and saliva. Among the included studies, all studies had a high risk of bias with level 2 evidence. With the evidence available, it can be concluded that herbal dentifrices and fluoride dentifrices have similar antimicrobial activity against cariogenic microorganisms.
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CASE REPORTS Top

Multi-disciplinary orthodontic camouflage treatment of a severe skeletal class III malocclusion with 1 year follow-up – A case report p. 338
Moina K Adeni, Ratna Parameswaran, Devaki Vijayalakshmi, Junaid Sainulabdeen
DOI:10.4103/ijdr.IJDR_551_20  
Rationale: Orthodontic camouflage serves its purpose in treating mild to moderate skeletal dysplasia and in conditions where the patient is reluctant to opt for orthognathic surgery or when it is contraindicated. Patient Concerns: A 22-year-old male was concerned about his irregular teeth. Diagnosis: Angle's dentoalveolar class III malocclusion on class III skeletal on an average mandibular plane angle with anterior crossbite, deep bite, crowding in maxillary and mandibular anteriors, proclined maxillary anteriors and retroclined mandibular anteriors with reverse overjet and congenitally missing 12, 22, palatally impacted 13 and retained deciduous 63 and palatally placed 23. Treatment: Orthodontic camouflage with a multi-disciplinary approach. Outcome: Optimal functional and dentofacial aesthetics were achieved by 22 months. Take-Away Lesson: The limitations of camouflage must be kept in mind and explained to the patient. The biomechanics need to be customized and integrating different specialties helps maximize the treatment benefits.
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Hemifacial hypertrophy – Report of 2 cases p. 344
SM Balaji, Preetha Balaji
DOI:10.4103/ijdr.ijdr_688_22  
Hemifacial hyperplasia (HH) is a rare congenital condition involving enlargement of one or more tissues of the face. The treatment is surgically challenging and requires expertise. This manuscript aims to report two similar appearing HH but warranting different surgical treatment. A 19-year-old female and a 14-year-old boy presented with right facial asymmetry since birth and sought correction of the same. Surgical treatment was planned. Based on clinical history, diagnosis and imaging, HH was diagnosed. The first case was entirely a soft tissue abnormality that was treated with debulking while the second case had involvement of facial bones, necessitating surgical recontouring. The facial asymmetry was addressed. Healing was uneventful. Though the aesthetical concern and appearance of the two cases of HH were same, the treatment vastly differed. This was based on the source of asymmetry. Proper diagnosis and informed decision are a key for successful surgical outcome.
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