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   Table of Contents - Current issue
Coverpage
April-June 2021
Volume 32 | Issue 2
Page Nos. 139-273

Online since Monday, November 22, 2021

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EDITORIAL  

Long COVID-19 and dental treatment p. 139
SM Balaji
DOI:10.4103/ijdr.IJDR_959_21  PMID:34810378
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ORIGINAL RESEARCH: EVALUATIVE STUDY Top

Oral health status and self- assessment of oral health risk factors among South Indian diabetic patients p. 140
Mukkavilli Madhuri, Suhas Kulkarni, Dolar Doshi, Srikanth Reddy, Srilatha Adepu, Sahithi Reddy
DOI:10.4103/ijdr.IJDR_508_18  PMID:34810379
Background: The disease profile of the world is changing at an astonishingly fast rate. It is essential that the impending nature of chronic disease is recognized and acted on urgently. India leads the world with the largest number of diabetics earning the dubious distinction of being termed the “diabetic capital” of the world. Aim: To assess and compare the oral health status and related oral health risk factors among diabetic patients in Hyderabad and Secunderabad. Settings: A cross sectional study was carried out in various diagnostic centers among 801 patients aged 30 years and above. Methods and Materials: Oral health status and self-assessed data on related oral risk factors were measured using modified World Health Organization (WHO) assessment form and oral health questionnaire for adults 2013. Statistical Analysis: Comparison of mean scores of the variables based on gender was assessed using ANOVA. Statistical significance was set at p < 0.05. Results: Females had higher proportion of untreated caries (362; 85%) and DMFT (Decayed, Missing and Filled Teeth; 375; 88%) compared to males. On the basis of loss of attachment, the mean number of sextants with no loss of attachment was mostly noted among female subjects. Conclusion: In the present study, though gingivitis was seen in higher percentage (82%), the presence of periodontal disease was relatively low (68.3%). It can be concluded that diabetic subjects may have poor oral health.
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Association between mother's behaviour, oral health literacy and children's oral health outcomes: A cross-sectional study p. 147
KR Sowmya, Manjunath P Puranik, KS Aparna
DOI:10.4103/ijdr.IJDR_676_18  PMID:34810380
Introduction: Parents' infant and early childhood oral health knowledge is of paramount importance, because oral health behaviours are the exclusive domain of parents during the early years of life. Studies exploring the association between mother's behaviour, oral health literacy and children's oral health outcomes are scarce. Aim: To evaluate the association between mother's behaviour, oral health literacy and children's dental caries experience. Materials and Methods: A cross-sectional study was conducted among one hundred pre-school children aged 2–6 years and their mothers from pre-schools in Bangalore, India. Data regarding their demographics, mother's knowledge, attitude and practice (KAP) was collected through a questionnaire. Mother's oral health literacy was assessed with Rapid Estimate of Adult Literacy in Dentistry-30 (REALD-30) scale. Caries experience of the children was recorded using Decayed Missing Filled Teeth (DMFT) Index. Data was entered into excel sheet and analysed using statistical package for SPSS 22.0. Results: The mean KAP, REALD-30 and DMFT scores were 13.17 ± 4.57, 17.68 ± 5.85, 2.61 ± 2.21, respectively. In this study, REALD-30 score negatively correlated with DMFT score and positively correlated with KAP score. In a linear regression, KAP and REALD-30 scores showed a highly significant association with dental caries. Conclusion: Mother's behaviour and oral health literacy influenced caries experience of the children. Therefore, improving the behaviour and oral health literacy of the mothers is the key to influence child's oral health.
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Assessment of the factors influencing dental students to choose dentistry as a career: A cross-sectional survey p. 153
Amol Karagir, Mahesh Ravindra Khairnar, Shridevi Adaki, Rohit Ishwar Dhole, Madhuri C Patil, Amritha Ingale
DOI:10.4103/ijdr.IJDR_407_19  PMID:34810381
Objective: Career choice, one of the most important process in a student's life, has an influence on his/her future life. Hence, it is important to understand student's motives behind choosing a specific career. Hence, the study was designed with an aim to evaluate the factors influencing dental students to choose dentistry as career. Methods: The present cross-sectional survey was conducted on 401 dental students from a dental institute. The data was collected using a structured questionnaire consisting of 13 reasons that possibly influenced students' decision to study dentistry. Data collected was analyzed using SPSS 20 software. Results: Majority of the students participating were female (77.1%). Top four reasons to choose dentistry as a profession were to help poor people (95.5%), to earn prestige and respect (95.0%) followed by self-interest (94.7%) and study of human parts especially teeth (92.8%). Making money was the reason reported by 77.8% of the students. Other reasons reported were inspiration from other dentists (63.3%), did not get admission to medicine (MBBS) course (52.1%), and no doctor in family (51.9%). Family members in medical/dental profession was the least reported reason (36.9%). There were no significant differences among males and females for reported reasons except for one reason, that is, did not get admitted to medicine (MBBS) course (60.9% male and 48.9% female; P = 0.031). Conclusion: Students were mostly influenced by own interest and altruistic nature to opt for dental profession.
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Parental issues and concerns for their children treated under general anaesthesia for early childhood caries: A qualitative research approach p. 158
Rachana Srinivas, Latha Anandakrishna
DOI:10.4103/ijdr.ijdr_5_21  PMID:34810382
Context: Most often, young children with early childhood caries (ECC) may need oral rehabilitation under general anaesthesia (GA) as treatment cannot be done chairside. A procedure under GA can be traumatic and stressful for both the parents and the children. Hence, it becomes necessary to understand the parents' opinions and address their concerns to provide better treatment. Aims: This qualitative study was conducted to explore the parental issues and concerns for their children treated under GA for ECC. Qualitative research approach was used so that it would enable us to address these issues better and prepare parents by counselling them in advance. Settings and Design: An in-depth interview was conducted with the parents of children who underwent oral rehabilitation under GA for ECC in the M.S. Ramaiah Memorial Hospital, admitted under the Department of Pedodontics and Preventive Dentistry. Participants and Methods: Data were audio-recorded and transcribed. Statistical Analysis Used: Data collected were analysed using thematic analysis. Results: The themes derived were 'Concerns and Issues of GA Procedures and Improved Oral-health-related Quality of Life'. Conclusions: The parents of children who underwent oral rehabilitation under GA initially had a few concerns and were reluctant about the procedure but were happy with the improvement post-operatively.
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Applicability of moyer's probability tables in north indian population of 16-18 years old p. 162
Manu Sharma, Sanjay Chachra, Abhishek Dhindsa, Samriti Bansal, Taranjot Kaur, Alpna Sharma, Gurpreet Kour
DOI:10.4103/ijdr.IJDR_677_19  PMID:34810383
Aims: To determine the applicability of Moyer's probability tables in North Indian population of 16–18 year olds and to formulate a new regression equation for the same group of population. Setting and Design: Evaluative Study. Methods and Material: 1000 children aged 16–18 years were selected as sample for the measurement of mesiodistal widths of permanent mandibular incisors, maxillary and mandibular canines and premolars using study models. The recorded values were then subjected to statistical analysis. Statistical Analysis Used: Software Package for Social Sciences (SPSS) software version 22.0. Results: The actual widths of the canine and premolars showed highly significant differences in maxilla and in mandible (P < 0.001), compared to widths predicted by Moyer's probability table at 75th percentile. Conclusion: Moyer's mixed dentition analysis was not an accurate method for prediction in North Indian population as it showed overestimation of tooth sizes. Hence, new regression equation has been formulated for the same.
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Evaluating upper lip changes during smiling and at rest in Indian population p. 167
Sagar Dahiya, Gunjan Negi, Kirti Dahiya, Anirudh K Mathur, Prasad Chitra
DOI:10.4103/ijdr.IJDR_637_18  PMID:34810384
Context: Smile aesthetics is one of the major goals to be achieved after orthodontic mechanotherapy as it visibly displays the results of orthodontic treatment. Although orthodontic retainers aid in maintaining post-treatment occlusion, soft tissue function and aesthetics, appropriate knowledge of smile changes with age can help orthodontists to obtain stable and aesthetically appealing treatment results. Aim: To assess and quantify soft tissue changes in the upper lip in vertical dimension at both repose and maximum smiling and to evaluate changes occurring with the smile index and upper lip with age and sex in subjects of Indian origin. Settings: Department of Orthodontics and Dentofacial Orthopaedics, Army College of Dental Sciences, Secunderabad, Telangana, India. Design: Observational study Methods and Materials: A total of 160 volunteers (80 males and 80 females) selected and were divided into 4 groups according to age and were further divided into 2 sub-groups according to gender. Thirteen measurements of relaxed and smiling upper lip were taken with a calibrated metal ruler and divider directly on the subjects. Statistical Analysis Used: Analysis of variance (ANOVA) was done followed by post hoc test to determine which groups were significant from others. Levene's test was done to assess equality of variance and t-test for equality of means was done. Results: Statistically significant results were obtained in between groups and sub-groups for parameters like smile index, upper lip elevation while smiling and smile pattern in males and females changing with increase in age. Conclusions: High smile patterns with more vertical smile are more common among females and low smile patterns are more common among males. With age, the smile tends to be more horizontal in both genders.
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ORIGINAL RESEARCH: PROSPECTIVE STUDY Top

A prospective randomized controlled trial on the comparative clinical efficiency and hygiene of a ceramic inter locking retainer and a flexible spiral wire bonded retainer p. 174
Abhishek Sinha, Saurabh Sonar, Puneet Batra, Sreevatsan Raghavan
DOI:10.4103/ijdr.IJDR_1050_20  PMID:34810385
Background: The lower canine to canine retainer is one of the most commonly used retention appliance. Objective: Compare and assess the clinical efficiency and oral hygiene maintenance with 2 retainers: flexible spiral wire and ceramic interlocking bonded. Setting and Sample Population: Orthodontic department of a dental college. Participants, Study Design and Methods: Prospective randomized controlled trial that involved 40 patients who had completed orthodontic treatment and were randomly allotted to either group: flexible spiral wire (FSW) or ceramic interlocking retainers. Allocation ratio was 1:1. Eligibility Criteria: Completed fixed orthodontic treatment with an acceptable treatment result. Main Outcomes: Oral hygiene was assessed at 3 (T1) and 6 (T2) months intervals after debonding using Gingival and Plaque index. The contact point displacement was assessed using 3D model superimposition and bonded retainer failure was noted. Randomization and Blinding: Computer-generated random allocation, only data analyzer was blinded. Statistics: Data normality was tested using the Shapiro-Wilk and Q-Q plot. Mixed model analysis was used to assess differences between the two groups for the above-mentioned parameters. The failure rate of the retainer was calculated by the Chi-Square test. Results: Only the plaque index score was significantly greater in the FSW group and showed a statistically significant difference (P < 0.05), rest of the parameters showed no statistically significant difference over the specified time points, although a mild increase in relapse was noted in both groups No serious harms were reported. Conclusion: Both retainers seem to be effective in maintaining the treatment results however the FSW seems to accumulate more plaque over a given period of time thereby mandating proper hygiene maintenance and follow-up.
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Periodontal heath in first trimester of pregnancy and birth weight outcomes p. 181
Varsha Christy Rani Balaji, K Saraswathi, S Manikandan
DOI:10.4103/ijdr.ijdr_94_21  PMID:34810386
Introduction: The oral microbiome is influenced by numerous immediate environmental factors including pH, anaerobic conditions, nutrition, and hormone levels. During pregnancy, due to the associated hormonal changes, periodontal tissues show an enhanced inflammatory response to plaque microbiome. This is mediated by female sex hormones that are drastically altered in pregnancy. This study was undertaken to estimate the association of birth weight and the influence of the oral periodontal health in pregnant women in Chennai, South India and correlate the same with education and body mass index (BMI). Methods: This was a controlled, minimal interventional, prospective, observational study to identify the relationship of gingival health in the first trimester of pregnancy and on birth weight. Potential participants were referred by health-care providers. Pregnant women (≥18 years and ≤25 years) in the first trimester were enrolled for this study. Results: Of the 165 pregnant women, 121 pregnant women formed the study group. Conclusion: It was found that low birth weight could be a consequence of several modifiable and non-modifiable factors. This study shows the association of oral health of the mother in the first trimester with low birth weight. The findings of this study need to be confirmed with a large-scale, multi-centric study accounting for all known confounders. Till such a study is performed, the need for optimal oral health of an expectant mother cannot be discounted and there is no absolute harm in having good oral hygiene.
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Efficacy of antioxidants therapy on progression of periodontal disease – A randomized control trial p. 187
Jyoti Wasti, Amit Wasti, Ritunja Singh
DOI:10.4103/ijdr.IJDR_227_20  PMID:34810387
Background and Aim: Increased oxidative stress has emerged as one of the prime factors in the pathogenesis of periodontitis. Hence, antioxidant therapy may become a promising tool in the treatment of periodontal disease. Uric acid is a major salivary antioxidant, levels of which decrease in periodontitis. The aim of the present study was to investigate the effect of antioxidant therapy on the progression of periodontal disease. Material and Methods: This is a randomized controlled clinical trial conducted among 48 systemically healthy participants having generalized gingivitis with probing depth <3 mm, plaque index (PI) <1, and no bone and attachment loss. Participants were randomly assigned equally (n = 24) into two groups (test and control) using the lottery method. Full mouth scaling and root planing were performed in both the groups and oral hygiene instructions were given. Periodontal assessment at baseline 1 h after scaling and root planing was done with clinical parameters by a single examiner. Test group was prescribed; the commercially available anti-oxidant containing natural lycopene with green tea extract. Sample collection was done for both the groups at baseline and at the 45th day. Results: It was observed that significantly high results were obtained during intra-group comparison for both modified plaque index and sulcus bleeding index from baseline to 45 days. After treatment, a very highly significant increase (P ≤ 0.001) in the test group and significant (P ≤ 0.05) increase in the control group were observed in salivary uric acid levels. Conclusion: Oral lycopene and green tea extract supplementation is positively associated with salivary uric acid levels and plays an important role in the management of gingivitis.
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Hydroxychloroquine- A new treatment option for erosive oral lichen planus p. 192
Subash Chandra Raj, Debajani Baral, Lokanath Garhnayak, Annuroopa Mahapatra, Kaushik Patnaik, Shaheda Tabassum, Jayant Kumar Dash
DOI:10.4103/ijdr.IJDR_943_20  PMID:34810388
Context: Oral Lichen planus (OLP) is a chronic, debilitating, immune-mediated disease whose management is considered a challenge in medical science. Aims: To quantitatively evaluate the effect of administration of enteral hydroxychloroquine (HCQS) as a monotherapy for six months on the extent and severity of erosive OLP using reticular score, erythema score and ulcerative score (REU score), and to subjectively evaluate the success of HCQS as a therapeutic drug for OLP-e using Tel Aviv-San Francisco Scale, visual analogue scale (VAS) and severity of burning sensation (BURN score). Settings and Design: Prospective clinical trial. Methods and Material: A total of 45 subjects received 200 mg of HCQS bid for six months. REU, VAS, BURN scores and Tel Aviv-San Francisco Scale readings were taken at the beginning of the study (baseline) and three- and six-month intervals post administration of enteral HCQS. Subjects were examined for any adverse drug outcomes for one year after the cessation of enteric HCQS therapy. Data were analysed with SPSS version 25. Results: There was a stark reduction in REU, VAS and BURN scores during the study period, with a statistically significant reduction (P < 0.05) seen at three- and six-month time intervals as compared to baseline. Further, the mean of change in R, E and U scores showed a statistically significant difference, with the highest reduction seen at baseline to six-month time interval. The Tel Aviv-San Francisco Scale showed 70%–100% remission in disease in more than 70% of subjects. Conclusions: Enteral HCQS can be considered a viable treatment option for the enigma that is erosive OLP.
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ORIGINAL RESEARCH: COMPARATIVE STUDY Top

Preferences and their correlation between children and their parents' attitudes towards non-pharmacological behaviour guidance techniques – A cross-sectional study p. 199
S.V. S. G. Nirmala, SK Inthihas, Dhigvijay Aerpogu, C Rama Subbareddy, Sivakumar Nuvvula
DOI:10.4103/ijdr.IJDR_817_18  PMID:34810389
Introduction: Dental treatment for children requires the use of behaviour guidance techniques (BGTs), which are used in the dental office to make children cope with dental treatment. Aim: Evaluate how children and parents felt towards BGTs used in a dental office, by attitude meter and to correlate them. Materials and Method: Children (200) from 7–17 years and their parents were selected randomly to participate in the study. Each child and parent was asked to watch four video scenes of live BGTs, which include Tell Show Do (TSD), Modeling, Reward system, and Hand holding. A questionnaire collected demographic data, and their expressive attitudes were assessed using Line of favour (LOF) scale and Kruskal-Wallis Test. Results: Most preferred BGTs for Group I was modeling, Group II Reward, Group III Tell Show Do, and Group IV was Modeling, with a mean score of 5.95, 6.04, 5.57, and 5.78, respectively. Gender wise preferences, 32% of boys and 34% of girls preferred modeling in Group I, whereas, in Group II, 20% of boys and 21% of girls preferred reward, respectively. Chi-square test revealed that there is no significant difference between the groups and gender for the preference of BGTs in Group I (P=0.893) and Group II (P=0.592). There was no significant correlation between preferences of children and their parents. Conclusion: Modeling was the most preferred BGT for primary school children and parents of High school children. A reward was the most preferred BGT for high school children. TSD was the most preferred BGT for parents of primary school children.
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Comparative analysis of the naso/oropharyngeal swab and oral bio-fluid (whole saliva) samples for the detection of SARS-CoV-2 using RT-qPCR p. 206
Parmar Girish, Pillai Jayasankar, Parmar Abhishek, Soni Sumeeta, Parmar Gunvant, Parmar Shalin
DOI:10.4103/ijdr.ijdr_483_21  PMID:34810390
Context: The Corona Virus Disease 2019 (COVID-19) is a contagious disease caused by the novel Coronavirus (2019-nCoV) and was declared a pandemic disease by the World Health Organization (WHO) in March 2020. The nasopharyngeal and the oropharyngeal swabs are being taken during the screening procedure. However, the virus is also present in the oral bio-fluid and hence it could be a potential tool for screening COVID-19 cases. Aim: The aim of the present study was to test the accuracy of whole saliva as a diagnostic specimen in COVID-19. Settings and Design: This cross-sectional, analytical study was conducted on out-patients visiting the COVID-19 hospital. Methods and Material: The whole saliva and the nasopharyngeal/oropharyngeal samples from 309 COVID-19 suspected patients were collected and subjected to RT-PCR analysis. Statistical Analysis Used: The paired t test was used to compare the measured variables (CT values) between the saliva and the swab samples. The positive predictive value (PPV), negative predictive value (NPV), the sensitivity, and the specificity of the tests were calculated for the saliva sample. Results: The saliva and swab results revealed a similar result (ties) in 86.73% of the samples. The sensitivity and the specificity between the swab and saliva samples were 40% and 96.85%, respectively. The positive predictive value of the saliva sample was 73.3%. Conclusions: The sensitivity of whole saliva when compared to the swab samples is low. Large sample studies are needed to validate the role of saliva as a diagnostic tool in COVID-19.
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Relationship between perceived chewing ability, oral health related quality of life and depressive symptoms among completely edentulous individuals p. 211
CS C Satishkumar, Sangeeta J Nair, Angel M Joseph, Sushanthi Suresh, Indumathi Muthupandian, Sathya Kumaresan, Awad Ashekhi, Gulrez Nadeem
DOI:10.4103/ijdr.ijdr_1141_20  PMID:34810391
Background: Edentulism affects the chewing ability of a person and can engender nutritional deficiencies which can affect the overall quality of life and depression. Aim: Our aim was to evaluate the association between perceived chewing ability, oral health-related quality of life (OHRQoL) and depressive symptoms among completely edentulous patients with and without dentures. Settings and Design: Institutional study and cross-sectional design. Methods: A cross-sectional study among 207 completely edentulous persons was conducted in South India. The subjects completed a self-administered questionnaire on demographics, Beck's depression inventory, oral health impact profile-edentulous (OHIP-EDENT), age when edentate, chewing ability, and denture satisfaction. Further, denture status was clinically evaluated. Statistical Analysis: Data were summarised and analysed using the Chi-square test and multivariate logistic regression. P < 0.05 was considered significant. Results: Persons not using complete dentures (odds ratio [OR] =3.5, P < 0.05), who reported impaired chewing ability (OR = 4.6, P < 0.05), those who became edentate before 55 years (OR = 4.6, P < 0.05) and with poor denture status (OR = 6.2, P < 0.05) were more likely to report depressive symptoms. Lesser impact in relation to OHRQoL was found to be protective against depression among completely edentulous (OR = 0.24, P < 0.05). Conclusion: Depressive symptoms were associated with impaired chewing ability, higher impacts on OHIP-EDENT, and edentulous persons not using complete dentures. High priority must be given to enhance awareness towards oral rehabilitation among completely edentulous to reduce the chance of depression occurring due to impaired chewing ability and poor OHRQoL.
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Assessment of pulp sensibility in the mature necrotic teeth using regenerative endodontic therapy with various scaffolds – Randomised clinical trial p. 216
Neelam Mittal, Harakh C Baranwal, Praveen Kumar, Sakshi Gupta
DOI:10.4103/ijdr.ijdr_253_21  PMID:34810392
Aim: This study aimed to evaluate and compare the possibility of regaining pulp sensibility and objectives of regeneration procedure in mature necrotic teeth using regenerative endodontics. Materials and Methods: A total of 36 mature necrotic teeth were selected and a regenerative endodontic procedure was performed. A total of four groups, each involving n = 9 teeth per group were randomly grouped as (1) periapical bleeding, (2) platelet-rich fibrin (PRF), (3) collagen, and (4) hydroxyapatite. Pulp testing and radiographic assessment of periapical healing (PH) were recorded at every 3-month interval for 1 year. Readings were compared as qualitative data using the Kruskal–Wallis test to see the inter-group significant difference. Results: Readings of pulp sensibility revealed non-significant results in all intervals. At 3 and 6 months, 22.3% in the PRF group and 11.15% in collagen group; and at 9 months, 44.4% in PRF group, 33.3% in the collagen group and 22.2% in hydroxyapatite group; and at 12-months, 66.6% in PRF, 44.4% in the collagen group, 33.3% in the hydroxyapatite group and 11.1% in the periapical bleeding group showed a positive response to the cold test. But all groups did not show a positive response to heat and electric pulp testing and showed good PH in all groups at the end of 12 months. Conclusions: The presence of sensibility to cold test is indicative of the formation of vital pulp-like tissues, which was the highest in the PRF group, followed by the collagen, hydroxyapatite and periapical bleeding groups.
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ORIGINAL RESEARCH: IN VITRO STUDY Top

Antimicrobial efficacy of acacia Nilotica (Babul) extract and its effectiveness in disinfecting gutta percha cones - An in vitro study p. 221
Dolly R Jagyasi, Neelam D Chandwani, Mohit K Gunwal, Aastha S Ranka
DOI:10.4103/ijdr.IJDR_233_20  PMID:34810393
Background: Gutta-percha cones used directly from the manufacturer's sealed packs harbour micro-organisms. During clinical use, the chances of contamination of gutta-percha increases. Hence, disinfection of gutta-percha cones before use is essential to prevent canal recontamination. Aim: To evaluate the antimicrobial efficacy of babul against chemical disinfectants, and its effectiveness in disinfecting gutta-percha cones. Materials and Methods: The extract of babul was used to assess its antimicrobial activity against E-faecalis, S. aureus and C. albicans using the agar diffusion method. A total of 120 cones acquired from freshly opened manufacturers' pack were cut into three equal parts and divided into group I which was directly placed into a nutrient broth, group II was clinically contaminated with gloves for 30 s and placed into a nutrient broth, and the third part was clinically contaminated with gloves and decontaminated for 5 min using the experimental disinfectants to check for the presence of turbidity. Statistical Analysis: The data were analysed by an Unpaired t-test and Chi-square test at a significance level of P < 0.05 using software SPSS 20. Results: Two percent chlorhexidine showed maximum antibacterial action against E. faecalis and S. aureus followed by babul extract. It was also found more efficacious in decontaminating gutta-percha cones followed by babul and 3% sodium hypochlorite in 5 min. Conclusion: Babul herbal extract is indeed effective in decontaminating gutta-percha cones and is a better alternative to chemical disinfectants.
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Green tea catechins showed antibacterial activity on streptococcus mutans –An in vitro study p. 226
Sanjeevini A Hattarki, Chetana Bogar, Kishore G Bhat
DOI:10.4103/ijdr.ijdr_512_21  PMID:34810394
Background: The main bacterial aetiological agents in caries formation are the α-haemolytic Streptococcal species Streptococcus mutans, which has been found to be the initiator of most dental caries. The leaves of Camellia sinensis known as green tea, has properties, such as antibacterial and anti-cariogenic. Epigallocatechin-3-gallate (EGCG) one of the most abundant catechins found in green tea is known to contribute to these effects. Aim: To evaluate the antibacterial effect of green tea catechins namely EGCG on S. mutans with two different methods at different concentrations. Objectives: 1) To assess the antimicrobial efficacy of EGCG by disc diffusion test at concentrations of 100, 75, and 50 μg/mL. 2) To assess the antimicrobial efficacy of EGCG by Minimum inhibitory concentration (MIC) test at concentrations ranging from 0.2 to 100 μg/mL. Methodology: Commercially available purest form of green tea polyphenol EGCG was used in the study. Disc diffusion test on agar medium and MIC test was used to determine the susceptibility of the S. mutans to green tea catechins EGCG. Results: The results of the agar well diffusion method showed that the EGCG extract has shown zones of inhibition against S. mutans at concentrations of 100 μg/mL (28.67 mm), 75 μg/mL (15.33 mm), 50 μg/mL (10.33 mm) while that of MIC test of EGCG extract of concentrations ranging from 0.2 to 100 μg/mL against S. mutans shows that the mean MIC value was 1.07. Conclusion: Catechins in the tea are potentially anti-cariogenic agents which can reduce bacterial presence in the oral cavity and have the potential to be further used for the preparation of dentifrice and mouthwash.
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Influence of volume of endodontic irrigants used in different irrigation techniques on root canal dentin microhardness p. 230
Buvaneshwari Arul, Nandini Suresh, Ranjithkumar Sivarajan, Velmurugan Natanasabapathy
DOI:10.4103/ijdr.IJDR_709_18  PMID:34810395
Introduction: Overzealous application of endodontic irrigants affects the root canal dentin mechanical properties. The effect of volume of endodontic irrigants on the microhardness of root canal dentin has not been studied. Aim: This study assessed the effect of volume of endodontic irrigants used in different final irrigation activation techniques on root canal dentin microhardness (RCDM). Methodology: Sixty human maxillary central incisors were embedded in acrylic resin in Kuttler's endodontic cube to the level of cementoenamel junction. The root samples were randomly divided into 4 experimental groups (n = 15): Group-NI-needle irrigation, Group-PUI–continuous passive ultrasonic irrigation, Group-EndoVac–apical negative pressure system, Group combination– EndoVac + PUI irrigation. Root canals were instrumented up to size 40 (F4). The resin mounted specimens were sectioned longitudinally into two halves and were reassembled in Kuttler's kube to carry out final irrigation activation. A predetermined standardized volume of irrigants was used in each group. The RCDM was measured after root canal instrumentation and after final irrigation using Vicker microhardness tester (coronal, middle, and apical third). The reduction in RCDM values (p < 0.0086) were analyzed using Kruskal Wallis and Mann Whitney-U tests. Results: Reduction in RCDM was observed with all the endodontic irrigating techniques tested. EndoVac and combination irrigation techniques showed maximum reduction in RCDM in all thirds of root canal. Conclusion: It is concluded that the volume of irrigants and agitation plays a role in reducing RCDM. The overall volume of irrigants to cause maximum reduction was 25 ml, beyond which neither volume nor agitation affects RCDM.
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EPIDEMIOLOGICAL WORK Top

Oral health status and treatment needs of children with sensory deficits in Chennai, India–A cross-sectional study p. 236
P Vishnu, R Mahesh, PD Madan Kumar, N Sharna
DOI:10.4103/ijdr.IJDR_809_18  PMID:34810396
Purpose: The negligence of oral health combined with barriers in accessing adequate oral care is more commonly encountered in children with sensory deficits. In a developing country like India, there is a severe lacuna in data regarding the oral health status and treatment needs in this group of population. The purpose of this study is to assess the oral health status and treatment needs of children with sensory deficits, using WHO criteria of Basic Oral Health Survey Methods, 1997. Materials and Methods: A descriptive cross-sectional study was conducted using the WHO criteria (Basic Oral Health Survey, 1997); questionnaire data regarding the demographic profile, oral hygiene status, degree of sensory impairment were recorded and tabulated. The Chi-square test was used to determine whether there existed a significant difference in the oral health status. The confidence interval was set at 95% and alpha error was assumed at 0.05. Results: Among the 742 sensory deficit children examined, 371 children are visually impaired and 371 are hearing impaired. Gingival bleeding and poor oral hygiene is diagnosed in more than 70% of the visually impaired children. The prevalence of trauma is estimated to be 8% in children, who are visually impaired. In the hearing impairment group, gingival bleeding because of inadequate oral hygiene is seen in 58% of the population examined. There is no statistically significant difference in the dental caries status between visually impaired and hearing impaired children (P > 0.05). There is also no statistically significant difference in the restorative treatment need and trauma status between visually impaired and hearing impaired children (P > 0.05). Conclusion: The present study shows a high prevalence of gingival diseases and dental caries in the special health care group children. The study signifies a wide spread presence of unmet treatment needs among children in this study population.
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Dentists in India feel hopeless as a fulltime academician: A national survey Highly accessed article p. 243
Srinivasan R Samuel, V Keerthi Narayan, J Vidhyadharan, Mebin G Mathew, Sunil K Akula
DOI:10.4103/ijdr.IJDR_746_19  PMID:34810397
Aims: Assess the relationship between job satisfaction and feeling of hopelessness among dental academicians. Settings and Design: Cross sectional study was conducted among dental academicians across India through email and social media using a pretested questionnaire. Methods and Materials: An Internet-based cross-sectional survey was conducted among dental academicians via social media and electronic mail (e-mail) throughout India. Demographics, credentials and job satisfaction across five dimensions (working conditions, pay and promotional potential, work relationships, use of skills and abilities and work activities) were rated on a 5-point Likert scale and a sense of hopelessness was assessed using Brief-H-Neg scale. The results were collected using self-reported Google forms. Bivariate and multivariate analysis were performed to identify the risk towards hopelessness, and the relationship between job satisfaction and hopelessness was assessed using student's t-test. Results and Conclusion: The mean hopelessness score among dissatisfied faculty was 8.5 and among satisfied was 5.6 (P < 0.05). Tutors, assistants and associate professors with salary of INR <50000/month were highly dissatisfied (P < 0.05), and those willing to quit reported significantly lesser hopelessness compared to no/maybe. Regarding job satisfaction, greater hopelessness was reported with poor work relationships, poor working conditions and poor pay and promotional opportunities (P < 0.05). Dental academicians in India are highly dissatisfied with their career as a full-time teaching faculty. Willingness to quit has a positive effect on hopelessness, depicting the stress faculties experience in institutions. Job satisfaction among academicians plays a vital role in the student's dental learning experience and dissatisfaction will have huge ramifications on the quality of dental education and future graduates in India.
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CASE REPORTS Top

An interdisciplinary approach to management of diastemas: A novel classification and a case report p. 250
Sindhu Saeralaathan, Vamsi Lavu, Mathan Rajan, SK Balaji, Arathi Ganesh
DOI:10.4103/ijdr.IJDR_952_20  PMID:34810398
Diastema between the teeth negatively affects the patients' smile, psychology and daily activities by creating a disharmony in the patients' face. The development of diastema has been attributed to several factors such as labial frenulum, microdontia, mesiodens, peg-shaped lateral incisors, agenesis, cysts, habits such as finger sucking, tongue thrusting, or lip sucking, dental malformations, genetics, proclinations, dental-skeletal discrepancies, and imperfect coalescence of interdental septum. Patients often present with complex problems that require a multidisciplinary treatment approach which includes determination of the aetiological factors, soft tissue morphology, occlusion, patient demands and aesthetic consideration to achieve satisfactory outcomes. Lack of current literature on classification of diastemas and multi-disciplinary approach of management led to the proposal of a new classification the ATAC (Anatomic and Therapeutic Classification) for management of the diastema. This case report highlights the use of the proposed classification for management of diastemas, requiring a perio-restorative intervention using a Chu's proportion gauge to achieve ideal aesthetics.
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Squamous cell carcinoma of mandible with unusual clinical presentation: A rare case report and review of literature p. 256
Pradhuman Verma, Muzammil , Preneet Kaur, Dhafer S Al Asmari
DOI:10.4103/ijdr.IJDR_700_19  PMID:34810399
Squamous cell carcinoma (SCC) is commonly seen malignant epithelial neoplasm of the oral cavity, which is characterized by variable clinical manifestations. It arises from dysplastic squamous epithelium. Majority of the spread of oral SCC (OSCC) to mandibular bone occurs by direct infiltration of the tumour through alveolar ridge or lingual cortical plate. Only 6% of the OSCC present with primary tumour; hence, a comprehensive whole body imaging needs to be done for ruling out primary tumour anywhere else in the body along with a proper clinical examination. Here, we present an unusual case of long-standing aggressive primary malignancy with unusual clinical presentation in mandibular anterior region associated with chronic tobacco chewing in a 65-year-old male patient.
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A rare case report of perioral sarcoidosis p. 261
SM Balaji, Preetha Balaji
DOI:10.4103/ijdr.ijdr_562_21  PMID:34810400
The Rationale: Sarcoidosis is a multisystemic granulomatous disease of unknown aetiology that usually presents with systemic lesions including the skin. Isolated cutaneous lesions are very rare. Patient Details: We present a middle-aged female patient, a known systemic lupus erythematosus patient, in remission developing an isolated, single sarcoidosis lesion in the perioral labial mucosa. The lesion was a rapidly growing nodular lesion with a papillary surface near the philtrum of the upper lip. Diagnosis: A biopsy revealed that to be a granulomatous lesion with large multinucleated giant cells. Using a panel of tests, by excluding tuberculosis and establishing the immunoprofile, the diagnosis was established. Although infrequent, perioral and oral lesions may constitute the first signs of systemic sarcoidosis. Outcomes and Take-away Lessons: For this reason, the oral health care provider needs to be watchful and when there is a suspicion of sarcoidosis, systemic sarcoidosis must be included in the differential diagnosis of oral and perioral granulomatous lesions.
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Management of marginal tissue recession using platelet-rich fibrin: A case report p. 264
Priyanka Prakash
DOI:10.4103/ijdr.IJDR_619_18  PMID:34810401
Background: Marginal tissue recession leads to exposure of root surfaces of teeth resulting in root sensitivity, caries, or an unsightly appearance. Its management is carried out both by eliminating contributing factors as well as using surgical techniques. Platelet-rich fibrin (PRF) is a seond-generation platelet concentrate first described by Choukroun et al. in 2001. This case report is of a Millers Class II recession in 41 regions managed using PRF with a double pedicle flap. Method: A 25-year-old patient presented with gingival recession height of 5 mm, measured from the cemento-enamel junction (CEJ) to gingival margin. The recession width was 3 mm at the CEJ and PD of 1 mm with respect to 41 region. There was no keratinized tissue apical to recession. However, adequate keratinized tissue was clinically present on either side of the recession defect wrt 41 region. A partial thickness double pedicle flap was raised wrt 41 region. PRF was prepared by centrifuging whole blood at 2,700 RPM for 12 min. The membrane was folded to create bulk and secured over the recession defect. Results: The patient was reviewed at regular intervals of 01, 06, months and 01 year postoperatively. Significant coverage of denuded root was achieved with good color match and relief from sensitivity. Results were stable one year postoperatively. Conclusion: Cases that present with a deep and wide recession are challenging to address owing to the extensive loss of keratinized tissue. In such cases, double pedicle flap can be carried out to augment gingiva by utilizing keratinized tissue adjacent to the defect site. Platelet concentrates like PRF contain platelet-derived growth factors that exhibit chemotactic and mitogenic properties that promote and modulate cellular functions involved in tissue healing, regeneration, and cell proliferation. PRF is an autologous biomaterial which may be used in root coverage procedures. Long-term studies with a larger sample size are required to establish PRF as a predictable method of gingival recession coverage.
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Comminuted middle third orbito-zygomatic complex fracture leading to blindness due to unanticipated tyre rim explosion during service – A rare case p. 268
R Sathyanarayanan, K Raghu, M Shyamala, Jude B Nithin Joseph, R Rajkumar
DOI:10.4103/ijdr.IJDR_652_18  PMID:34810402
An explosion is caused by conversion of solid, liquid into gas with resultant energy release. Blast injuries of large tyres are similar to injuries resulting from landmine explosions. Most of the patients were polytraumatised, initial evaluation and management should follow ATLS. Trauma following tyre blast results in severe soft tissue, orthopedic and head injuries. Head and face is the most commonly affected region followed by upper limb. A 40 year old male patient was watching a car tyre getting inflated with air. Unfortunately the tyre rim exploded on his face, which led to penetrating injury to the eye ball and comminuted middle third fractures. Patient was stabilized and primary hemostasis was achieved. Fractured maxilla was fixed by arch bar wiring and stabilized by using circum-suspension wiring bilaterally. Left eyeball was removed due to open globe injury and intraocular content loss. Unusual maxillofacial injuries are more common. Decision making and treatment of facial penetrating injuries depends on number of factors, which includes location and extent of injury, type of foreign body involved, proximity of vital structures, extent of injury to soft and hard tissue and the relative benefits and risk ratio for the patient. In this case report we have explained about the primary assessment and management of blast injuries.
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LETTER TO EDITOR Top

Anti-microbial resistance and dentistry p. 272
Ankita R Verma, Vijay Prakash Mathur
DOI:10.4103/ijdr.ijdr_4_21  PMID:34810403
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