Statement of Problem: The use of osseointegrated implants as a foundation for the prosthetic replacement of missing teeth has become widespread in the last decade. Owing to the remarkable success of dental implants, there has been growing interest in identifying the factors associated with implant failure. Given the well-documented deleterious effect of smoking on wound healing after tooth extraction and its association with poor quality bone and periodontal disease, a negative effect of tobacco use on implant success is to be expected. Purpose: To establish the relationship between smoking and implant-related surgical procedures (i.e, sinus lift procedures, bone grafts and dental implants), including the incidence of complications related to these procedures and the long-term survival and success rates of dental implants among smokers and nonsmokers based on relevant literature. Materials and Methods: Relevant clinical studies published in English between 1990 and 2006 were reviewed. The articles were located through Medline and, manually, through the references of peer-reviewed literature. This was supplemented with a hand search of selected dental journals and text books. Results: The majority of the past and current literature implicates smoking as one of the prominent risk factors affecting the success rate of dental implants with only a handful of studies failing to establish a connection. Most of the studies report the failure rate of implants in smokers as being more than twice that in nonsmokers. These findings are difficult to ignore. There is a statistically significant difference between smokers and nonsmokers in the failure rates of dental implants. Smoking also has a strong influence on the complication rates of implants: it causes significantly more marginal bone loss after implant placement, it increases the incidence of peri-implantitis and affects the success rates of bone grafts. The failure rate of implants placed in grafted maxillary sinuses of smokers is again more than twice that seen in nonsmokers. Conclusion: Smokers have higher failure rates and complications following dental implantation and implant-related surgical procedures. The failure rate of implants placed in grafted maxillary sinuses of smokers is more than twice that seen in nonsmokers.

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Sleep disordered breathing is a term which includes simple snoring, upper airway resistance syndrome, and obstructive sleep apnea (OSA). Simple snoring is a common complaint affecting 45% of adults occasionally and 25% of adults habitually and is a sign of upper airway obstruction. Snoring has also been identified as a possible risk factor for hypertension, ischemic heart disease, and stroke. The role of dentistry in sleep disorders is becoming more significant, especially in co-managing patients with simple snoring and mild to moderate OSA. The practicing dental professional has the opportunity to assist patients at a variety of levels, starting with the recognition of a sleep-related disorder, referring patients to a physician for evaluation, and assisting in the management of sleep disorders. Obesity is the main predisposing factor for OSA. In nonobese patients, craniofacial anomalies like micrognathia and retrognathia may also predispose to OSA. Diagnosis of OSA is made on the basis of the history and physical examination and investigations such as polysomnography, limited channel testing, split-night testing, and oximetry. Nocturnal attended polysomnography, which requires an overnight stay in a sleep facility, is the standard diagnostic modality in determining if a patient has OSA. As far as treatment is concerned, the less invasive procedures are to be preferred to the more invasive options. The first and simplest option would be behavior modification, followed by insertion of oral devices suited to the patient, especially in those with mild to moderate OSA. Continuous positive airway pressure (CPAP) and surgical options are chosen for patients with moderate to severe OSA. The American Academy of Sleep Medicine (AAOSM) has recommended oral appliances for use in patients with primary snoring and mild to moderate OSA. It can also be used in patients with a lesser degree of oxygen saturation, relatively less day time sleepiness, lower frequency of apnea, those who are intolerant to CPAP, or those who refuse surgery. Oral appliances improve the blood oxygen saturation levels as they relieve apnea in 20-75% of patients. They reduce the apnea-hypopnea index (AHI) by 50% or to < 10 events per h. Oral appliances also reduce the AHI to normal in 50-60% patients.

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Background and Objectives: Chewing twigs of the mango or neem tree is a common way of cleaning the teeth in the rural and semi-urban population. These twigs are also believed to possess medicinal properties. The present study was conducted to evaluate the antimicrobial effects of these chewing sticks on the microorganisms Streptococcus mutans , Streptococcus salivarius , Streptococcus mitis , and Streptococcus sanguis which are involved in the development of dental caries. An additional objective was to identify an inexpensive, simple, and effective method of preventing and controlling dental caries. Materials and Methods: The sticks were sun dried, ground into a coarse powder, and weighed into 5 gm, 10 gm, and 50 gm amounts. These were added to 100 ml of deionized distilled water. After soaking for 48 h at 4°C, the water was filtered. The filtrate was inoculated onto blood agar plates containing individual species of microorganisms and incubated at 37°C for 48 h. Results: Mango extract, at 50% concentration, showed maximum zone of inhibition on Streptococcus mitis . Neem extract produced the maximum zone of inhibition on Streptococcus mutans at 50% concentration. Even at 5% concentration neem extract showed some inhibition of growth for all the four species of organisms. Interpretation and Conclusion: A combination of neem and mango chewing sticks may provide the maximum benefit. We recommend the use of both the chewing sticks.

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Genes are specific sequences of bases that encode instructions to make proteins. When genes are altered so that encoded proteins are unable to carry out their normal functions, genetic disorders can result. Gene therapy is designed to introduce genetic material into cells to compensate for abnormal genes or to make a beneficial protein. This article reviews the fundamentals in gene therapy and its various modes of administration with an insight into the role of gene therapy in Periodontics and future percepts and the technical and ethical issues of using gene therapy.

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The aim of this study was to determine the degree of conversion and residual stress of resin composite preheated to different temperatures and to compare it to room-temperature composite. The composite resin was preheated to 40ºC, 50ºC, and 60°C and packed into brass rings and light-cured. The degree of conversion and residual stress were analysed using Fourier transform infra-red spectroscopy and X-ray diffraction, respectively. The results obtained were tabulated and statistically analyzed using Kruskal-Wallis test and Tukey's honestly significantly different test. The results showed significant increase in the degree of conversion and residual stress with increase in preheating temperature.

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Objective: The existing eruption schedules for permanent and deciduous dentition are based on studies in the Western population. Since Indians differ from Westerners racially, genetically, and environmentally, these studies fail to provide relevant guidance on the eruption schedule in the Indian population. This study aims at determining the eruption pattern of permanent mandibular molars and central incisors in the south Indian population. Materials and Methods: 10,156 apparently healthy Indian children in the age-group of 6-9 years were examined with mouth mirror and probe under adequate illumination for the status of the eruption of the permanent mandibular first molar and permanent mandibular central incisor. Pearson's Chi-square test with Yates' continuity correction was used to calculate the P -value for comparison of proportion between girls and boys. The values obtained in our study were compared with the standard values. The Z-test with continuity correction was used to calculate the P -value. Results: As per our study, the permanent mandibular first molars and central incisors erupted one to two years later compared to the values reported in Westerners. The earlier eruption of the permanent mandibular first molars compared to the permanent mandibular central incisors, as well as the earlier eruption of both the teeth in girls compared to boys, were in accordance with the existing literature. Conclusion: The eruption age reported by us may form a standard reference for eruption age in Indians.

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The influence of trace elements on the prevalence of caries is a complex subject. However, the demonstration of an inverse relationship between caries prevalence and fluoride (F) intake indicates the potential effect of trace elements on caries. Aims and Objectives: This in vitro study sought to estimate and compare the trace element concentrations in sound and carious enamel of primary and permanent teeth. Materials and Methods: Forty sound and carious primary and permanent teeth, extracted from children and adolescents of Davangere city, were collected. The teeth were divided into four groups (of ten each) and enamel samples were prepared by mechanical grinding. The trace elements were estimated using atomic absorption spectrophotometer. Results and Conclusions: The results of our study showed the presence of 18 trace elements (F, Sr, K, Al, Si, Ni, B, Fe, Cu, Mn, Co, Cr, Zn, Mg, Se, Pb, Mo, and V) in the enamel of sound and carious primary and permanent teeth. The mean, standard deviation, and range (at 95% confidence level) were calculated for each element. The concentrations of F, Sr, and K were significantly ( P <0.05) higher in sound enamel of permanent teeth than in sound enamel of primary teeth. The concentrations of F, Sr, K, Al, and Fe were significantly ( P <0.05) higher in sound enamel of permanent teeth than in carious enamel of permanent teeth. The concentrations of F, K, and Si were significantly ( P <0.05) higher in sound enamel of primary teeth than in carious enamel of primary teeth.

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Plant-derived medicines have been a part of our traditional health care system, and the antimicrobial properties of plant-derived compounds are well documented. The purpose of this study is to evaluate the effect of an aqueous extract of Terminalia chebula (a medicinal plant) on salivary samples and its potential for use as an anticaries agent in the form of mouthwash. A concentrated aqueous extract was prepared from the fruit of T. chebula . A mouth rinse of 10% concentration was prepared by diluting the extract in sterile distilled water. The efficacy of the mouth rinse was assessed by testing on 50 salivary samples. Salivary samples were collected from subjects assessed to be at high risk for caries. Salivary pH, buffering capacity, and microbial activity were assessed before rinsing, immediately after, and 10 min, 30 min, and 1 h after rinsing. There was an increase in the pH and buffering capacity and decrease in microbial count. An aqueous extract of T. chebula used as a mouth rinse seems to be an effective anticaries agent.

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Introduction: Bioaerosols are important considerations in infection control as well as in occupational health. Bioaerosols may carry potentially hazardous microbes, viruses, fungi, allergens, and other toxic substances that may harm the dental operator, patient, and the dental assistant by causing nosocomial infections. Objective: To assess the level of atmospheric microbial contamination before, during, and after dental treatment procedures in the dental operatory of a mobile dental unit (MDU). Materials and Methods: The study included three treatment sessions on different working days, with an interval of one month. The MDU was fumigated before the start of the study. Brain Heart Infusion Agar with 5% sheep blood was used to collect the gravitometric settling of aerosols produced before, during, and after dental treatment procedures. The agar plates were sent for aerobic and anaerobic culture. Results: The results showed that atmospheric microbial contamination (CFUs/plate) was 4 times higher during working sessions as compared to the levels before the working sessions. At the end of the working day, aerosols decreased by almost 3 times that seen during work. Conclusion: The aerosols increased during and after work sessions. This shows the increased risk of transmission of infectious agents to the dentists who work in the MDU. Hence, all necessary preventive measures should be advised and need to be followed strictly.

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Papillon-Lefevre syndrome is a rare autosomal recessive disorder in which there is palmoplantar keratinization and premature loss of both deciduous and permanent teeth. The palmoplantar keratoderma typically has its onset between the ages of 1 and 4 years and severe periodontitis starts at the age of 3 or 4 years. An early diagnosis of the syndrome can help preserve the teeth by early institution of treatment, using a multidisciplinary approach. We present two cases of the syndrome having all of the characteristic features.

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Aim: To evaluate the effect of immediate loading on the primary stability of endosseous implants placed in the anterior incisor region by mapping the stability, using resonance frequency analysis, over a period of time. Materials and Methods: A total of eight implants (Zimmer Screw-Vent) were placed in four patients. The Osstell™ resonance frequency analyzer was used to determine the primary stability at baseline (day 1), 15 ^th day, 30 ^th day, 60 ^th day, and 90 ^th day for each of the eight implants. Analysis of data was done using SPSS (Statistical Package for Social Science; version 4.0.1). Results: All implants showed adequate initial stability at baseline with an ISQ > 50. Implant nos. 1, 3, 4, 7, and 8 showed a high initial stability at baseline (ISQ > 65), following which a decrease in the stability was recorded during the 15 ^th day, 30 ^th day, and 60 ^th day. By the 90 ^th day, the stability values were nearly equivalent to those obtained at baseline. The highest mean stability value was recorded on the day of implant placement. The lowest mean stability recording was obtained on the 30 ^th day after implant osteotomy. By the 90 ^th day, the mean stability value was nearly equivalent to that obtained at baseline. Conclusions: Within the limitations of this study, it can be concluded that immediate loading of implants placed in the maxillary and mandibular incisor region does not seem to have an adverse effect on the osseointegration of implants, which achieved a high primary stability. The use of the resonance frequency analyzer as a tool to monitor the variation in the stability of the implants over a period of time has been validated.

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In the recent World Health Organization classification of odontogenic tumours, desmoplastic ameloblastoma has been characterized as a variant of ameloblastoma, with specific clinical, radiographical, and histological features. Till date, 145 cases have been reported in Japanese, Chinese, Malaysian, Western, and African populations, with very few cases described in Indians. Here, we report five cases in the Indian population. The male to female ratio was 3:2. The mean age at diagnosis was 33.2 years. Four of the tumours were located in the maxilla, in the anterior premolar region. The lone mandibular tumour was located anteriorly, crossing the midline. Three of the tumours had a mixed radiologic appearance with poorly defined borders. Unilocular change was seen in one of them. Two tumours presented as unilocular radiolucencies with specks of radiopacities and well-circumscribed borders. Histologically, irregular odontogenic islands, with a stretched-out 'kite-tail' appearance, were seen in a dense desmoplastic stroma. The peripheral layer of the epithelial islands was made up of flattened cells and the inner core was made up of spindle-shaped and, in some instances, squamous-shaped cells. In two cases, odontogenic epithelium in the form of follicles, typical of solid/multicystic ameloblastoma, was seen and these were typed as 'hybrid' variants. All the cases were treated by resection.

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Desmoplastic ameloblastoma (DA) is a rare variant of ameloblastoma (AM). The location of this lesion, its histology and radiological features differ from those of conventional AM. We report a case of DA in the canine / premolar region of the left maxilla of a 32-year-old woman and present a brief review of the literature. Radiographically, it had a mixed radiolucent / radiopaque appearance with ill-defined margins. Histologically, the tumor was characterized by extensive stromal desmoplasia and small tumor islands of odontogenic epithelium in the stroma, along with a few areas of reactive bone formation. The tumor was treated by partial maxillectomy and the patient was disease free after 1 year.

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The aim of this study is to encourage and initiate the application of generalized linear models (GLMs) in the analysis of the covariates of decayed, missing, and filled teeth (DMFT) index data, which is not necessarily normally distributed. GLMs can be performed assuming underlying many distributions; in fact Poisson distribution with log built-in link function and binomial distribution with Logit and Probit built-in link functions are considered. The Poisson model is used for modeling the DMFT index data and the Logit and Probit models are employed to model the dichotomous outcome of DMFT = 0 and DMFT ≠ 0 (caries free/caries present). The data comprised 7188 subjects aged 18-30 years from the study on the oral health status of Karnataka state conducted by SDM College of Dental Sciences and Hospital, Dharwad, Karnataka, India. The Poisson model and binomial models (Logit and Probit) displayed dissimilarity in the outcome of results at 5% level of significance ( P <0.05). The binomial models were a poor fit, whereas the Poisson model showed a good fit for the DMFT index data. Therefore, a suitable modeling approach for DMFT index data is to use a Poisson model for the DMFT response and a binomial model for the caries free and caries present (DMFT = 0 and DMFT ≠ 0). These GLMs allow separate estimation of those covariates which influence the magnitude of caries.

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Hypertension, also called a 'silent killer,' is one of the most common medical problems seen in our profession. A prospective study was conducted in the Department of Oral Medicine and Radiology to determine the incidence of the appearance of nutrient canals in the periapical radiographs of the mandibular anterior region of patients with high blood pressure. A total of 100 patients, between 10-80 years, were examined. After taking a proper history, systemic and oral examinations were done and the findings were recorded under two categories, hypertensive patients and normotensive patients. They were further subdivided according to their periodontal status. Intraoral periapical radiographs of the lower anterior region were then taken. Radiographs were interpreted with a good X-ray viewer and the use of a magnifying glass. Findings were recorded on a prepared format.

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