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   Table of Contents - Current issue
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May-June 2020
Volume 31 | Issue 3
Page Nos. 337-499

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EDITORIAL  

Research in asia pacific region p. 337
SM Balaji
DOI:10.4103/ijdr.IJDR_729_20  PMID:32769262
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ORIGINAL RESEARCH: EVALUATIVE STUDY Top

Children's perspective on color, smell and flavor of toothpaste Highly accessed article p. 338
Sahil Choudhari, Deepa Gurunathan, AC Kanthaswamy
DOI:10.4103/ijdr.IJDR_363_18  PMID:32769263
Introduction: The foundation for healthy permanent teeth in children and teenagers is laid during the first years of life. Poor diet, poor habits of food intake, and inadequate toothbrushing habits during the first 2 years of life have been shown in several studies to be related to tooth decay in children. The development of caries in primary teeth further increases the risk of developing caries in permanent teeth. Materials and Methods: A survey was conducted with 787 school children aged between 5 years and 12 years in Chennai city on their perspective of toothpaste color, smell, and flavor. Results: Of 787 children, 222 chose red as the color they want in their toothpaste whereas only 61 children preferred white as their toothpaste color. The survey showed that 50% of the children wanted their toothpaste to taste sweet, followed by minty (20%), sour (14%), and spicy (11%). When asked about what they would like their toothpaste to smell like, majority (41%) of children opted for fruity, followed by sweet (23%), minty (18%), and fragrant (16%). Conclusion: Based on the responses made by 787 children aged between 5 and 12 years, it can be concluded that children prefer red color, fruity smell, and sweet flavor.
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Correlation of oral health related quality of life with dentition status and treatment need among 12 year old school children of Dilsukhnagar, Hyderabad p. 343
Shiva Kumar Patanapu, Dolar Doshi, Suhas Kulkarni, B Srikanth Reddy, Adepu Srilatha, D Satya Narayana
DOI:10.4103/ijdr.IJDR_728_18  PMID:32769264
Aim: To determine the relationship between Oral Health-related Quality of Life (OHRQoL) with Dentition Status and Treatment need among 12 year old school children of Dilsukhnagar, Hyderabad. Patients and Methods: A cross sectional study was carried out among 990 private school children aged 12 years old in Dilsukhnagar, Hyderabad city. OHRQoL was assessed by 16-item Child Perceptions Questionnaire (CPQ11-14), and Oral hygiene was evaluated using Simplified Oral Hygiene Index (OHI-S), and Dentition status and Treatment need. The data was analyzed using Statistical Package for Social Sciences (SPSS) version 21.0. Study population proportions and mean scores were compared using Chi-square test, Student t- test, and Analysis of Variance (ANOVA). Spearman's analysis was done to determine correlation between CPQ11-14and its domain scores with OHI-S and Dentition status and Treatment Need based on gender. P < 0.05 was considered statistically significant. Results: In the present study, all domains of CPQ11-14i.e., Oral Symptoms (OS) (3.27 ± 2.5; P = 0.0001), Functional Limitation (FL) (1.48 ± 2.1; P = 0.02), Emotional Wellbeing (EW) (1.83 ± 2.5; P = 0.02) and Social Wellbeing (SW) (1.25 ± 2.02; P = 0.0002) showed significant gender difference, with males having higher mean score compared to females. The majority of the study population was caries free 789 (79.7%). In addition, the dental caries experience among males and females was around 20% (p = 0.92). When total mean DMFT and DT scores were compared based on gender, no statistically significant difference was noted though females showed higher mean score. Conclusion: The study results indicate that, there is a correlation between oral hygiene status and dentition status with quality of life.
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Role of structured rehabilitation protocol in post surgical cases of restricted mouth opening p. 350
Ankita Chugh, Kriti Mishra, Kushal K Sahu, Yogesh Mittal, Vinay K Chugh
DOI:10.4103/ijdr.IJDR_732_17  PMID:32769265
Background: Long term effectiveness of surgical management of chronically restricted mouth opening in OSMF or TMJ ankylosis depends largely on postoperative physiotherapy. This in turn is dependent on patient's compliance. Use of adjunctive aids besides pharmacotherapy that reduces patients pain and improves compliance with exercise is warranted. Aims: To evaluate the role of TENS and structured rehabilitation programme in postoperative physiotherapy in OSMF and TMJ ankylosis patients. Methods and Materials: A pilot study was conducted in which 6 patients of restricted mouth opening were put on a structured rehabilitation protocol in which TENS, heat and cold therapy with structured mouth opening exercise regimes. Interincisal opening, VAS score and a subjective assessment of post surgical discomfort was evaluated. Results and Conclusions: Results revealed an improved compliance and cooperation by patients. Pain on VAS scale also reduced from mean of 7.8 on day 1 to 3.6 on day 5 in this group. The mean discomfort on day 3 was reported as mild to moderate. An early attainment of passive mouth opening closest to intraoperative mouth opening was also reported on day 5 which is usually not achievable without any physiotherapy intervention.
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Work-related musculoskeletal pain and its self-reported impact among practicing dentists in Puducherry, India p. 354
Kuldeep Singh Shekhawat, Arunima Chauhan, S Sakthidevi, Basavaraj Nimbeni, Shruthi Golai, Lincy Stephen
DOI:10.4103/ijdr.IJDR_352_18  PMID:32769266
Background: Work-related musculoskeletal pain (MSPs) is not uncommon among dentist and often limits their work efficiency impacting their quality of life. Aim: The present research was conducted to identify site-specific pain resulting from musculoskeletal disorders (MSDs) among practicing dentists and determine its impact on their quality of life. Setting and Design: A cross-sectional questionnaire study conducted among practicing dentists of Puducherry Taluk, Puducherry, India. Method and Materials: A closed-ended, self-administered questionnaire was distributed to 95 practicing dentists to identify site-specific MSP from the study subjects. Data on pain due to MSDs, frequency of pain, its impact on quality of life, relieving factors, patients attended per day, working hours per day, and awareness on ergonomics were also recorded. Statistical Analyses: The data were analyzed for descriptive statistics, and Chi-square tests was used for proportions. Results: Almost all respondents experienced pain due to MSDs. Approximately, 11.1% “always” experienced elbow pain; 5.6% “always” experienced pain in neck and back. Approximately, 83% “sometimes” experienced pain in the back. Pain in elbow was significantly associated with gender (P = 0.036), qualification (P = 0.029), and years of practice (P = 0.032). Approximately, 36% reported having an impact on their life. Conclusion: The magnitude of the problem is slowly shifting from “sometimes” to “always.” Although small in proportion, pain due to MSDs has an impact on dental practitioners' quality of life, and elbow pain was reportedly higher in the study setting. Measures need to be implemented before MSD becomes a career limiting occupational hazard.
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Indian women dentists perspectives towards balancing professional, personal and social responsibilities p. 358
Yeluripati Sai Nirupama, Naveen Kumar Boppana, Narayana Rao Vinnakota, Ravi Kumar Thetakala, Praneetha Kallakuri, Burri Kiran Karthik
DOI:10.4103/ijdr.IJDR_299_18  PMID:32769267
Introduction: The literature on women in dentistry clearly shows the evolution and elevation of women in academic as well as clinical dentistry. Female dentists in India continue to face the need to balance their careers with the competing social and personal responsibilities of marriage, homemaking, and child rearing. Aim: To assess Indian Women Dentists perspectives towards balancing professional, personal, and social responsibilities. Methodology: This cross-sectional study was conducted for 1 month among 159 female dental professionals comprising all the female dental practitioners in Rajahmundry city and all the female interns, postgraduates, and academicians from 2 dental institutions in Rajahmundry city. A 23-item pretested questionnaire was distributed to the participants on the first day and collected after 1 day. The results were analyzed using SPSS software (V.22). The categorical data were analyzed using the χ2 test and P ≤ 0.05 was considered as statistically significant. Results: Among the study participants, 79.2% of study participants agreed that family commitments were not obstacles for their career (P = 0.02), 86.2% responded that women should be successful in both home-making and career and 89.9% of participants reported as not regretting being women and this finding was found to be statistically significant. Conclusion: Majority of the women perceived that women ought to balance professional, personal, and social responsibilities equally.
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Circadian dynamics in the functional interaction of the lateral teeth occlusal surfaces' relief p. 363
Viktor Ivanovich Shemonaev, Aleksandr Vladimirovich Mashkov, Anton Sergeevich Patrushev
DOI:10.4103/ijdr.IJDR_792_18  PMID:32769268
Aim: This study describes the relationship of the chronophysiological organization of the lateral teeth occlusion and the parameters of the chewing unit of the human dentofacial system (bioelectric potentials, the force of the masticatory muscles, masticatory efficiency) which should be considered in modeling of prosthesis occlusal surfaces. Materials and Methods: Examination of 200 respondents with a “day” chronotype, with Angle class I bilateral occlusion at the age of 18–35 years was conducted daily for 3 days. From 8.00 to 20.00, every 4 hours, the amplitude of the electromyography, the jaw muscles' force, the masticatory efficiency, the area of the occlusal contacts, and the near-contact zones were determined. Results: The activity of the masticatory muscles increased during the period from 12.00 to 16.00, which coincided with the escalation of the masticatory efficiency and of the occlusal contacts area. The relationship between the occlusal surfaces' relief and masticatory efficiency is described by two types of occlusal surfaces' topography – smoothed and pronounced, differing by the ratio of the areas of the occlusal contacts and the near-contact zones in 0.25- and 1-mm wide. Conclusion: The modeling of the occlusal surface of the permanent prosthetic restorations for patients with the “day” chronotype should be carried out with the area values of occlusal contacts and near-contact zones corresponding to the period of masticatory muscles activity from 12.00 to 16.00 and in accordance with the characteristic type of the occlusal surfaces' relief.
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Psychological status and uric acid levels in oral lichen planus patients – A case- control study p. 368
Hena Shaw, Aravinda Konidena, Abhilash Malhotra, Nirvana Yumnam, Farheen Farooq, Vineet Bansal
DOI:10.4103/ijdr.IJDR_289_19  PMID:32769269
Background and Aims: Oral lichen planus (OLP) has varied etiology and clinical expression may be influenced simultaneously by different mechanisms. Psychological disturbances and oxidative stress are some such factors proposed in the etiopathogenesis of OLP. The aim was to assess the possible association of psychological traits like stress, anxiety, depression, serum and salivary uric acid levels with disease expression in OLP patients. Methods: A case-control study was conducted in OLP subjects (n = 43) with a clinical and histopathological diagnosis, age and gender matched healthy controls (n = 42) to evaluate psychometric properties through DASS – 42 scale and uric acid (serum and salivary levels) evaluation through “Modified Trinder Method, End point” method. Results: The mean depression, anxiety, stress scores in OLP group were 16.51 ± 7.21, 15.58 ± 6.78 and 15.05 ± 6.11 and the scores in control group were 6.31 ± 3.48, 5.02 ± 2.70 and 5.69 ± 3.39 respectively. The mean value of serum UA level and salivary UA level in OLP group were 4.70 ± 1.33 mg/dl and 5.25 ± 1.61 mg/dl respectively, while the corresponding scores in control group were 5.86 ± 1.12 mg/dl and 6.18 ± 1.28 mg/dl. Conclusion: OLP group had significantly higher depression, anxiety, stress and total scores. Mean serum and salivary uric acid levels were significantly lower in OLP subjects when compared with controls. Clinical Relevance: Correction of psychological traits in oral lichen planus patients may significantly improve the clinical picture, while uric acid levels can be employed for biochemical evaluation in lichen planus patients to analyse oxidative stress.
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ORIGINAL RESEARCH: COMPARATIVE STUDY Top

Comparative evaluation of various herbal and synthetic solutions on disinfection of guttapercha: An in vitro study p. 376
Pachalla M Sailaja, Sohel Ahmed, Komera S Devi, Sandeep Shiva
DOI:10.4103/ijdr.IJDR_556_17  PMID:32769270
Background: Although gutta-percha cones are usually supplied in aseptic packages, once opened and used, they may be contaminated. Chair side disinfection of these cones is important and critical for success of endodontic therapy. Gutta-percha being heat labile, chemical disinfection is the only viable alternative for the sterilization of these cones. Aim: The aim of the study was to evaluate an effective method of disinfection of gutta-percha cones using various herbal and chemical solutions after intentional contamination with Staphylococcus aureus and Enterococcus faecalis. Materials and Methods: 150 gutta-percha cones were selected for the study. Based on the contaminants used, 140 gutta-percha cones were divided into 2 groups: Group A and Group B with 70 cones in each group and the remaining 10 cones (Group VIII) which were uncontaminated served as negative control. The cones from Group A were contaminated with Staphylococcus aureus (S. aureus) and Group B were contaminated with Enterococcus faecalis (E. faecalis). The contaminated cones from both groups were subdivided into 7 groups with 10 cones in each group. Group I cones were disinfected with Q Mix 2 in 1, Group II with 3% sodium hypochlorite, Group III with chitosan, Group IV with aloe vera juice, Group V with amla juice, and Group VI with pancha tulsi. Group VII consisted of gutta-percha cones without any disinfection in both Group A and Group B which served as positive control. The disinfection time was 1 min. All the cones were then incubated in thioglycollate media for 7 days. The thioglycollate media was subcultured and colony forming units were counted. The data were analyzed by one-way ANOVA and post-hoc Tukey tests using SPSS 17.0 software. Results: There was a statistically significant difference present in the mean colony forming units among all the groups (P < 0.05). Conclusion: Pancha Tulsi and Q Mix 2 in 1 possessed superior antibacterial activity when compared to other experimental solutions.
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Assessment of dentofacial widths in adults with anterior open bite p. 382
R Dawal, MS Ravi, PS Murali, CR Soans, Shetty Kaushik
DOI:10.4103/ijdr.IJDR_472_18  PMID:32769271
Context: Anterior open bite is a complex condition involving a combination of various dental and skeletal components in three dimensions. The data on the differences and changes in the transverse relation in individuals with anterior open bite are limited. Aims: To assess the dental arch widths in individuals with anterior open bite using study casts and facial widths using frontal cephalogram and to compare these widths with that of individuals without anterior open bite. Materials and Methods: Eighty adults [40 with and 40 without anterior open bite, mean (standard deviation) age = 20.68 years] were selected. The study group was divided into skeletal (n = 19) and dental (n = 21) open bite groups according to Jarabak's ratio. Posteroanterior cephalograms and study casts were analyzed. Results: The mean width of zygomatic arch (112.18 mm) and condylar region (100.55 mm) in the control group was significantly higher (P < 0.05). The mean gonial width in the skeletal open bite group (81.143 mm) was significantly (P < 0.05) lesser than the dental open bite group (84.842). The maxillary intercanine width for the skeletal open bite group (36.48 mm) was significantly (P < 0.01) higher than that of the dental open bite group (34.26 mm). Conclusion: A transverse deficiency was seen in in the zygomatic and condylar regions in adults with anterior open bite. Individuals with a skeletal open bite showed a narrow gonial and wider maxillary intercanine width compared with individuals with dental open bite.
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Comparative evaluation of direct sinus lift with bone graft and zygoma implant for atrophic maxilla p. 389
SM Balaji, Preetha Balaji
DOI:10.4103/ijdr.IJDR_410_20  PMID:32769272
Introduction: Implant rehabilitation of atrophic maxilla is challenging. The aim of this manuscript is to compare the clinical outcome of rehabilitation of atrophic maxilla (long span) by zygomatic implants (ZI) versus conventional sinus lift with augmentation procedures dental implants (SLAP-DI). Materials and Methods: A retrospective record analysis of a cohort of 25 patients fulfilling the inclusion and exclusion criteria, over a period of 6 years were performed. The patients had been either treated with ZI or SLAP-DI. The outcome measures were: prosthesis, implant and augmentation failures, any complications, patients' number of days with total or partial impaired activity, time to function and number of dental visits, assessed by independent assessors from records. The data was analyzed using SPSS with P ≤ 0.05. Results: There were 16 (64%) men and 11 (44%) had ZI while 14 (56%) underwent SLAP-DI. There were no prosthesis or implant failures in this cohort. Between ZI and SLAP-DI, there was no gender difference (P = 0.648), border line significance in minor complication (P = 0.075), with less complication encountered in SLAP-DI than the ZI. None of the cases had major complications that required hospitalization or severe medical therapy. Of the 14 cases that underwent SLAP, 11 (78.6%) had no augmentation failure (resorption <10%). ZI had older age (P = 0.000), with greater number of teeth missing (P = 0.002), with lesser time for functional loading (P = 0.000), required less number of visit to dentist (P = 0.000), and lesser bone loss at insertion site (P = 0.005).Discussion & Conclusion: The results are discussed in light of previous pertinent literature. This short term (~ 1 year follow-up) suggest that SLAP-DI and ZI have certain similar features. There is no statistical difference in outcome barring the time needed to functional loading (1.3 days vs. 444.3 days). Relatively more complications were reported for ZI, but had no statistical significance. Long-term and multi-center data are needed to confirm the results.
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Impact of oral diseases on daily activities among 12- to 15-year-old institutionalized orphan and non-orphan children in Bengaluru city: A cross-sectional analytical study p. 396
Varsha K Pavithran, R Murali, Madhusudan Krishna, A Shamala, Maanasi Yalamalli, A Vinod Kumar, Romshi Raina
DOI:10.4103/ijdr.IJDR_260_18  PMID:32769273
Background and Objective: As parents are the primary decision-makers of child's health, a study was conducted to assess and compare the oral health status and impact of oral diseases on daily activities among 12- to 15-year-old institutionalized orphan and non-orphan children in Bengaluru city. Materials and Methods: This cross-sectional analytical study was conducted among 210 orphans and 210 government school children living with parents. Data with regard to the impact of oral diseases on daily activities were collected by means of Child Oral Impacts on Daily Performances (C-OIDP) index, and oral health status was determined using WHO Oral Health Assessment Form 1997. Statistical Analysis: Descriptive statistics of the key variables were reported and data were analyzed using Pearson's Chi-square test, Mann–Whitney U-test, One-way analysis of variance and Step-wise multiple linear regression analysis. Statistical significance was set at P < 0.05 for this study. Results: Common oral health problems perceived by orphans and non-orphans were bleeding gums (16.8% and 12.4%) and toothache (12.7% and 13.7%), respectively. The daily performances most affected were cleaning mouth (33.3%; orphans 5.35 ± 4.22; non-orphans 7.05 ± 7.55; P = 0.000) and eating (33.1%; orphans 6.91 ± 6.09; non-orphans 7.07 ± 6.78; P = 0.003). Oral mucosal condition, dental fluorosis, dentofacial anomalies, and calculus showed significant difference among orphans and non-orphans (P = 0.000). Conclusion: C-OIDP score was high in orphans. Age, dental fluorosis, and decayed teeth were the significant factors for determining C-OIDP score. More than half of the study subjects were suffering from oral diseases which required treatment to improve their quality of life.
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Comparison of primary stability in craniofacial implant with V-shape and buttress thread design in goat skull using resonance frequency analysis p. 403
Karthikeyan Ramkumar, S Sripriya, A Meenakshi, C Sabarigirinathan, C Thulasingam
DOI:10.4103/ijdr.IJDR_447_17  PMID:32769274
Background and Aims: To find out the primary stability in maxillofacial implant with two different thread designs. Methods: Two group of implants were selected for the study – Group I maxillofacial implant with V-shape thread, and Group II implant with buttress thread. The drills for placing the implant were made indigenously. Goat skull was selected for placing the implant. Group I, II implant was placed in the goat skull at five different sites to find the primary stability. The primary stability was measured using Resonance Frequency Analysis (RFA) device. The transducer was screwed to the implant and made to vibrate by magnetic pulse. The vibration was recorded as Implant Stability Quotient (ISQ). Results: The ISQ values of Group I range from 32-46 and Group II range from 57-67. The results were subjected to statistical test and found to be significant at 95% level. Conclusion: The ISQ values for the buttress (Group II) is more than (Group I) which is observed in this study. Hence this study supports the buttress thread as the favourable thread pattern for the craniofacial implant.
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Correlation between skeletal development and maxillary canine eruption p. 408
Ruba J Mohammad
DOI:10.4103/ijdr.IJDR_29_19  PMID:32769275
Aim: The aim of this study was to find a correlation between the permanent maxillary canine eruption and the cervical vertebral maturation index (CVMI). Materials and Methods: 145 subjects (73 male and 72 female) in the age of 7–14 years were examined radiographically with lateral cephalographs and orthopantomographs. The CVM patterns were evaluated on the lateral cephalograph using the classification of Hassel and Farman. The stage of the permanent maxillary canine eruption has been investigated on the orthopantomographs depending on its vertical height in relation to the adjacent incisor. Descriptive statistics were obtained for both CVMI stages and canine eruption grading. Spearman rank correlation test was used to determine the correlation between both methods. The minimum level of significance was considered less than 0.05 (P < 0.05). Results: Results showed a strong correlation between CVMI and the grading of the maxillary canine eruption in both female and male and the (r) value estimated was 0.862 and 0.758, respectively. Over 90% of deceleration stage of CVMI in both genders show canine eruption (pubertal growth spurt) about 91.66% for female and 95.65% for male and a small percentage of delay eruption 8.33% and 4.35% in female and male gender, respectively, with a predilection to the female gender. Conclusions: A significant correlation between the permanent maxillary canine eruption stages and skeletal maturity was found. The eruption of maxillary canine occurs before the end of pubertal growth. Any delay in the eruption of maxillary canine after the deceleration stage of CVMI, suggesting a chance of impaction.
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Impact of implants number and attachment type on the peri-implant stresses and retention of palateless implant-retained overdenture p. 414
Salah A Hegazy, Nesreen El Mekawy, Radwa M K Emera
DOI:10.4103/ijdr.IJDR_772_18  PMID:32769276
Objectives: To evaluate the impact of implants number and attachments type on the peri-implant stresses and retention of maxillary palateless implant-supported overdenture. Materials and Methods: Four edentulous maxillary educational acrylic resin models were used. According to the implants number and type of attachment used, four groups were compared: Group I, 2-locator attachments in the canine area; Group II, 2- OT equator attachments in the canine area; Group III, 4-locator attachments in the canine, second premolar area and Group IV, 4-OT equator attachments in the canine, second premolar area. Implants retained palateless overdenture was constructed on each model. Four self-protected linear strain gauges were cemented on each implant. A digital loading device was used to apply compressive loads to measure the resulting peri-implant stresses. Forcemeter and Universal testing machines were used to test the retention of palateless overdenture. Results: A significant difference between the same implant number and distribution with different attachments was found (P = 0.003, P = 0.020), respectively. Least stresses amount was found around the 4-implant locator palateless overdenture, while the highest was found around the 2-implant OT equator palateless overdenture. Nevertheless; the result was that 2-implant locator palateless overdenture recorded insignificant higher retentive forces than the 4-implant OT equator one. Conclusions: It can be concluded that the implant-retained palateless overdenture with four locator attachments is considered a promising treatment option regarding stress distribution. Using locator attachments, for implant-retained palateless overdenture with either two or four implants considering their superior retentive properties, is advantageous when compared to OT equator attachments.
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Comparison of oral micro-flora in caries active and caries free Indian children using culture techniques and PCR analysis p. 420
Kalpana Bansal, Rama Chaudhary, Vijay P Mathur, Nitesh Tewari
DOI:10.4103/ijdr.IJDR_39_19  PMID:32769277
Background and Aims: Although Streptococcus mutans has been implicated as the major etiologic agent in the development of dental caries, however, this organism has not been found to be present in all children with caries. Thus it remains to be elucidated whether a single or specific consortium of bacteria is responsible for the caries process. The aim of this study is to evaluate the oral microflora of Indian children suffering from dental caries and to compare the same in children with no caries. Methods: The study was carried out on 67 out-patient 2-14 years old children who reported to the department of Paediatric Dentistry. Dental plaque samples from superficial and deep carious lesions and caries free surfaces in caries active children (n = 35) were collected using a sterile excavator in storage vials and subjected to various conventional and molecular microbial techniques. Caries free children (n = 32), who did not have any carious lesion served as controls. The data obtained was subjected to Pearson's Chi Square/Fischer's Exact tests to determine the statistical difference between the microflora of groups. Results: Main organisms isolated were: Streptococcal species mainly S anginosus, S salivarius, S gordonii: Lactobacilli spp; Coagulase negative Staphylococci, Staph epidermidis, Staph aureus. Other organisms such as Klebsiella spp, Acinetobacter, Enterococcus, E coli could also be found. There was a statistical difference in the frequency of isolation of non-mutans Streptococcal species (P = 0.008) and Lactobacilli species (P = 0.0001) in the two groups. Conclusions: The study suggests that caries activity in this population of children is associated with a diverse microbial flora without detectable S mutans. Main organisms associated with dental caries in this population are: Gram-positive cocci and bacilli mainly the non-mutans Streptococcus and Lactobacilli. Frequent consumption of sugar containing food promotes the presence and growth of cariogenic organisms.
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ORIGINAL RESEARCH: PROSPECTIVE STUDY Top

Knowledge, attitude and oral care practices for preventing ventilator-associated pneumonia among critical care nurses – A questionnaire study p. 426
Yamini Mannava, Sangeeta Umesh Nayak, Ashita Uppoor, Dilip Naik, Abhiram Maddi
DOI:10.4103/ijdr.IJDR_611_16  PMID:32769278
Background: A cross-sectional study was conducted among intensive care unit (ICU) nurses in private hospitals in India to identify knowledge and practice of ICU nurses in the prevention of ventilator-associated pneumonia (VAP). Methods: Knowledge of 135 nurses working in ICU was tested using a questionnaire consisting of 18 questions. Fourteen forms were excluded from the statistical analysis due to incomplete data entry by the participants. The data of 121 filled questionnaires were analyzed. The information letters, consent forms, and questionnaires were handed to ICU nurses by Research assistant. Data were coded and entered into SPSS version for descriptive and inferential statistics. Results: A majority of the participants perceived oral care as a necessity in all critically ill patients. Nurses were generally aware of the most likely mechanism of acquiring pneumonia. The type and frequency of oral care varied widely. Many of them stated that they had adequate supplies to provide oral care. Although a majority of nurses had some formal training in oral care, they would appreciate an opportunity to enhance and improve their knowledge and skills. Conclusion: The methods of oral care provided vary widely. In summary, randomized controlled trial to date has demonstrated that tooth brushing is associated with a trend toward lower rates of VAP in intubated mechanically ventilated critically ill patients. But it is also to be noted that there was no clear difference between electric and manual tooth brushing. In-house training and workshop can provide required skills needed for the betterment of the treatment provided.
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Effect of bidi cigarette smoking on interleukin-1β and 8 levels in chronic periodontitis patient p. 433
Sonia Nath, Jayant Prakash, Virendra Kumar Prajapati, Nitesh Sharma, Shaju Jacob Pulikkotil
DOI:10.4103/ijdr.IJDR_783_17  PMID:32769279
Introduction: Bidi, a leaf rolled cigarette, is the most popular form of smoking in India. Bidi cigarette contains higher tar, ammonia, and nicotine content than a conventional cigarette and is more hazardous. Aim of Study: The aim of this study was to determine the effect of bidi smoking on periodontitis by assessing the interleukin (IL)-1β and IL-8 from a gingival crevicular fluid (GCF). Materials and Methods: A total of 60 patients were selected, which included 40 patients diagnosed with chronic periodontitis (20 bidi smokers and 20 non-bidi smokers) and 20 periodontal healthy controls. Diseased and healthy sites were selected from each of the chronic periodontitis subjects. Clinical parameters assessed were plaque index (PI), gingival index (GI), periodontal probing depth (PPD), recession (RC), and clinical attachment level (CAL). Pooled GCF samples were taken from the same site and analyzed for IL-1β and IL-8 using enzyme-linked immunosorbent assay. Results: Bidi smokers displayed decreased levels of IL-1β and IL-8 than non-bidi smokers for both healthy and diseased sites and significantly reduced IL-8 levels among bidi smokers when compared to controls. Among bidi smokers, the diseased site had significantly higher levels of IL-8 than the healthy site. Non-smoker subjects with chronic periodontitis especially diseased sites contained significantly higher amounts of IL-1β and IL-8 than smokers and controls. The PI scores were highest among bidi smokers with reduced BOP and GI scores. Conclusions: Bidi smoking influenced the cytokine profile among periodontitis patients exhibiting decreased levels of IL-1β and IL-8.
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Awareness, attitude, and practice of pediatricians regarding early childhood caries and infant oral healthcare of children in Puducherry- A cross-sectional survey p. 439
GS Prathima, Muthukrishnan Kavitha, Gurusamy Kayalvizhi, Adimoulame Sanguida, Mohandoss Suganya, Selvabalaji Arumugam
DOI:10.4103/ijdr.IJDR_180_18  PMID:32769280
Context: Early Childhood Caries (ECC) is the most virulent form of caries, which requires early intervention. Pediatricians are health professionals who first examine the child, and must be able to educate parents about basic preventive dental care, early diagnosis of pathological changes in the oral cavity and appropriate referrals for the children. Aims: To assess the awareness, attitude, and practice among pediatricians regarding ECC and Infant Oral Healthcare (IOHC) in Puducherry. Settings and Design: Setting: Study was conducted among pediatricians of Puducherry. Design: Observational Cross-sectional study. Methods and Material: After obtaining consent from Pediatricians, a prevalidated questionnaire was distributed and collected from them regarding their awareness, attitude, and practices toward ECC and IOHC. Statistical Analysis Used: Percentage. Results: Out of 85% Pediatricians who responded, 57% of them were aware of initial white spot lesions, and 39% of them were aware of maternally-derived Streptococcus mutans disease. 100% of them were willing to avail information, training on IOHC. Conclusions: It is clear from the study that Pediatricians in Puducherry had limited awareness regarding the prevention of oral diseases. It is essential to provide sufficient knowledge to them by incorporating a module on ECC and infant oral health care in their curriculum.
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Gender determination by morphometric analysis of mandibular ramus in sriganganagar population: A digital panoramic study p. 444
Saloni , Pradhuman Verma, Princy Mahajan, Ankush Puri, Sukhleen Kaur, Sakshi Mehta
DOI:10.4103/ijdr.IJDR_547_17  PMID:32769281
Background: Mandible is a dimorphic, dense compact bone that makes it very durable and well preserved in mass disasters for personnel identification. Mandibular ramus morphometric measurements can be used for gender determination using orthopantomogram (OPG) or on dry mandibles. Aim: To determine gender from morphometric analysis of mandibular ramus of 200 digital OPG of patients from Sriganganagar population. Materials and Methods: The study was conducted on randomly selected digital OPG of 200 patients of both genders between the ages of 21 and 70 years taken using CS8000C machine from daily OPD. Morphometric analysis of mandibular ramus (maximum ramus breadth, minimum ramus breadth, condylar height, projective height of ramus, and coronoid height) was done twice by single maxillofacial radiologist independently at an interval of 1 day and mean of both the values were considered. The collected data was tabulated and analyzed using SPSS Software version 20 using independent -test and discriminant function analysis. Results: Out of total 200 subjects, 37% were male and 63% were female. Mean of minimum ramus breadth, maximum ramus height, and projected ramus height was noted significantly more among males while maximum ramus breadth was noted slightly higher in females. The overall accuracy for determining sex from mandibular ramus was found to be 77.6%, whereas for determining male and female, the accuracy was 78.4% and 76.8%, respectively. Conclusion: Mandibular ramus can be used for sexual dimorphism by morphometric analysis done on OPG among Sriganganagar population.
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Direct maxillary sinus floor augmentation and simultaneous implant placement for rehabilitation of the severely resorbed posterior maxilla: A prospective clinical study p. 449
Pulkit Khandelwal, Vikas Dhupar, Francis Akkara, Neha Hajira
DOI:10.4103/ijdr.IJDR_848_18  PMID:32769282
Aims and Objectives: The aim of this prospective clinical study was to evaluate the success of one-stage direct (lateral) sinus lift procedure in severely atrophic posterior maxilla. Materials and Methods: One-stage direct (lateral) sinus lift procedure was carried out at 15 sites in 13 patients. All patients included in the study presented with partially edentulous posterior maxilla with one or more missing teeth and residual bone height less than 5 mm. Three months after surgery, patients were evaluated to access increase in residual bone height, density of new bone formed and implant stability. Patients were also evaluated after 3 months of prosthetic placement for the success of implant-supported prosthesis. Results: At 3 months post-operatively, increase in residual bone height was 8.31 ± 1.63 mm and the mean density of the newly formed bone around the implants was 417 ± 66.61 HU. All implants were stable and successfully osseointegrated, except one implant that was lost. The success rate of implant stability was 96.3% during the study period. Conclusion: Single-stage direct (lateral) maxillary sinus floor augmentation is a good treatment option with predictable outcome for patients with deficient alveolar bone in posterior maxilla.
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ORIGINAL RESEARCH: RETROSPECTIVE STUDY Top

Bone mineral density and mandibular osteoporotic alterations in panoramic radiographs: Correlation by peripheral bone densitometry in men Highly accessed article p. 457
Luciana Munhoz, Isabela Goulart Gil Choi, Daniel Key Miura, Plauto Christopher Aranha Watanabe, Emiko Saito Arita
DOI:10.4103/ijdr.IJDR_440_18  PMID:32769283
Aim: Mandibular cortical index has proven to be inversely correlated to bone densitometry; however, trabecular bone pattern has not been widely studied. Thus, the main objectives of this study were: (1) to analyze the correlations between three different sites of peripheral dual-energy X-ray absorptiometry with the mandibular cortical index and the trabecular bone pattern classification; (2) to assess the correlation between the mandibular cortical index and the trabecular bone pattern; (3) to evaluate the diagnostic accuracy of the mandibular cortical index and the trabecular bone pattern using panoramic radiographs in a sample of Brazilian men. Additionally, peripheral dual-energy X-ray absorptiometry findings in men were described. Materials and Methods: There are about 44 men who had previously undergone panoramic radiography and bone densitometry were evaluated. Mandibular cortical index and trabecular bone pattern classifications were performed. The median T-scores of the men were analyzed. Spearman's test was performed to assess correlations. Results: An inverse correlation was found between mandibular cortical index and proximal bone densitometry site. No correlation was found between mandibular cortical index and trabecular bone pattern or between peripheral densitometry and trabecular bone pattern. Greater accuracy was observed in mandibular cortical index when compared to trabecular bone pattern. Mandibular cortical index evaluations by panoramic radiographs are a useful screening tool for low bone mineral density, but trabecular bone pattern cannot be applied to screen patients for osteoporosis risk. Mandibular cortical index has an inverse correlation with proximal sites of forearm densitometry.
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ORIGINAL RESEARCH: IN VITRO STUDY Top

A study to assess the microbial profile and index of microbial air contamination in dental operatories p. 465
Geetha Banu Shanmugaraj, Arthi Krishna Rao
DOI:10.4103/ijdr.IJDR_707_18  PMID:32769284
Background: Microbial contamination of air in dental operatory is an important source of infection. In this study, passive air sampling using settle plates was used as an effective method to assess the microbial profile and index of microbial air contamination (IMA) in dental operatories. Aim: To assess the microbial profile and index of microbial air contamination (IMA) in dental operatories. Setting and Design: This study design was a experimental cum diagnosis study and was conducted in four outpatient dental operatories in a self-financing dental college using stratified random sampling technique. Materials and Methods: Twenty air samples were collected by leaving blood agar plates open for 1 h, 1 m above the floor and 1 m from the wall. After incubation at 37°C for 48 h, colonies were counted to assess the number of colony-forming units (CFUs) per plate. The number of CFU is the IMA. The evaluation of aerobic bacterial and fungal profiles of representative colonies was done by standard microbiological methods. Results: Independent sample 't' test was applied for this study. All air samples collected near the dental treatment unit showed more contamination than the ambient air. As per the IMA classes, the IMA near the dental treatment unit ranged from fair to poor. IMA of ambient air in all the four operatories was within the acceptable values. The most common microorganism isolated was Staphylococcus species. Conclusion: Passive air sampling is one of the effective ways of quantifying airborne bacteria as used in the present study. Air microbial level evaluation is a step towards cross-infection prevention.
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The effect of leachable components of resin cements and its resultant bond strength with lithium disilicate ceramics p. 470
MV Mavishna, Kondas Vijay Venkatesh, Dhanasekaran Sihivahanan
DOI:10.4103/ijdr.IJDR_398_19  PMID:32769285
Objectives: To evaluate the leachable components of resin cements in oral simulating fluids using high performance liquid chromatography and its resultant shear bond strength with ceramics. Methods: Forty extracted permanent human mandibular molar teeth were sectioned horizontally with a disc beneath the dentino-enamel junction to expose the coronal dentin surface and later finished with 600-grit silicon carbide paper to create a uniform flat surface. Forty Lithium Di-silicate Ceramic block cylinders were sliced in a saw cutting machine at 250 rpm under water-cooling to obtain the discs. The teeth and the ceramic discs were then randomly assigned to two groups on the basis of material used for luting the ceramic disk. Group I: Ceramic disc luted with tooth surface using Variolink II Dual cure Resin Cement, Group II: Ceramic disc luted with tooth surface using multilink speed self-adhesive self-curing resin cement. All ceramic discs were etched with 5% HF acid (IPS Ceramic Etching Gel, Ivoclar, Schaan, Liechtenstein) for 20 seconds, then rinsed thoroughly for 20 seconds and dried for 20 seconds. Ceramic specimens were luted on dentin surfaces with the application of 5 kg load. The samples were stored in 75% ethanol solution for 2 weeks at 37 degree Celsius for chemical aging. HPLC Analysis were performed to analyze the eluted monomer. After HPLC Analysis, Samples were then loaded using universal testing machine for the evaluation of shear bond strength between ceramic discs and the resin cements before and after the elution of monomers. Results: Under HPLC analysis, results showed that the peak release of monomer is Bis-GMA in both the groups. The shear force required to break the bond between the ceramic luted to tooth surface with the resin cements were more for Group I. Statistical results: The statistical analysis was done using ANOVA and paired t-test and it shows P value ≥0.05, hence the null hypothesis is rejected. Conclusion: The monomer eluded from all the groups are identified as Bis-GMA, The eluded monomer decreases the bond strength between the resin cement and the ceramic due to water sorption, The Variolink II (dual cure) resin cement shows improved bond strength than the Multilink (self-cure self-adhesive) resin cement.
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Effect of different intraradicular posts in the dimensions of root canal computed tomography images p. 475
Carolina C S. Vasconcelos, Marco Antônio Z. Loureiro, Marcela R A. Elias, Tessa L Botelho, Ana Paula R. Magalhães, Daniel A Decurcio
DOI:10.4103/ijdr.IJDR_866_18  PMID:32769286
Objectives: To evaluate the effect of different intraradicular posts on the dimensions of computed tomography (CT) images in cone-beam and fan-beam equipment. Materials and Methods: A total of 15 root canals of bovine teeth were instrumented up to a file #50 and root-filled by the active lateral condensation technique. The teeth were randomly divided into three groups, according to the type of intraradicular post: 1) tight fiberglass post; 2) anatomical fiberglass post; and 3) metal post. The root canals were desobturated in 10 mm and tomographic images were acquired in two devices, a cone-beam and fan-beam equipment. Then, the intraradicular posts were cemented using an automix self-conditioning and self-adhesive resin cement, and the final acquisitions of the CT images were performed for analysis. The diameter of the canal was compared before and after cementation of the intraradicular posts. The t-test was used between the initial and final measurements of each tomograph and also between the cone-beam and fan-beam tomographs (α = 0.05). Results: The anatomical fiberglass post presented the smallest dimensional change among the initial and final measurements, followed by the tight fiberglass post, with the metal post being the material that showed the most considerable dimensional difference in the cone-beam. Conclusion: All of the intraradicular posts used promoted a change in the size of the CT image. The fan-beam scanner promoted greater dimensional change in the images.
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Hydroxyapatite carriers as drug eluting agents—An In Vitro analysis p. 481
Deepti Simon, K Ajith Kumar, Suresh Babu Sivadasan, Harikrishna Varma, Anita Balan
DOI:10.4103/ijdr.IJDR_357_19  PMID:32769287
Introduction: Hydroxyapatite based drug carriers offer a customized alternative to the delivery of pharmacologic agents in the osseous skeleton. They have an added advantage of being biocompatible and osteoconductive. This in vitro study aims to quantify the drug eluting properties of HA granules by spectrophotometry. Materials and Methods: HA and HASi beads were loaded with gentamicin/ amoxycillin- clavulanate/ vancomycin and grouped into 5. Drug elution was evaluated by means of UV spectrophotometry. Results: Drug eluent levels were well above bactericidal levels in all 5 groups. Conclusion: HA and HASi are viable options for clinicians for targeted drug delivery.
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SYSTEMATIC REVIEW Top

Barriers to utilisation of dental care services among children with special needs: A systematic review p. 486
Lakshmi Krishnan, Kiran Iyer, PD Madan Kumar
DOI:10.4103/ijdr.IJDR_542_18  PMID:32769288
Background: Disabled population accounts for 2.86 Crore of total Indian population. Among these 27.4% of population consists of children within age group of age 0 to 19 years. Studies have shown oral health status of children with special needs is lower than children without special needs. Though there are various attributing factors, access to dental care delivery and difficulties faced during dental treatment delivery are of major concern. Therefore the aim of this systematic review was set to assess the barriers faced by children with special needs during utilization of dental services; through caregiver's perception. Materials and Methods: For this review MEDLINE, EBSCO, COCHRANE, EMBASE and Google Scholar were the electronic data bases searched based on the PICO. PRISMA guidelines were followed for final inclusion of articles. Results: The search generated a total of 259 articles from five different electronic bases: PUBMED, EMBASE, EBSCO, COCHRANE and GOOGLE SCHOLAR. Based on inclusion criteria, 7 articles made it to final analysis. All the 7 studies reported that dentist were unwilling to treat children with special needs as a major barrier followed by fear towards dentist by the children with special needs. Conclusion: The cross sectional studies of this review were assessed for quality using a modified Newcastle Ottawa Scale, proposed by Egger et al. in 2003. Even though the available literature forms a lower standard of evidence, further evaluation of barriers are recommended using better designed studies to substantiate the in equal access to healthcare facilities by these marginalized population.
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EPIDEMIOLOGICAL WORK Top

Home visits in primary care: Differences among professional categories and health macro-regions p. 494
Leandro M Diniz, Gabriela A C. Rhodes, Mauro H.N G. Abreu, Ana C Borges-Oliveira, Loliza L.F H. Chalub
DOI:10.4103/ijdr.IJDR_261_19  PMID:32769289
Context: Home visit is a modality of health care that is expanding in Brazil and in the world. Public and private services have invested in the implementation of this type of assistance. It happens due to its potential to transform the model of care, highlighting the work quality of the primary health care teams. Aims: To analyze house call rates in primary care in the Brazilian public healthcare system according to professional categories and health macro-regions in the state of Minas Gerais, southeast region of Brazil. Settings and Design: An ecological study that used as the information source the production data from the Primary Care Information System (2010 to 2015). Methods and Materials: House call rates (per 3000 inhabitants) by primary care professionals constituted the response variable. The independent variables were professional categories and the 13 health macro-regions of the state. Statistical Analysis Used: The data were analyzed using the Mann-Whitney test. Results: A total of 26,932,463 house calls were performed in the period, but the number of visits in 2015 was significantly lower compared to 2010. Significantly higher house call rates were found for some professional categories (mid-level professionals and nurses) and significant differences were found among the macro-regions (P < 0.05). Conclusions: The profile of house calls by primary care professionals revealed the constant presence of this care modality, but the distribution of these visits is uneven among the different professional categories and macro-regions of the state.
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