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   Table of Contents - Current issue
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November-December 2017
Volume 28 | Issue 6
Page Nos. 593-716

Online since Monday, December 18, 2017

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GUEST EDITORIAL  

Quality management - Dental office applications Highly accessed article p. 593
Mounir Doumit
DOI:10.4103/ijdr.IJDR_237_17  PMID:29256452
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EDITORIAL Top

Need for more research on burden of oral diseases in India p. 594
SM Balaji
DOI:10.4103/ijdr.IJDR_677_17  PMID:29256453
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ORIGINAL RESEARCH: EVALUATIVE STUDY Top

Evaluation of knowledge, awareness, and attitude toward emergency dental trauma management among the school teachers of Kolkata p. 595
Rahul Kaul, Parul Jain, Nilanjana Saha, Suchetana Goswami, Shantanu Mukhopadhyay, Subrata Saha, Subir Sarkar
DOI:10.4103/ijdr.IJDR_118_17  PMID:29256454
Introduction: Traumatic dental injuries (TDIs) are very common in childhood. Majority of TDI occur at home followed by schools. The prognosis of TDIs to a great extent is dependent on prompt emergency measures taken at the site of accident. Hence, it is of paramount importance to assess the knowledge of people present at the site of accident that generally includes parents, teachers, and sports coaches. Aim of Study: The aim of the study was to assess the knowledge, attitude, and awareness of school teachers of Kolkata regarding management of TDIs. Materials and Methods: A cross-sectional survey was conducted on 400 school teachers of Kolkata over a period of 2 months using a pretested close-ended questionnaire. The questionnaire had three parts: Part 1 contained questions on personal information, Part 2 contained questions based on two imaginary cases of trauma, and Part 3 related to their attitude toward dental trauma education. Chi-square test was done to describe the strength of the associations. Results: : The overall knowledge of school teachers regarding management of TDIs was not found to be satisfactory. It was observed that most of the teachers were in favor of taking immediate professional consultation for the emergency management, but most of them were unaware of the steps to be taken on their part to minimize complications and improve prognosis. Conclusion: Despite the lack of knowledge and awareness regarding management of dental trauma, school teachers of Kolkata had a good attitude toward management of dental trauma and its education.
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Are dentists happy? A study among dental practitioners in coastal Andhra Pradesh using subjective happiness scale p. 604
Sudhakar Kaipa, Kalyan Kumar Paul, Anurag Satpathy, Venkatarao Epari
DOI:10.4103/ijdr.IJDR_18_17  PMID:29256455
Introduction: The role of dental professionals in the society is vital. This profession allows the flexibility to balance a professional and personal life. Practice of dentistry at times is quite stressful, and stress impedes happiness and subjective well-being. Several studies have reported about stress among dental professionals and their various effects; however, studies evaluating the level of happiness (happiness index) among dentists are few and lack in this geographic region. Objectives: The present study was conducted to assess the subjective happiness level among dental professionals. Materials and Methods: A cross-sectional study was conducted among 194 dentists in Andhra Pradesh, India. A questionnaire measuring dimensions of professional satisfaction by Subjective Happiness Scale was used to assess the happiness level. The results were expressed in percentages, means, and mean rank. Independent samples nonparametric tests (Mann–Whitney U-test and Kruskal–Wallis test) and multivariable analyses were used to assess the determinants of happiness. Results: The mean happiness index of the respondents was 21.71 (0.26 standard error). Overall 67% of the respondents had an above average happiness score. Higher happiness score was found to be significantly associated with age, postgraduate degree, male gender, type of professional attachment, duration of practice, urban location of practice, and spouse employment status in univariate analysis. However, multivariable analysis showed association with type of professional attachment only. Conclusion: Although dentistry has been recognized as a stressful profession, majority of the dentists under study had a happiness score above the mean, and the level of satisfaction was influenced by various sociodemographic factors.
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Human permanent teeth are divided into two parts at the cemento-enamel junction in the divine golden ratio Highly accessed article p. 609
Rahul Anand, Sachin C Sarode, Gargi S Sarode, Shankargouda Patil
DOI:10.4103/ijdr.IJDR_525_16  PMID:29256456
Aim: The aim of this study is to find out whether tooth length (crown length + root length) follows the rule of most divine and mysterious phi (ϕ) or the golden ratio. Methods: A total of 140 teeth were included in the study. The crown-root ratio was manually calculated using vernier caliper and its approximation to golden ratio or the divine number phi (ϕ) was examined. Results: The average root-crown ratio (R/C) for maxillary central incisor was 1.627 ± 0.04, and of its antagonist, mandibular central incisor was 1.628 ± 0.02. The tooth-root ratio (T/R) for the same was 1.609 ± 0.016 and 1.61 ± 0.008, respectively. Similar values were appreciated for lateral incisors where the R/C ratio in the maxillary and mandibular teeth was 1.632 ± 0.015 and 1.641 ± 0.012 and the T/R ratio was 1.606 ± 0.005 and 1.605 ± 0.005, respectively. Conclusion: On measuring the tooth length in linear fashion from the cusp tip to the root apex, we found that the tooth was divided into two parts at the cemento-enamel junction in the golden ratio. This information can be exploited in restorative and implant dentistry in future.
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Re-evaluation of interarch space determination in fully dentate adults with different facial forms: A clinical study p. 613
Anupama Aradya, Ramesh Chowdhary
DOI:10.4103/ijdr.IJDR_625_15  PMID:29256457
Aim: The aim is to determine the average inter-arch space of fully dentate subjects at rest and at occlusion with different facial forms. Materials and Methods: Fifty subjects each of three groups of facial form, square, taper, and oval facial with a complete set of maxillary and mandibular arch teeth with average age from 25 to 40 years were included in this study. An equal number of male and females were included in all the groups. Vertical height at rest and at occlusion was recorded in every subject of the all the three groups using a prescribed procedure, and freeway space (FWS) was measured. Results: The collected data were statistically evaluated, and it showed the mean and median for each facial form subjects, square facial form (3, 2.32), taper facial form (2.62, 2), and ovoid facial form (2.68, 2), respectively. No significant difference between any of the readings (P < 0.05). However, 9% of the individuals showed the FWS range of 5–6 mm. The lowest and highest FWS measurements were 1 and 7 mm, respectively. One more significant factor is that majority (56%) of the square facial form subjects showed FWS range of 3–4 mm. Conclusion: The conclusions were drawn, to understand the average inter-arch space in various facial forms, which was more than 3–4 mm.
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Topographic assessment of human enamel surface treated with different topical sodium fluoride agents: Scanning electron microscope consideration p. 617
Gurlal Singh Brar, Amandeep Singh Arora, Vineet Inder Singh Khinda, Shiminder Kallar, Karuna Arora
DOI:10.4103/ijdr.IJDR_675_16  PMID:29256458
Introduction: Continuous balanced demineralization and remineralization are natural dynamic processes in enamel. If the balance is interrupted and demineralization process dominates, it may eventually lead to the development of carious lesions in enamel and dentine. Fluoride helps control decay by enhancing remineralization and altering the structure of the tooth, making the surface less soluble. Methodology: One hundred and twenty sound human permanent incisors randomly and equally distributed into six groups as follows: Group I - Control, II - Sodium fluoride solution, III - Sodium fluoride gel, IV - Sodium fluoride varnish, V - Clinpro Tooth Crème (3M ESPE), and VI-GC Tooth Mousse Plus or MI Paste Plus. The samples were kept in artificial saliva for 12 months, and the topical fluoride agents were applied to the respective sample groups as per the manufacturer instructions. Scanning electron microscope (SEM) evaluation of all the samples after 6 and 12 months was made. Results: Morphological changes on the enamel surface after application of fluoride in SEM revealed the presence of globular precipitate in all treated samples. Amorphous, globular, and crystalline structures were seen on the enamel surface of the treated samples. Clear differences were observed between the treated and untreated samples. Conclusion: Globular structures consisting of amorphous CaF2precipitates, which acted as a fluoride reservoir, were observed on the enamel surface after action of different sodium fluoride agents. CPP-ACPF (Tooth Mousse) and Tricalcium phosphate with fluoride (Clinpro tooth crème) are excellent delivery vehicles available in a slow release amorphous form to localize fluoride at the tooth surface.
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ORIGINAL RESEARCH: COMPARATIVE STUDY Top

Velar morphological variants in oral submucous fibrosis: A comparative digital cephalometric study p. 623
Bhagyashree Mahadevappa Patil, Syeda Arshiya Ara, Girish Katti, Sajna Ashraf, Uzma Roohi
DOI:10.4103/ijdr.IJDR_275_16  PMID:29256459
Context: Soft palate (velar) plays a significant role in various important functions in the head and neck region. Its diverse morphology is implicated in a variety of diseases. Knowledge about the varied morphological pattern of soft palate in oral submucous fibrosis (OSMF) patients can give us a clear understanding about disease progress in the oropharyngeal region for a proper diagnosis and also help the maxillofacial surgeon in successful structural and functional corrections associated with this disorder. Aim: (1) To evaluate the morphological variations of soft palate in OSMF patients using digital lateral cephalogram. (2) To assess the morphological variations of soft palate with respect to the different clinical stages of OSMF patients. Subjects and Methods: A total number of 300 patients were included in the study (150 participants each in study and control group), evaluated clinically, and subjected for digital lateral cephalogram for evaluating velar morphological variants. Statistical Analysis: The data were statistically evaluated using SPSS 11.5 software with Student's t-test, Chi-square test, and ANOVA. Results: Among Group I, 34 participants had Stage I OSMF, 90 participants had Stage II OSMF, and 26 participants had Stage III OSMF. Type I velar was commonly seen in Stage I OSMF, Type VI velar in Stage II OSMF, and Type III velar in Stage III OSMF. There was statistically highly significant decrease in anterior-posterior (AP) length and increase in width of superior-inferior (SI) measurement, as compared to the Group II. Conclusion: There was diminution in AP length and increase in SI measurement as the OSMF disease progressed.
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Knowledge, attitude and practices of institution-based dentists toward nicotine replacement therapy p. 629
Swikant Shah, Hemamalini Rath, Gaurav Sharma
DOI:10.4103/ijdr.IJDR_231_17  PMID:29256460
Background: Dental institutions provide very good platform to educate budding dentists to inculcate the habit of tobacco cessation counseling, including nicotine replacement therapy (NRT). Aims: The aim of this study is to assess and compare the knowledge, attitude, and practice of institutionally attached postgraduate students and faculty members of the dental profession toward NRT. Methods: For a cross-sectional survey among 201 participants from four dental colleges in Odisha, India, a 28-item questionnaire was developed, subdivided into four categories: demographic details, assessment of NRT knowledge (21-item), assessment of attitude (5-item), practice (1-item with 4 subgroup questions), and 1-item assessing barriers. Statistical Analysis Used: Data were analyzed using descriptive statistics, Chi-square test, and multiple logistic regression. Results: Only one-third of participants were aware of the dosage, mechanism of action, pharmacology, duration of the prescription, brand name, side effects, contraindications, and availability. Around two-third of participants who claimed to practice NRT, agreed to follow up the patients whom they prescribed NRT. Half of the study participants reported that they do not keep a record of these patients. Around 10% of respondents practicing NRT were confident enough to practice it without facing any problem. Major barriers for practicing NRT was found to be a lack of awareness (54.22%) followed by availability and bitter taste. The total knowledge score was found to be the strongest predictor of practicing NRT in multiple logistic regression. Conclusion: Lack of detailed knowledge regarding NRT reduces the chance of practicing inspite of having a positive attitude among institutionally attached dentists.
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Dermatoglyphics in periodontics: An assessment of the relationship between fingerprints and periodontal status - A cross-sectional observation study p. 637
Prutha Vaidya, Swapna Mahale, Pallavi Badade, Ayushya Warang, Sunila Kale, Lavanya Kalekar
DOI:10.4103/ijdr.IJDR_621_16  PMID:29256461
Context: Widespread interest in epidermal ridges developed only in the last several decades; however, it is still at infancy in the world of dentistry. The word “dermatoglyphics” comes from two Greek words (derma: Skin and glyphe: Carve) and refers to the epidermal skin ridge formations which appear on the fingers, palms of the hands, and soles of the feet. Aims: This study aims to assess the relationship between finger prints and chronic periodontitis. Materials and Methods: Two hundred patients were equally divided into chronic periodontitis and periodontally healthy group. The fingerprint patterns of the participants were recorded with a rolling impression technique using duplicating ink on executive bond paper. Statistical Analysis Used: The descriptive analysis of the data was presented as percentage frequency. The percentage frequencies of each pattern on each individual finger were calculated, and statistical tests were applied. Unpaired t-test was used for intergroup comparisons (P < 0.05). Results: There were statistically more whorls and less arches in both right and left hands in patients with chronic periodontitis. Conclusions: Dermatoglyphics can lead to early diagnosis, treatment, and better prevention of many genetic disorders of the oral cavity and other diseases whose etiology may be influenced directly or indirectly by genetic inheritance.
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Association of level of education and utilization of restorative dental care among rural women in India: Cross-sectional study p. 642
Neeta Shetty, Kundabala Mala, BS Suprabha, Ramya Shenoy
DOI:10.4103/ijdr.IJDR_456_16  PMID:29256462
Background: The utilization of restorative dental care is very scarce in rural India. Association between level of education and health of a person has been well-documented in many countries and time periods with a range of potential factors shaping the connection between both. Objectives: This cross-sectional survey was conducted to evaluate an association between the level of education (educational qualification) and utilization of restorative dental care among rural women associated with self-help groups. Materials and Methods: A semi-structured questionnaire was administrated to 660 rural women associated with self-help group by trained research assistants. The 604 completed questionnaires were received and reviewed. The education levels were divided into three groups: Group 1 - illiterates (17.2%), Group 2 - school educated (69.4%), and Group 3 - college educated (13.4%). Chi-square test was applied to evaluate the utilization of dental services by rural women, and logistic regression was applied to evaluate the influence of their educational qualifications on utilization. Results: A total of 604 properly filled questionnaires out of 660 (91.51% response rate) were included in the analysis. Only 56.9% of the sampled rural women indicated that they have visited dentists earlier. The maximum number of individuals who have never visited the dentist belonged to illiterate group (55.7%), and the association was statistically significant (0.004) when compared with educated individuals. Conclusion: The results of this study concluded that the level of education has a significant influence on the utilization of dental care.
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Perceptions about toothbrush contamination and disinfection among dental students in Bengaluru City: A cross-sectional study p. 646
KR Sowmya, Manjunath P Puranik, Jesline Merly James, Bhavna Sabbarwal
DOI:10.4103/ijdr.IJDR_301_17  PMID:29256463
Introduction: Toothbrushes are vital to remove dental biofilm and to prevent dental caries and periodontal disease. Repeated use of toothbrushes leads to contamination; hence, disinfection is essential in the maintenance of a brush. Current understanding and perception among dental students about toothbrush contamination and disinfection are essential. Aim: The aim of this study was to assess the perceptions about toothbrush contamination and disinfection among postgraduates and interns in Bengaluru city. Materials and Methods: A cross-sectional study was conducted using self-administered questionnaire among 400 postgraduates and interns from five dental colleges in Bengaluru. The statistics were computed with the Statistical Package of Social Sciences (SPSS) version 22 software and Chi-square test was used. A P < 0.05 was considered statistically significant. Results: There was a statistically significant difference regarding the source of information on tooth brush contamination (P = 0.008) and common mode of transmission of contamination (P = 0.01) between the two groups. The difference was found to be statistically significant (P = 0.01) regarding sharing of toothpaste. Only less than half of the participants, in both the groups practiced disinfection. Conclusion: There was a statistically significant difference in the perceptions about tooth brush contamination and disinfection among postgraduates and interns that might be attributed to their higher academic knowledge and clinical experience.
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ORIGINAL RESEARCH: PROSPECTIVE STUDY Top

Gingival and periodontal changes in patients undergoing in vitro fertilization treatment: A clinical study p. 650
Leena Smadi
DOI:10.4103/ijdr.IJDR_712_16  PMID:29256464
Aims: The aim of this study was to investigate the effect of in vitro fertilization (IVF) treatment on different parameters of periodontal status. Settings and Design: This was a clinical observational study. Materials and Methods: One hundred and seventy-nine patients who underwent IVF treatment according to the standard IVF protocols were examined using the simplified oral hygiene, gingival index (GI), sulcus bleeding index (SBI), and determining the clinical attachment loss (CAL). A full-mouth examination except for the third molars was performed at 4 sites per tooth (mesiobuccal, distobuccal, mesiolingual, and distolingual). Periodontal evaluation was performed before infertility treatment, at the end of infertility treatment, and 14 days after embryo transfer. Statistical Analysis: The Kruskal–Wallis or Fisher's tests were used to compare the median or mean values as appropriate. Results: The oral hygiene index simplified was 0.49, 0.32, and 0.37 at pretreatment, on the day of human chorionic gonadotropin (HCG) trigger, and on the day of the pregnancy test, respectively. The GI showed significant differences before and after treatment. The mean GI was 0.13 at pretreatment compared to 0.51 and 0.53 on the days of HCG trigger and of the pregnancy test, respectively. The same trend was seen for SBI. There were no differences in CAL among the three examinations. There was no difference between the two groups except for GI (0.71 vs. 0.48 for a positive pregnancy test vs. nonpregnancy, respectively). Conclusions: IVF medications and a superphysiological condition affect oral health, particularly gingival and periodontal statuses, and likely complicate the relationship between infertility, sex hormones, and infertility management. Larg-scale studies are needed to confirm the effect of such treatment on oral health.
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Influence of arthrocentesis irrigation volume at temporomandibular disorder treatment p. 655
Maysa Nogueira De Barros Melo, Josiane Nascimento Dos Santos Melo, Viviane Almeida Sarmento, Roberto Almeida De Azevedo, Christiano Sampaio Queiroz
DOI:10.4103/ijdr.IJDR_422_15  PMID:29256465
Introduction: Temporomandibular disorder (TMD) treatment varies from conservative therapy to invasive procedures such as arthrocentesis. The procedure is simple and has speed, low cost, low morbidity and good patient acceptance. Literature variations, however, have been found about the type and volume of the solution used for the irrigation of temporomandibular joint (TMJ). Subjects and Methods: The aim of this study was to compare the results provided by two different volumes of 0.9% saline solution (100 ml and 250 ml) used in arthrocentesis technique for TMD treatment. It included patients unresponsive to conservative treatment. Preoperative (T0) and postoperative evaluations were performed at T1 (30th day), T2 (60th day), and T3 (90th day), in which maximal mouth opening (MMO), pain, and the presence or absence of joint sounds were recorded. Patients were randomized into two groups: 1 – submitted to arthrocentesis using 100 ml of 0.9% saline solution in TMJ and 2 – arthrocentesis performed using 250 ml of 0.9% saline solution in each TMJ. Data were submitted to descriptive and comparative analyses for each parameter per group and between groups. The effect size was calculated according to Cohen test. Minimum detectable change (MDC) was obtained and the sensibility was calculated. A statistical significance of 5% was established. Group 1 obtained increase in MMO and decrease in pain (statistically significant); in Group 2, pain decreased significantly. In Group 1, clicking decreased significantly. No statistical differences were found between groups (P = 0.333). MMO and pain results exceeded MDC, and sensibility was good. Conclusion: In conclusion, arthrocentesis is effective in TMD symptoms' relief, without statistical difference between the volumes used.
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Angular cheilitis: A clinical and microbial study p. 661
Nirima Oza, Jitendra J Doshi
DOI:10.4103/ijdr.IJDR_668_16  PMID:29256466
Aims: The aim of the present study was to examine clinical types and microbiological flora isolated from angular chelitis. Materials and Methods: An eroded and/or erythematous, with or without fissure formation, nonvesicular lesion radiating from the angle of the mouth was considered to be angular chelitis. A sample of the present study comprised of 40 patients having unilateral or bilateral angular chelitis and 20 healthy individuals without any lip lesions. Clinical examination was done. In both test and control groups, the sample for microbial analysis was obtained from angle of the mouth. Results: Clinically, four types of angular cheilitis lesions were found, Type I, II, III, and IV. The most common type of lesion found was Type I lesion. Microorganisms isolated from the lesion were Staphylococcus aureus, Candida or Streptococci in 33 (82.5%) cases either in pure culture or mixed culture. Among these 33 patients, S. aureus was found in 25 (75.5%) cases, Candida in 16 (48.4%) cases, and Streptococci in 5 (13.5%) cases, respectively. Out of 16 cases positive for Candida, in 13 cases further isolation of Candida was possible. Candida albicans was found in 6 cases and Candida stellastodia in 7 cases. In majority of the dentulous and edentulous patients, S. aureus showed profuse growth. Conclusions: There are microorganisms associated with angular cheilitis.
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ORIGINAL RESEARCH: RETROSPECTIVE STUDY Top

A study for determination of various positioning errors in digital panoramic radiography for evaluation of diagnostic image quality p. 666
Apurva Mohite Khator, Mukta B Motwani, Anuraag B Choudhary
DOI:10.4103/ijdr.IJDR_781_16  PMID:29256467
Faulty radiographs have poor diagnostic quality, and repetition of such poor-quality radiographs leads to increased patient exposure to radiation. Since digital panoramic radiography has replaced manual radiography, the only hindrance in producing good-quality radiographs is the positioning errors. Objectives: Our study aims to determine the various positioning errors and their relative frequency and to identify those errors directly responsible for diagnostically inadequate images. Materials and Methods: Five hundred panoramic radiographs taken serially (from the year 2007) were retrospectively assessed for the positioning errors by three oral and maxillofacial radiology specialists using a performa enlisting the errors. The three specialists had different duration of clinical experience and they evaluated the orthopantograms as diagnostically acceptable or unacceptable. They also observed the relative frequency of all the positioning errors. Statistical Analysis: The kappa value for intraobserver agreement was calculated, which suggested that the agreement among the observers was fair. Results: Of the 500 panoramic radiographs viewed by the three observers, 25 (5%) had no errors, while 475 (95%) showed one or more positioning errors. The most common error in our study was found to be head turned to one side (33.8%) and the least common error was patient movement during exposure (1.8%). Conclusion: Positioning errors are very common in digital panoramic radiography, and they lead to production of poor-quality radiographs. The operator should take this fact into consideration and spend more time in patient positioning, thereby reducing the repetition of radiographs and unwanted patient exposure.
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ORIGINAL RESEARCH: IN VITRO STUDY Top

Repercussion of noni mouthwash on surface characterization of Nickel-Titanium archwire p. 671
Dhivya Dilipkumar, S Dhinahar, P Deenadayalan, Akshay Tandon, Poonkuzhali Suresh
DOI:10.4103/ijdr.IJDR_143_17  PMID:29256468
Objective: Maintaining oral hygiene is very important during orthodontic therapy mouthwashes are prescribed as an adjunct to improve patient's oral hygiene. Commercially available mouthwashes e.g. Chlorhexidine, Listerine, fluoride containing mouthwashes have shown to alter the surface characteristics of orthodontic wires. Hence the purpose of the study was to evaluate the effect of Noni mouthwash on surface quality and compositional changes of Nickel Titanium orthodontic wires. Materials and Methods: In this in vitro study pre-formed 0.014 inch NiTi arch wire was used. The study comprised of two samples, one control and one test sample which were 25mm in length. Control sample was stored at room temperature without any manipulation while test sample was immersed in Noni mouthwash solution for 1.5 hours, after which the test specimen was removed from the mouthwash solution and rinsed with distilled water. Both control and test samples were sent for scanning electron microscopy analysis, to qualitatively characterize the topography of the wire surface. Electron dispersion spectrum analysis was done to evaluate the various components of both the wires. Results: No significant difference in the average surface roughness for both wire samples was observed. There was no significant difference seen in the composition of wire after immersion in Noni mouthwash. Conclusion: Noni mouthwash did not have significant influence on the surface roughness or altered the composition of the Ni-Ti wire. Hence Noni mouthwash may be prescribed as a natural, non-destructive prophylactic agent for orthodontic patients.
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Comparative evaluation of different periods of enamel microabrasion on the microleakage of class V resin-modified glass ionomer and compomer restorations: An In vitro study p. 675
Disha Bansal, Mrinalini Mahajan
DOI:10.4103/ijdr.IJDR_657_16  PMID:29256469
Context: The design of the class V cavity presents a clinical challenge in the field of adhesive dentistry as the margin placement is partially in enamel and partly in dentin, and the trouble associated with this design is the microleakage at the dentinal margin. When these restorations undergo microabrasion due to cosmetic reasons, this trouble aggravates to the significant levels. Aims: The aim of this study was the measurement of microleakage of class V glass ionomer restorations over two different periods of enamel microabrasion. Settings and Design: This in vitro experimental study was conducted on 120 class V cavities which had been prepared on the buccal and lingual surfaces of 60 sound human premolars. One-half of the cavities were restored with the resin-modified glass ionomer cement (GIC) (60 cavities) and another half with the compomer (60 cavities). Finishing and polishing were performed. Subjects and Methods: Then, the teeth were classified into six groups (n = 20). Microabrasion treatment was performed with Opaluster (Ultradent Product Inc., South Jordan, UT, USA) for 0 (control no treatment), 60 and 120 s. Then, teeth were thermocycled between 5°C and 55°C, immersed in rhodamine B solution (24 h), and sectioned longitudinally in buccolingual direction. Dye penetration was examined with stereomicroscope (×10). Microleakage scores were statistically analyzed. The mean occlusal margin scores and gingival margin scores were compared between all the groups using the Kruskal–Wallis test, Mann–Whitney U-test, Wilcoxon signed-rank test, and post hoc comparison. There was a significant difference between Group 1a, Group 2a, Group 1b, Group 2b, Group 1c, and Group 2c. Statistical Analysis Used: Statistical analysis used in this study was Kruskal–Wallis test, Mann–Whitney U-test, Wilcoxon signed-rank test, and post hoc comparison. Results: The least microleakage scores were observed in occlusal margins of control groups (without microabrasion). Moreover, in both restorations, the microleakage scores in occlusal margins were higher than gingival margins, and compoglass had less microleakage in occlusal and occlusal plus axial walls of class V cavities compared with resin-modified GIC. Whereas, the light-cured glass ionomer had less microleakage in the gingival and gingival plus axial walls of class V cavities when compared with compoglass. Conclusions: The least microleakage scores were observed in occlusal margins of control groups (without microabrasion). Moreover, in both restorations, the microleakage scores in occlusal margins were higher than gingival margins.
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Effect of smear layer thickness and pH of self-adhesive resin cements on the shear bond strength to dentin p. 681
Mohammad Esmaeel Ebrahimi Chaharom, Amir Ahmad Ajami, Mahmoud Bahari, Haleh Rezazadeh
DOI:10.4103/ijdr.IJDR_12_16  PMID:29256470
Context: There are concerns in relation to the bonding efficacy of self-adhesive resin cements to dentin covered with the smear layer. Aims: This study aims to evaluate the effect of smear layer thickness and different pH values of self-adhesive resin cements on the shear bond strength to dentin. Materials and Methods: The dentin on the buccal and lingual surfaces of 48 sound human premolars were abraded with 60- and 600-grit silicon carbide papers to achieve thick and thin smear layers, respectively. The samples were divided into three groups (n = 16) based on the cement pH: Rely-X Unicem (RXU) (pH < 2); Clearfil SA Luting (CSL) (pH = 3); and Speed CEM (SPC) (pH = 4.5). In each group, composite resin blocks were bonded to the buccal and lingual surfaces. After 24 h, the shear bond strength values were measured in MPa, and the failure modes were evaluated under a stereomicroscope. Statistical Analysis: Data were analyzed with two-way ANOVA and post hoc least significant difference tests (P < 0.05). Results: Cement pH had a significant effect on the shear bond strength (P = 0.02); however, the smear layer thickness had no significant effect on the shear bond strength (P > 0.05). The cumulative effect of these variables was not significant, either (P = 0.11). Conclusion: The shear bond strengths of SPC and CSL self-adhesive resin cements were similar and significantly lower than that of RXU. The smear layer thickness was not a determining factor for the shear bond strength value of self-adhesive resin cements.
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SYSTEMATIC REVIEW Top

Epidermal growth factor receptor: Role in human cancer p. 687
Prashanth Rajaram, Poornima Chandra, Smriti Ticku, BK Pallavi, KB Rudresh, Poorva Mansabdar
DOI:10.4103/ijdr.IJDR_534_16  PMID:29256471
Cells are constantly exposed to various external stimuli which regulate the growth and survival of the cells. The signal transduction from the external environment to the interior of the cell is carried out by cell surface or transmembrane receptors. Epidermal growth factor receptor (EGFR) is a type I receptor tyrosine kinase and along with its ligands, EGFR is involved in the regulation of multiple cellular pathways. EGFR and its signaling pathway have been studied extensively for the biological and pathophysiological role in health and disease. There is enough evidence to suggest that EGFR is involved in the pathogenesis and progression of various cancers. This review discusses the structural anatomy and physiology of EGFR and its ligands, the role of EGFR in cancer and EGFR-targeted therapy.
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CASE REPORTS Top

Surgical management of recurrent neurofibroma of infratemporal region: A case report with 20-year follow-up p. 695
SM Balaji
DOI:10.4103/ijdr.IJDR_674_17  PMID:29256472
Head-and-neck region is one of the common locations for neurogenic tumors such as neurofibroma. Neurofibromas are usually found in individuals with neurofibromatosis, which is an autosomal dominant disease. Although mostly associated with neurofibromatosis, solitary forms have also been reported. Solitary neurofibromas are rare tumors and widely described in the literature as benign. Mostly, these solitary tumors tend to occur in the gastrointestinal system. Neurofibromas of the head and neck are not uncommon, but rarely been reported to occur in the infratemporal region. We report a very rare case of recurrent solitary neurofibroma originating from the infratemporal region. Complete excision of the primary tumor was done before 20 years. Tumor arising in this anatomical location requires a conservative surgical approach for cosmetic reason.
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An uncommon case of fibrolipoma p. 699
Ahanthem Nandita Devi, MB Sowbhagya, P Balaji, TS Mahesh Kumar
DOI:10.4103/ijdr.IJDR_718_16  PMID:29256473
Lipoma is a common benign soft-tissue neoplasm derived from mature adipose tissue neoplasm, but its presence in the oral and pharyngeal region is relatively uncommon. Oral lipoma was first described by Roux in 1848 as “yellow epulis.” It has an incidence rate of about 1%–4% of all benign oral lesions, with a prevalence rate of about 0.0002%. Fibrolipoma is an extremely rare subtype of lipoma which accounts for 1.6% of all facial lipomas. Specific anatomic locations of occurrence within the oral and maxillofacial region include the parotid region, buccal mucosa, lips, submandibular region, tongue, floor of mouth, and palate. Here, we present fibrolipoma, a very rare subtype of lipoma involving the left retromolar region in a 50-year-old female patient.
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SHORT COMMUNICATION Top

Rare molariform supernumerary teeth: Why are they bilateral? p. 702
Parul Jain, Rahul Kaul, Subrata Saha
DOI:10.4103/ijdr.IJDR_242_17  PMID:29256474
Anterior supernumerary teeth in the permanent dentition may be supplemental or rudimentary. Rudimentary types are further classified as conical, tuberculate, and molariform. The molariform type has been only rarely reported. We report a rare variety of anterior supernumerary teeth - the molariform type, occurring bilaterally and in association with a midline supernumerary tooth. We also suggest a hypothesis for the bilateral occurrence of supernumerary teeth.
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EPIDEMIOLOGICAL STUDY Top

Tobacco use, oral cancer screening, and oral disease burden in Indian women p. 706
Immanuel Joseph, Thavarajah Rooban, Kannan Ranganathan
DOI:10.4103/ijdr.IJDR_330_17  PMID:29256475
Introduction: India lacks data on national level adaptation of oral cancer screening measures and burden of oral diseases. We intend to address the issue through a secondary data analysis of existing data and reports. Materials and Methods: Data were acquired from the National Family Health Survey-4 (2015-2016). Of the 699,686 responses, representing 99% of India's women population living in all of India, the following data from the age group of 15–49 years were mined – any tobacco use, desire to quit tobacco use, and oral cavity screening for cancers. Data from Central Health Intelligence Bureau 2016 was used to identify population served by dentists in each state. The state-level data of the District Level Household and Facility Survey-4 (2012–2013) were mined for household population having symptoms of chronic illness including mouth/dental illness persisting for more than 1 month and had sought treatment. Statistical Analysis Used: SPSS version 20; Descriptive statistics for values in proportions; Pearson's correlation test assessed between the various factors. Results: Tobacco use in any form was highly prevalent among the North Eastern states, and there was also a lack of willingness to quit the habit. There was unequal distribution of dentists in different states. No significant statistical correlation was found between the proportions. Conclusion: There is disparity existing in treating seeking behavior of the general population as well as the need for dental treatment. The skewedness in dentists' distribution among the nation as compared with oral burden of diseases needs to be correlated before oral health policies are planned.
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Stem cells in dentistry: A study regarding awareness of stem cells among dental professionals p. 711
Parita K Chitroda, Girish Katti, Nikhat M Attar, Syed Shahbaz, G Sreenivasarao, Ambika Patil
DOI:10.4103/ijdr.IJDR_771_16  PMID:29256476
Background: Dental stem cell, a type of adult stem cell, exhibits multipotent differentiation capacity and is drawing worldwide attention because of its numerous applications. The advances in applications of dental stem cells seem to be unsurpassed in the near future, for which specialized skills and knowledge in this arena are of prime significance. Hence, there is a need to acquire more knowledge about dental stem cells to obtain maximum benefits from it in the coming years. Dental stem cells in India are still at the budding stage, and there seems to be limited awareness regarding dental stem cells. Aim: This study aimed to assess the awareness of stem cells among the dental professionals. Methodology: The present study was a questionnaire-based study of dental professionals (MDS, BDS, postgraduates, and interns) of three different institutions. Results: Results showed that 95.2% of dental professionals are aware of the terminology dental stem cells and 53.9% of them are aware of various applications of dental stem cells. Chi-square test showed a significant correlation between the sources of information, source of dental stem cells, and clinical applications in relation to the academic qualification of the dental professionals. Conclusion: This study revealed a good level of awareness among the dental professionals, and it also showed the need to spread more knowledge about the advances in applications, storage, banking, and guidelines related to dental stem cells.
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