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   2018| September-October  | Volume 29 | Issue 5  
    Online since November 2, 2018

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The difficulties in continuing education in geriatric dentistry; analysis
Alex Mersel
September-October 2018, 29(5):541-542
DOI:10.4103/ijdr.IJDR_658_18  PMID:30409928
  4 1,849 93
Role of anxiety and depression in association with migraine and myofascial pain temporomandibular disorder
Masoud Nazeri, Hamid-Reza Ghahrechahi, Amin Pourzare, Fatemeh Abareghi, Sahand Samiee-Rad, Mohammad Shabani, Shokouh Arjmand, Ramin Abazarpour
September-October 2018, 29(5):583-587
DOI:10.4103/0970-9290.244932  PMID:30409936
Background: Previous studies have demonstrated a strong association between primary headaches (HAs) and temporomandibular disorders (TMDs), specifically the myofascial pain subtype of TMD (MP TMD). The role of anxiety and depression in presentation and maintenance of MP TMD and migraine is previously demonstrated. Therefore, the objective of the current study was to evaluate the modification effect of anxiety and depression on the possible association of MP TMD and migraine. Methods: In this retrospective case–control study, individuals between 15 and 45 years old who were diagnosed with migraine HA according to the international classification of headache disorder-II (ICHD-II) were selected as case subjects (n = 65). Non-HA control subjects were matched by sex and age (n = 63). Research diagnostic criteria (RDC/TMD) (Axis I) was used to diagnose patients with MP TMD; other subtypes of RDC/TMD Axis I were excluded from the study. Subjects' anxiety and depression were screened using Persian version of Hospital Anxiety and Depression Scale-14. Chi-square and Mantel–Haenszel tests were used to analyze the data. P < 0.05 was considered statistically significant. Results: A significant association was found between migraine and MP TMD so that subjects with MP TMD had a five times chance of developing HA (P < 0.001). Further analysis using stratification method revealed that anxiety and depression have a modification effect in the association of MP TMD and HA and MP TMD patients with anxiety or depression had more chance of developing migraine HA (P = 0.003). Conclusion: Association between HA and TMD was observed in this study. Besides, we depicted that anxiety and depression interact in this association so that patients who did not have anxiety or depression did not demonstrate an association between TMD and HA. We suggest further studies to confirm the modifying effects of anxiety and depression.
  2 4,141 101
Antimicrobial Efficacy of Acacia nilotica, Murraya koenigii L. Sprengel, Eucalyptus hybrid, Psidium guajava extracts and their combinations on Fusobacterium nucleatum and Porphyromonas gingivalis
BR Chandra Shekar, Ramesh Nagarajappa, Richa Jain, Rupal Singh, S Suma, Rupesh Thakur
September-October 2018, 29(5):641-645
DOI:10.4103/ijdr.IJDR_52_17  PMID:30409946
Background: The herbal extracts have been effectively tried in the treatment and prevention of many oral diseases. Aim: The aim is to assess the antimicrobial efficacy of Acacia nilotica, Murraya koenigii L. Sprengel, Eucalyptus hybrid, Psidium guajava extracts and their combinations on Fusobacterium nucleatum (Fn) and Porphyromonas gingivalis (Pg). Materials and Methods: The extraction process was carried out by Soxhlet apparatus using ethanol as solvent. The combinations of the four plant extracts were prepared by combining an equal quantity of 10% solution of each of the four plant extracts. The antimicrobial efficacy testing of the plant extracts and their combinations on Fn and Pg was performed using agar well diffusion method. Columbia 5% of sheep blood agar plates were used for antimicrobial efficacy testing under anaerobic conditions. The qualitative assay was carried out to identify the various phytochemical constituents. Dimethyl sulfoxide and 0.2% chlorhexidine acted as negative and positive controls, respectively. The mean diameter of inhibition zone between different categories was compared using one-way analysis of variance. Results: All the individual plant extracts and their double, triple, and quadruple combinations were effective in inhibiting the growth of these bacteria. However, 0.2% chlorhexidine produced the highest mean diameter of inhibition zone. Conclusion: The plant extracts in combinations offer enhanced antimicrobial efficacy due to their synergistic action besides slowing the development of bacterial resistance. Hence, these extracts in combinations could be used tried as effective alternates to chlorhexidine.
  2 2,133 106
Root coverage by modified coronally advanced flap with and without platelet-rich fibrin: A clinical study
Nisheet Dixit, Arundeep Kaur Lamba, Farrukh Faraz, Shruti Tandon, Kamal Aggarwal, Abdul Ahad
September-October 2018, 29(5):600-604
DOI:10.4103/ijdr.IJDR_22_17  PMID:30409939
Background: Marginal gingival recession can cause major functional and esthetic problems. Advanced flaps are the simplest, yet unpredictable procedures for managing these conditions. The predictability of root coverage can be increased by combining coronally advanced flap (CAF) or its modified approach with other regenerative techniques. Objective: To ascertain the potential benefits of platelet-rich fibrin (PRF) on modified CAF for the treatment of gingival recession. Materials and Methods: Study comprised of 12 patients with Millers' class I and class II gingival recession in two non-adjacent anterior teeth having a minimum 3 mm width of attached gingiva. Following split-mouth design, one tooth with gingival recession was subjected to modified CAF, while another was treated by CAF with PRF. The clinical parameters, i.e., plaque index, modified sulcular bleeding index, vertical gingival recession depth (VGRD), gingival recession width (GRW), clinical attachment level (CAL), and gingival thickness (GT) were recorded at baseline, 1 month, 3 months, and 6 months. Results: VGRD, GRW, CAL, and GT improved significantly from baseline to 1 month in both test and control groups. However, change in these parameters from 1 month to 3 months and 3 months to 6 months were statistically nonsignificant in both groups. On intergroup comparison, only the change in GT was found to be statistically significant (P < 0.05) at all three post-treatment visits. Conclusion: Benefits of the combined technique in terms of increased GT appear to justify the use of PRF along with modified CAF for the treatment of mild to moderate gingival recessions.
  1 4,307 301
Peripheral giant cell granuloma manifestation in pregnancy
Chitra L Patil, Rajesh P Gaikwad, Akshaya B Banodkar, Nilofar B Attar, Gulnar D Sethna
September-October 2018, 29(5):678-682
DOI:10.4103/ijdr.IJDR_110_17  PMID:30409953
The peripheral giant cell granuloma (PGCG) is a benign oral lesion occurring on the gingiva and alveolar ridge. It is the most common oral lesion and occurs at an average age of 30 years. The upsurge in the levels of estrogen and progesterone in pregnancy leads to a plethora of changes in various parts of human body, including the oral cavity. In the oral cavity, changes are commonly seen on the gingiva. These include pyogenic granuloma, PGCG and also peripheral ossifying fibroma, etc., The etiology of PGCG in our case might be related to hormonal alterations during the gestation period.
  - 3,179 107
Management of maxillary first molar with six canals using operating microscope
KV Kishan, Devika Das, Naveen Chhabra, Vishnu Pratap Singh Rathore, Vimal Remy
September-October 2018, 29(5):683-686
DOI:10.4103/ijdr.IJDR_722_16  PMID:30409954
The purpose of this article was to highlight the importance of having a thorough knowledge about the root canal morphology. This case report highlights the unusual anatomy of a maxillary first molar with three mesiobuccal (MB) canals, two palatal canals, and one distobuccal canal which is extremely rare. The use of operating microscope was crucial, both for the detection and for the management of the additional canals. The use of surgical operating microscope and digital radiograph showed that MB root had Type 3-1 of Gulabivala classification and palatal canal showed Vertucci's Type II canal morphology This report describes and discusses the identification of variation in canal morphology of maxillary first molar and the use of latest adjuncts in successfully diagnosing and negotiating them.
  - 3,686 131
Rare granular cell tumor affecting a 13-year-old boy
SM Balaji, Preetha Balaji
September-October 2018, 29(5):687-689
DOI:10.4103/ijdr.IJDR_651_18  PMID:30409955
Granular cell tumor (GCT) is a rare soft-tissue neoplasm, first described in 1926. GCT often manifests as a single, painless nodule that shows a slow enlargement in the cutaneous, subcutaneous, or submucosal tissues. It is commonly reported in adults in the third to sixth decade of life. This case report is of an incidental finding in a young boy, who was radiologically examined for orthodontic treatment purpose and found to have a radiolucent lesion in the mandible. The lesion was later diagnosed as GCT. Central GCT is rare, and the presentation in a child is even rare. Although GCT is reported to be benign, it can turn malignant in 2% of the cases and possibly metastasize too. The local recurrence within a year is characteristic for malignant GCT. The 1-year follow-up of the present case indicated no local recurrence. The case stresses the need for the frequent dental examination, specialist reference. GCT should be included in the differential diagnosis of head and neck masses, even when inside jaws. It shall be remembered that such tumors may arise in any atypical locations and there is a possibility of malignancy.
  - 1,903 77
Role of research evidence in clinical decision–making: Intuition versus clinical experience versus scientific evidence
SM Balaji
September-October 2018, 29(5):543-544
DOI:10.4103/ijdr.IJDR_785_18  PMID:30409929
  - 1,955 69
Parental awareness, knowledge, and attitude toward conscious sedation in North Indian children population: A questionnaire-based study
Ranu Bhandari, Seema Thakur, Parul Singhal, Deepak Chauhan, Cheranjeevi Jayam, Teerthesh Jain
September-October 2018, 29(5):693-697
DOI:10.4103/ijdr.IJDR_120_17  PMID:30409957
Aim: The purpose of this study is to find the opinion, attitude, beliefs, and the existing knowledge of parents of Himachal Pradesh suburban city about conscious sedation. Objective: To know the effect of education of parent and prior sedation experience of the child on opinion, attitude, and knowledge of parent about conscious sedation. Methodology: A questionnaire in Hindi/English was provided to parents who accompanied their child for the treatment in the Paedodontics Department of HPGDC College Shimla. Information regarding demography, existing knowledge gained through television, the internet, opinion about the safety of the procedure, knowledge of nothing by mouth guidelines, restraints usage, and knowing their preferences of staying with the child during treatment was explored. Questions were straight yes or no type and multiple choice type. Some questions were statements and wanted the respondents to strongly agree, agree, disagree, or strongly disagree. Results and Conclusion: A total of 350 questionnaires were collected. Parents feel sedation is safe in the dental office as an adjunct to dental treatment. Education played a role in existing knowledge about sedation and perception about the safety of conscious sedation.
  - 1,992 120
Comparative evaluation of cathepsin K levels in gingival crevicular fluid among smoking and nonsmoking patients with chronic periodontitis
Priya Lochana Gajendran, Harinath Parthasarathy, Anupama Tadepalli
September-October 2018, 29(5):588-593
DOI:10.4103/ijdr.IJDR_95_17  PMID:30409937
Background: The aim of the study is to comparatively evaluate the levels of cathepsin K (CSTK) in gingival crevicular fluid (GCF) among smoking and nonsmoking patients with chronic periodontitis (CP). Materials and Methods: A total of 160 systemically healthy male patients were included in the study. Based on probing pocket depth, clinical attachment level, plaque index, and modified sulcular bleeding index, the patients were allotted into four groups: Group I - with forty subjects who were smokers with healthy periodontium, Group II - with forty nonsmoking subjects with healthy periodontium, Group III - forty patients who were smokers with CP, and Group IV - with forty nonsmoking CP patients. Those who claimed to have never smoked were recruited into the nonsmoker group, whereas subjects who reported smoking ≥10 cigarettes per day for more than 5 years were recruited into the smoker group. The GCF samples were collected using microcapillary pipettes and analyzed for levels of CSTK using enzyme-linked immunosorbent assay. Results: The GCF concentration of CSTK was expressed in pg/μl. The mean CSTK levels in the groups were Group I - 0.158 ± 0.043 pg/μl, Group II - 0.145 ± 0.026 pg/μl, Group III - 15.768 ± 12.40 pg/μl, and for Group IV - 11.59 ± 12.15 pg/μl, respectively. The levels of CSTK were statistically higher in Group III when compared with Group IV (P = 0.037) (P < 0.05). Conclusion: CSTK levels were significantly increased in smokers with CP than nonsmokers, suggesting a positive influence of smoking on CSTK which could possibly play a role in the increased susceptibility for osteoclastic bone destruction in smoker subjects.
  - 1,488 163
Reverse rotary instrumentation in the apical third of the root canal system: An scanning electron microscope analysis
Raksha Bhat, Mithra N Hegde
September-October 2018, 29(5):594-599
DOI:10.4103/ijdr.IJDR_143_15  PMID:30409938
Aims: The aim of the present study was to evaluate the efficacy of reverse rotary instrumentation in disinfection of the root canal at the apical third and qualitative confirmatory analysis using the scanning electron microscope (SEM). Subjects and Methods: Sixty single-rooted mandibular premolars were instrumented up to Protaper rotary file size F2 and contaminated with a known species of Enterococcus faecalis (ATCC 29212). The samples were then divided into three groups; Group 1: Experimental group-irrigation by agitation of 1% NaOCl with reverse rotary instrumentation; Group 2: Negative control-no irrigation; and Group 3 positive control-irrigation with 1% NaOCl using a 30-gauge needle. The colony forming units of all the groups were checked. SEM analysis of the samples was focused on the apical third to confirm the absence of E. faecalis biofilms. The data obtained were statistically analyzed by the Fisher's exact test and Pearson's Chi-square test. Results: Group I and III showed significant reduction in the growth of E. faecalis (P ≤ 0.001). SEM confirmed dense bacterial colonies in the Group II consistent with biofilm formation and reduction in bacterial colonies in Group I and II. Conclusion: Agitation with reverse rotary instrumentation in the apical third of the root canal along with 1% sodium hypochlorite proved effective in disinfection of the apical third of the root canal, which was further confirmed by scanning electron microscopic analysis. Hence, it can be used as an adjunct during rotary instrumentation in efficient cleansing of the root canal system in the apical third of the root canal system.
  - 1,451 96
Impacted mandibular third molar: Comparison of coronectomy with odontectomy
Kanika Singh, Sanjeev Kumar, Sukumar Singh, Vijay Mishra, Pradeep Kumar Sharma, Deepak Singh
September-October 2018, 29(5):605-610
DOI:10.4103/ijdr.IJDR_549_16  PMID:30409940
Aim: Damage to the inferior alveolar nerve (IAN) while extracting lower third molars is often caused by the intimate relationship between the nerve and the roots of the teeth. The aim of this study was to compare the sequelae of coronectomy with odontectomy in impacted mandibular third molars. Patients and Methods: This study included thirty patients which were divided into two groups, Group-I (test group) including 15 patients undergoing coronectomy and Group-2 (control group) of 15 patients undergoing odontectomy. Investigations included digital orthopantomogram. The parameters for this study included pain, swelling, nerve paresthesia, trismus, postoperative infection, postoperative wound dehiscence, postoperative pocket depth, and migration. Results: In Group-1 (coronectomy group), the patients underwent follow-up for 6 months to evaluate migration of the retained mandibular third molar root which was in proximity with the IAN. There was a mean increase in migration when the distance from the inferior border of IAN until the apex of the retained mandibular third molar root was measured which was by 3.43 mm after 6 months of follow up. Conclusion: On statistical analysis, the result in this study showed no statistical difference in both the groups in all the parameters that were taken.
  - 7,498 134
Comparison of efficacy of 0.75% ropivacaine and 2% lidocaine with 1:200,000 adrenaline in pain control in extraction of mandibular posterior teeth: A double-blind study
Rishab Ranjan, SN Santhosh Kumar, Manju Singh
September-October 2018, 29(5):611-615
DOI:10.4103/ijdr.IJDR_150_17  PMID:30409941
Background: Two percent lidocaine hydrochloride is the gold standard for dental anesthesia against which newer local anesthetic agents may be compared. 0.75% ropivacaine is a newer, long-acting amide local anesthetic agent with inherent vasoconstriction property. Aim: This study aims to compare the efficacy of 0.75% ropivacaine and 2% lidocaine hydrochloride with 1:200,000 adrenaline in pain control in extraction of mandibular posterior teeth. Settings and Design: This is a prospective, double-blind, and split-mouth study. Subjects and Methods: Twenty patients were divided into two groups according to the right and left sides of patient – side A and side B. The side, where 0.75% ropivacaine was to be administered, was randomly selected by flip coin method. Then, the pterygomandibular and long buccal nerve blocks were administered with 0.75% ropivacaine and necessary dental extraction was performed. After 1 week, the same procedure was repeated using 2% lidocaine hydrochloride with 1:200,000 adrenaline. The parameters assessed were pain on injection, onset of anesthesia, pain during the extraction, and duration of anesthesia. Statistical Analysis Used: The nonparametric data were assessed by Mann Whitney “U” test. Results: The mean onset of action for solution A was 7.15 ± 4.934 min and for solution B was 9.75±5.128 min. This was statistically significant. The mean duration of action, pain on injection, and pain during extraction were not significant. Conclusion: This study clearly states that there is no clear advantage of using 0.75% ropivacaine in pterygomandibular nerve block over the gold standard. However, more clinical studies with larger sample size are necessary.
  - 2,831 141
Habit-breaking methods employed by mothers of children with nonnutritive sucking habits resident in suburban Nigeria
Nneka Kate Onyejaka, Kikelomo Adebanke Kolawole, Morenike Oluwatoyin Folayan, Elizabeth Obhioneh Oziegbe, Nneka Maureen Chukwumah, Titus Ayodeji Oyedele, Hakeem Olatunde Agbaje, Olusegun Victor Oshomoji
September-October 2018, 29(5):545-550
DOI:10.4103/ijdr.IJDR_404_16  PMID:30409930
Context: Parents are often concerned about their children's nonnutritive sucking (NNS) habits and may institute mechanisms to try to break them. Aim: The study identified various methods instituted by mothers resident in a suburban Nigeria to break NNS habits of children, reasons for wanting to break the habit, and the association between instituted methods and sociodemographic profile of the mothers. Materials and Methods: The data of 129 mothers of children aged 4 years to 12 years who had NNS habits at the time of conducting a household survey were analyzed. Statistical Analysis: Tests of associations were conducted to determine the association between maternal age and level of education and methods employed to break child's NNS habits. Results: Eighty-four mothers (65.1%) made efforts to break the habit. Habit persisting to older age was the main concern. The most common method employed for breaking habits was punishing the child (54.8%).Only 7 (20.0%) mothers who were concerned about NNS habit(s) sought professional advice. A greater though insignificant percentage of mothers in the 25–34 years age group (57.2%; P = 0.48) and those with secondary school level of education (56.0%; P = 0.12) made efforts to break their children's NNS habits. Conclusions: The majority of mothers were concerned about their children's NNS habits. However, very few concerned mothers sought professional advice. Efforts need to be made to improve the public awareness about the availability of professional services for managing NNS habits and potential impact of employing nonprofessional methods to break habits.
  - 2,105 112
Knowledge and attitude of general dentists regarding common emergencies in dental offices: A cross-sectional study in Shiraz, Iran
Azita Azad, Zahra Talattof, Zahra Deilami, Maryam Zahed, Amir Karimi
September-October 2018, 29(5):551-555
DOI:10.4103/ijdr.IJDR_587_16  PMID:30409931
Background: Medical emergencies are likely to occur in dental offices due to the use of anesthetics, anxiety, and systemic complications of the patient. Since such emergencies are life threatening in many cases, preparedness of the dentist is highly required. Aims: This study was carried out to evaluate the dentists' knowledge and attitude regarding diagnosis and treatment of medical emergencies in dental offices in Shiraz, Iran. Methods: This cross-sectional study was performed on 150 general dentists in Shiraz with at least 5 years since graduation in 2015. They were asked to complete a validated questionnaire including the dentists' demographic information and inquiries about their performance and knowledge in emergency situations. Statistical Analysis Used: Independent t-test, one-way ANOVA, and Pearson's correlation coefficient were used in this study. Results: According to the inclusion criteria, 105 dentists participated in the study. The mean knowledge and attitude of the dentists was estimated 4.98 (±1.50) out of 10. No significant correlation was detected between age, sex, number of patients per day, and working hours with the knowledge of managing an emergency situation (P > 0.05). Out of the number of studied dentists, 49% had attended training workshops and 90% called for re-attending a workshop. The knowledge score of those who had participated in workshops was significantly higher than those who had not (P = 0.016). Conclusion: The results of this study revealed that the dentists' knowledge about emergency situations was average while the knowledge was higher in those who had attended emergency workshops. Thus, retraining courses and workshops must be considered more often for graduated dentists.
  - 3,217 155
Effectiveness of crystallization test in screening of potentially malignant oral disorders and oral cancer
Ratna Kumari V N Tarigoppula, BR Ahmed Mujib, Rashmi Naik
September-October 2018, 29(5):556-561
DOI:10.4103/ijdr.IJDR_535_16  PMID:30409932
Aim: This study aims to determine the effectiveness of crystallization test in screening of oral potentially malignant disorders (PMDs) and oral cancer. Materials and Methods: Thirty patients of oral PMD, 30 patients of oral cancer and 40 normal healthy people were selected. One drop of blood was collected and added to 1 cc of double-distilled water at room temperature to get a final dilution of 6% hemolyzed blood. 0.1–0.2 cc of this blood sample is added to 10 cc of 20% cupric chloride solution and further is subjected to crystallization test. Results: In the normal healthy group, the pattern was typical with an eccentrically placed center of gravity with needles arranged in radiating fashion. Whereas in oral PMD and cancer groups, there was “transverse form” formation. This test had sensitivity and specificity of about 83.33% and 86.84% for PMDs group and 96.30% and 86.84% for oral cancer group respectively. Conclusion: Crystallization test was found to be sensitive, reliable, economical and less-invasive procedure for screening of oral PMDs and oral cancer.
  - 3,057 202
Evaluation of relationship between nutritional status and oral health related quality of life in complete denture wearers
Rajlakshmi Banerjee, Jaishree Chahande, Sujoy Banerjee, Usha Radke
September-October 2018, 29(5):562-567
DOI:10.4103/ijdr.IJDR_285_17  PMID:30409933
Introduction: The prevalence of malnutrition increases with old age, especially in developing countries like India, and it is the most common cause of morbidity and mortality, because of many factors out of which dentate status is one. Aim and Objective: The aim of this study is to evaluate and determine the effect of nutritional status and dietary intake on the oral health-related quality of life (OHRQOL) of elderly edentulous complete denture-wearing patients and to know whether elderly complete denture wearers have a higher risk of malnutrition. The objective was to assess the need to include dietary and nutritional counseling during prosthodontic rehabilitation of elderly edentulous patients. Materials and Methods: A cross-sectional study was conducted among 200 elderly denture-wearing patients above 60 years of age from Nagpur, Maharashtra. Mini-Nutritional Assessment (MNA) questionnaire was used to assess nutritional status, and Geriatric Oral Health Assessment Index (GOHAI) questionnaire was used to determine the OHRQOL of these patients. Descriptive statistics were used to analyze data using SPSS version 21 (SPSS Inc., Chicago, IL, USA). Results: Among the assessed participants, nearly 95% of them had total scores of GOHAI between 12 and 57 which require “needed dental care.” As per MNA, 10.5% had adequate nutrition, 70% were at risk of malnutrition, and remaining 19.5% of participants were malnourished. There was a significant correlation between GOHAI and MNA scores. Conclusion: Low nutritional status was associated with the poor OHRQOL among the elderly. A strong association was found between mean GOHAI and MNA scores and thereby nutritional status and OHRQOL. The use of conventional dentures increases the risk of malnutrition in the elderly due to inability to eat and chew food properly. Dietary analysis and counseling should be strictly incorporated into geriatric treatment planning during prosthetic rehabilitation.
  - 6,259 219
Sociodemographic and behavioral factors associated with early childhood caries among preschool children of Western Maharashtra
Riya Jain, Snehal Patil, KM Shivakumar, Samuel Raj Srinivasan
September-October 2018, 29(5):568-574
DOI:10.4103/ijdr.IJDR_158_17  PMID:30409934
Introduction: Early childhood caries is a preventable disease of multifactorial etiology and is a public health problem affecting majority of the preschool-age children of the country. If left untreated, it has many social, economic, and nutritional implications and affects the quality of life of the affected child. Methods: This cross-sectional study was conducted among 200 preschool children of Karad city, western Maharashtra, to assess the prevalence of dental caries among the preschool children and to assess the factors affecting the development of dental caries. Various child-level, parent-level, attitudinal- and family-level factors, and clinical variables were evaluated. Results: High prevalence of caries of 87.5% was observed in the study sample. Bivariate analysis showed a significant association of age of child (P < 0.001), age of mother at birth (P = 0.041), feeding during 1st year (P = 0.034), snacking habits (P = 0.001), and brushing frequency (P = 0.03) with dental caries. On multivariate analysis, the factors of snacking habits (P = 0.003) and age of child (P = 0.002) remained significantly correlated with dental caries. Conclusion: There was a strong and consistent relation of the snacking habits with the prevalence of dental caries among the preschool children of Karad city. There is a need to sensitize the caregivers regarding the role of frequent snacking in dental caries.
  - 2,508 155
Knowledge, attitude, and practice of dental implants among dental postgraduates and practitioners in Davangere City, Karnataka: A cross-sectional study
Disha Nagpal, Shobha Prakash, Dheeraj D Kalra, Gagandeep Singh
September-October 2018, 29(5):575-582
DOI:10.4103/ijdr.IJDR_500_15  PMID:30409935
Background: Implant therapy has become an important part of treatment to restore function and esthetics in partially/completely edentulous patients. Inspite of the progress made in implant dentistry since its inception, there have been some loopholes in scientific based knowledge and established clinical experience amongst dental professionals and postgraduates.So,an analysis was performed of the real picture. Objectives: A study was conducted to assess and compare the knowledge, attitude and practice of dental implants among dental postgraduate students and dental practitioners (General and institutional)in Davangere City, Karnataka and to identify the variations in their knowledge, attitude and practice with respect to dentist's factors (years of experience, implant training and their specialization). Materials and Methods: A cross sectional questionnaire based survey was conducted using census approach with informed consent. A pretested, self administered questionnaire containing demographic details and knowledge ,attitude and practice based questions was distributed and collected back from the respondents. Responses were coded before and decoded after the analysis. Statistical analysis was performed using SPSS SoftwareV17.0. Results: The results were determined after the statistically analyzed and concluded that the knowledge was widespread among postgraduates and dental practitioners and variations existed amongst the subjects with respect to age, gender, years of experience, practice type, implant training and their specialization. It was also found that the attitude and practice towards implants and their evidence based knowledge about the same was variable.
  - 2,111 140
Effect of antioxidant on orthodontic bracket bond strength after vital bleaching
Deepti Yadav, Vineet Golchha, Nandini Kamat, Rahul Paul, Pooja Sharma
September-October 2018, 29(5):646-650
DOI:10.4103/ijdr.IJDR_36_17  PMID:30409947
Objectives: The objective of this study is to compare the neutralization effect of various antioxidant agents on the bond strength of composite resins on stainless steel and ceramic brackets immediately bonded to previously bleached teeth. Materials and Methods: One hundred and sixty human maxillary premolars were used for the study. Teeth were divided into four groups (n = 40): Group 1 (control), Group 2 (bleached), Group 3 (sodium ascorbate), and Group 4 (tocopherol acetate). Each group was divided into two subgroups, one was bonded with stainless steel and other with ceramic brackets using 3M Transbond XT. Universal testing machine was used to determine the shear bond strength (SBS). Results: Among the metal brackets, Group 1A had the highest SBS (12.18 + 1.41 MPa) and Group 2A had the least SBS (6.18 + 1.49 MPa). Weibull analysis indicated that bond strength for a 90% probability of failure was highest for Group 1A (13.99 MPa) and lowest for Group 2A (8.49 MPa). For ceramic brackets, Group 1B had the highest SBS (13.80 + 1.69 MPa) and Group 2B had the least SBS (8.05 + 1.85 MPa). Weibull analysis indicated that bond strength for a 90% probability of failure was highest for Group 1B (14.61 MPa) and lowest for Group 2B (8.85MPa). Conclusion: The in vitro study showed that bleaching reduced the SBS significantly, and this could be effectively reversed by the application of antioxidants in both metal and ceramic brackets.
  - 1,408 80
Micro-shear bond strength of composite resin to glass ionomer cement using an alternative method to build up test specimens
Amanda Barreto Ramos, André Fábio Vasconcelos Moro, Gustavo Miranda Rocha, Cesar Dos Reis Perez
September-October 2018, 29(5):651-656
DOI:10.4103/ijdr.IJDR_499_16  PMID:30409948
Context: Despite the relevance of the sandwich technique, there are still doubts about the best adhesive strategy and surface treatment for glass ionomer cements (GICs). Aim: The aim of this study is to evaluate the best surface treatment for GIC to ensure an effective and durable adhesion to resin, through micro-shear test, using an alternative method to build up test specimens. Subjects and Methods: Eighty GIC samples were divided into eight groups (n = 10) according to five surface treatments (none, etching, air drying, grinding, and grinding plus etching) and according to the adhesive system (conventional or self-etch). Five starch tubes were positioned on each sample, and a flowable composite was inserted generating 50 resin test bodies per group and a total of 400 tested areas. All specimens were submitted to the micro-shear test: half immediately and half after thermal cycling (10,000 cycles of 20 s each/5° and 55°C). All samples were analyzed to evaluate fracture. Representative samples were also analyzed by scanning electron microscopy and energy dispersive spectroscopy. Data were analyzed with two-way ANOVA and Tukey's honest significant difference post hoc test (P <.05). Results: The bond strengths in the thermal cycled specimens were lower and showed a statistically significant difference (P = 0). The “grinding” groups showed the highest bond strength. Conclusions: The alternative method to build up test specimens was effective and easy to execute. Grinding of the GIC surface, which is not normally performed before the use of the adhesive system, represented the best option of surface treatment.
  - 1,764 81
Evaluation of the effect of denture cleansers on the surface roughness of hard denture base material: An In vitro study
Jinal Barochia, Sujatha Kamath
September-October 2018, 29(5):657-662
DOI:10.4103/ijdr.IJDR_810_16  PMID:30409949
Background: Maintaining the oral hygiene of denture wearers is a challenge faced in modern dentistry. Biofilm formed on dentures has been associated with denture stomatitis, malodor, aspiration pneumonia, infectious endocarditis, gastrointestinal infection, and chronic obstructive pulmonary disease. Objective: The purpose of this study was to evaluate the effect of denture cleansers on the surface roughness of hard denture base material. Materials and Methods: A total of 100 heat-cure acrylic resin specimens were fabricated with dimensions 30 mm × 15 mm × 3 mm in length, width, and thickness, respectively. All specimens were distributed into four groups randomly. Three commonly prescribed denture cleansers were used for immersion in this study. Regular tap water was used for immersion in the control group. Surface roughness was determined before immersion and after immersion in denture cleansing solutions using contact profilometer. The data were subjected to statistical analysis using paired t-test, one-way analysis of variance, and Tukey's multiple post hoc test. Results: The change in surface roughness of acrylic samples immersed in Clanden group was statistically significant (P < 0.05) at individual group level. However, the change in surface roughness of acrylic samples after immersion, when compared between the groups, namely, control, Clinsodent, Clanden, and Fittydent, was not statistically significant (P > 0.05). Conclusion: Within the limitation of this study, the three denture cleansing materials, namely, Clinsodent powder, Clanden tablet, and Fittydent tablet, are safe to be prescribed as denture cleansers.
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A comparison of the effect of application of sodium ascorbate and amla (Indian gooseberry) extract on the bond strength of brackets bonded to bleached human enamel: An In vitro study
Shivani Keni, Supriya Nambiar, Pramod Philip, Siddarth Shetty
September-October 2018, 29(5):663-666
DOI:10.4103/ijdr.IJDR_720_16  PMID:30409950
Introduction: Whitening of teeth is a popular choice among dental clinicians and patients. However, the changes in enamel structure and composition induced by the bleaching agents cause a decrease in the shear bond strength of brackets leading to premature bracket debonding. Among several methods to overcome this, the most common is delaying bonding by 2–4 weeks. This waiting period can be eliminated by applying an antioxidant (sodium ascorbate) which causes a reversal in the reduction of bond strength. Aim: This study aims to compare the efficacy of a naturally occurring antioxidant (gooseberry) and sodium ascorbate in normalizing the bond strength of enamel to prebleached levels. Materials and Methods: Seventy-two extracted premolars were divided into 4 equal groups; 1st group – control group – unbleached teeth, bonded directly, 2nd group – bleached with 16% carbamide peroxide (8 h for 1 week), then bonded. 3rd and 4th group – similarly bleached, followed by application of 10% sodium ascorbate and gooseberry extract (3 h respectively), then bonded. Bond strength was checked using Instron Universal Testing Machine. Results: The bond strength of the control group was the highest and that of the carbamide group was drastically reduced. Considerable increase in the bond strength was seen after treatment with sodium ascorbate with negligible difference between sodium ascorbate and control group (P > 0.05). Conclusion: Treatment with gooseberry extract did improve the bond strength but was not as effective as sodium ascorbate postbleaching.
  - 1,914 96
A three-dimensional finite element analysis to evaluate stress distribution tooth in tooth implant-supported prosthesis with variations in non-rigid connector design and location
K Sumathi Nitin, TV Padmanabhan, V Anand Kumar, N Parthasarathi, M Uma Maheswari, S Madhan Kumar
September-October 2018, 29(5):634-640
DOI:10.4103/ijdr.IJDR_538_16  PMID:30409945
Background: The physiologically mobile natural tooth and rigidly fixed dental implant causes different distribution of stress when connected in prosthesis and nonrigid connector compensates this. Understanding of biomechanical behavior is necessary for an adequate choice and construction of this type of rehabilitation. However, there has been insufficient research focusing on different location and type of the nonrigid connector related with the prognosis of both implant and the tooth. Aim of the Study: The purpose of this finite element (FE) analysis was to evaluate the stress distribution around bone, implant, and tooth in tooth implant fixed prosthesis under static load with variations in design and location of nonrigid connectors under simulated functional loads. Materials and Method: Three, 3-dimensional FE models connecting tooth and implant were constructed with different location and type of nonrigid connector. Simulated occlusal load was applied on the restorations and stresses developed in the supporting structures were monitored. Results: The highest stresses were found around the implant in model with nonrigid connector placed between the tooth and implant and model with modified nonrigid connector. On the other hand, less stress was noted around the implant where nonrigid connector was placed between the implant and pontic. Conclusion: It is advisable to place the nonrigid connector between the implant and the pontic to protect the implant from torque effects in a tooth implant fixed prosthesis.
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Effectiveness of casein phosphopeptide-amorphous calcium phosphate and xylitol chewing gums on salivary pH, buffer capacity, and Streptococcus mutans levels: An interventional study
Krishnan Padminee, Saravanan Poorni, Davidson Diana, Dasarathan Duraivel, Manali Ramakrishnan Srinivasan
September-October 2018, 29(5):616-621
DOI:10.4103/ijdr.IJDR_166_17  PMID:30409942
Aim: The aim of the study is to compare the anticariogenic effectiveness of Casein phosphopeptide- Amorphous Calcium phosphate (CPP-ACP) and xylitol chewing gums based on salivary pH, buffer capacity, and Streptococcus mutans levels. Materials and Methods: A group of twenty individuals in the age group of 18–25 years were randomly divided into two Groups A and B. Test arm A received xylitol gums and test arm B received CPP-ACP gums and they were instructed to use the gums thrice daily for 2 weeks. Unstimulated salivary samples were collected before they began the use of the gums for baseline values, 24 h after beginning the usage of chewing gums and at the end of 14 days. The samples were analyzed for pH, buffer capacity, and S. mutans levels. Results: A statistically significant reduction of salivary S. mutans levels, improvement in salivary pH, and buffer capacity were displayed in both groups 24 h and 14 days after the intervention when compared with baseline. Group B showed more statistically significant improvement in pH than group A after 24 h (P = 0.028) and at the end of 2 weeks (P = 0.041). Conclusion: CPP-ACP has better ability than xylitol in improving the pH of saliva. Both CPP-ACP and xylitol gums individually have remarkable ability in bringing down S. mutans levels while simultaneously improving the pH and buffer of saliva.
  - 2,175 109
Gaps in oral health-care service provision systems for children in Nigeria: A case study of a tertiary health institution
Olawunmi Adedoyin Fatusi, Eyitope Ogunbodede, Christiana Ayomide Sowole, Morenike Oluwatoyin Folayan
September-October 2018, 29(5):622-626
DOI:10.4103/ijdr.IJDR_734_16  PMID:30409943
Background: The study investigated the common dental conditions of children seen in a Nigerian tertiary hospital. The referral patterns were also determined to know how many of the patients had sought care at the lower levels of health before visiting a tertiary hospital. Methods: All the children aged 0–15 years seen at the Dental hospital, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria over a 4-year period were included in the study. Information retrieved from their case notes including patterns of referral, presenting complaints, diagnosis, and treatment were extracted from the case records of the patients. Treatment plans for patients seen at this tertiary hospital were categorized into primary, secondary, and tertiary health-care services. Results: A total of 1,866 children sought treatment over a 4-year period at this tertiary hospital of which 1715 (91.9%) sought treatment without referral from lower levels of care. Only 102 (5.4%) children were referred from primary health care (PHC) centers. Six hundred and seventy-five (36.2%) children presented with pain while 502 (26.9%) attended for a “check-up.” Furthermore, 779 (41.8%) children were diagnosed with periodontal disease (including gingivitis) and 539 (28.9%) with dental caries. Scaling and polishing with oral hygiene instruction was the most common treatment recommended. Only 5% of children seen at this tertiary health facility required specialized oral health-care services provided by tertiary health institutions. Conclusions: The range of oral health care needed and service provided by and for patients who visited this tertiary health-care institution can be effectively provided in a primary or secondary oral health-care delivery center. The poor integration of oral health care into PHC services in Osun State burdens the tertiary health-care institutions to provide nonspecialized oral health-care services.
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Evaluation of incidence of mental nerve loop in Central India population using cone beam computed tomography
Deepshikha Rodricks, Tushar Phulambrikar, Siddharth Kumar Singh, Anjali Gupta
September-October 2018, 29(5):627-633
DOI:10.4103/ijdr.IJDR_50_17  PMID:30409944
Context: Anatomical literature has described the anterior loop being an extension of the mental nerve which is present anterior to the mental foramen while the caudal loop has been described as the distance between the lower border of the mental foramen and the lowest point of the mandibular canal. The knowledge and identification of the anterior and caudal loop of the mental nerve are important in surgical procedures performed around the mental foramen to avoid inadvertent damage to these vital structures resulting in postoperative complications. Aim: The present study was conducted to determine the incidence and measurement of mental nerve loop in the mandibular arches using cone beam computed tomography (CBCT). Settings and Design: A total of 200 CBCT images were retrieved and inspected for the presence of the mental nerve loop. The length of the anterior loop was measured by counting the number of consecutive contiguous vertical cross sections displaying two round hypodense images. This number was multiplied by the thickness of the slices. The caudal loop was measured as the distance between the lower border of the mental foramen and the lowest point of mandibular canal. Statistical Analysis Used: Shapiro–Wilk test and Mann–Whitney U-test were used. P < 0.05 was considered statistically significant. Results: 57.5% (n = 200 scans) presented with the anterior loop of the mental nerve with a mean length of 0.50 mm and 0.37 mm on the right side and left side, respectively. All the samples of CBCT scans taken were having caudal loop extension with a mean length of 3.53 mm. Conclusion: A considerable number of individuals (57.5%) in the present study presented with the anterior loop of the mental nerve. CBCT was found to be an effective imaging modality for the detection of anterior loop of the mental nerve.
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Sodium bicarbonate: A review and its uses in dentistry
Sathyasree Madeswaran, Sivakumar Jayachandran
September-October 2018, 29(5):672-677
DOI:10.4103/ijdr.IJDR_30_17  PMID:30409952
Denture stomatitis, periodontitis, and peri-implantitis are the growing problems in restorative dentistry. Chemicals play an important role as an adjuvant to mechanical cleaning of teeth, implants, surrounding tissues, and prostheses. Current mouth rinses are reported to affect the tissues and prostheses if used on a long-term basis. Sodium bicarbonate, the common baking soda, has been reported to be versatile. A search of the resources through Medline and Google Scholar was made to understand the current status of the mouth rinses and the use of sodium bicarbonate. Different MeSH and search criteria were used for the different search engines. Baking soda, being a common household item, with its ready availability, safety, minimal abrasivity, and bactericidal property makes it a patient-friendly mouthwash, component in the dentifrice, or chewing gum, which can be used on a long-term basis as an adjunct virtually free of any side effects.
  - 29,367 241
Comparison of shear bond strength of orthodontic color change adhesive with traditional adhesive
Sara Youssefinia, Omid Mortezai
September-October 2018, 29(5):690-692
DOI:10.4103/ijdr.IJDR_780_16  PMID:30409956
Introduction: The purpose of this study was to compare the shear bond strength of color-change adhesive with a conventional light-cure adhesive at different debonding times. Materials and Methods: Seventy-two intact extracted human permanent premolar teeth were used in this research. The brackets were bonded with Transbond XT (Group I) and Transbond Plus color change adhesive (Group II). Each of the two adhesive groups were then further divided into three subgroups of 12 specimens each, for a total of six subgroups. The subgroups represented the three different time points to be tested, 15 min, 24 h, and 1 week. Then, the shear bond strength (SBS) of the brackets was tested with a Universal Testing Machine. Adhesive remnant index (ARI) scores were calculated for each debonded teeth. Results: Although Transbond XT yielded the lowest SBS values at 1 week, there was no significant difference between samples regarding shear bond at different times and ARI. Conclusion: The application of these adhesives did not affect bond strength. Both adhesives demonstrated acceptable bond strength to withstand orthodontic forces throughout the experiment.
  - 1,240 67
Ectopic teeth in the maxillary sinus: A case report and literature review
LG Lombroni, G Farronato, G Santamaria, DM Lombroni, P Gatti, Marco Capelli
September-October 2018, 29(5):667-671
DOI:10.4103/ijdr.IJDR_347_17  PMID:30409951
Ectopic eruption of teeth is a rare phenomenon although there have been reports of teeth in the nasal septum, mandibular condyle, and maxillary sinus. This impaction can present itself in a variety of ways such as chronic or recurrent sinusitis, sepsis, and facial numbness and can also be asymptomatic. The aim of this study was to describe, by means of research literature and by a case report, the characteristics and occurrence of ectopic eruption in the maxillary sinus. We have analyzed and compared clinical cases of ectopic teeth in the maxillary sinus with a search on PubMed utilizing keywords such as “ectopic,” “teeth,” “sinus,” “maxillary,” and Boolean operators “or” and “and” up until 2016. Fifty-one cases were found, of which 53% were female. The age ranged between 3 and 72 years, with an average age of 28.36 years. The higher prevalence of ectopic teeth is the 3rd molars. Ten of these teeth are associated with a dentigerous cyst, 1 by an osteoma, and 2 by soft tissue. Standard treatment for an ectopic tooth is extraction, but for other patients, treatment of choice in asymptomatic ectopic tooth cases is continued observation. Ectopic teeth tend to form a cyst or tumor if not managed.
  - 3,521 82
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