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   Table of Contents - Current issue
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May-June 2022
Volume 14 | Issue 3
Page Nos. 209-330

Online since Tuesday, June 28, 2022

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REVIEW ARTICLES  

Dental care service quality assists in comprehensive clinical dental risk management: A narrative review p. 209
Didin Mirandani, Darmawan Setijanto
DOI:10.4103/jioh.jioh_221_21  
Aim: There are numerous studies developed to assess the service quality in health care. Risk management in health care is viewed as the most difficult duty during the delivery of health services, as healthcare risks have a significant impact on the wellbeing of patients, clients, visitors, and healthcare employees and can disrupt the smooth delivery of health services. The aim of this study is to review the literature associated with the critical contribution of risk management theory in measuring the quality of dental services. Materials and Methods: The main search engines used for the literature review were PubMed central and ScienceDirect. Articles were limited to those published within the past 5 years. The article type was review articles. Result: The initial search retrieved 30 articles. After a full‐text review of all the articles, only 10 were included. The review article contributes to the knowledge that the involvement of risk management theory in the assessments of service quality can affect the increasingly high quality of service and avoid a harmful effect on patients in dental practices. More risk management procedures were used in dental treatment, which had a favorable impact on the quality of service provided to patients. Conclusion: The application of risk management theory in dental practices can continuously improve patient care while also lower the incidence and severity of accidents that could lead to medical malpractice or professional liability lawsuits.
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Evolution of facial profile and soft tissue methods of orthodontic assessments: A narrative review p. 215
Juliza Md Lepi, Noraina H Norman
DOI:10.4103/jioh.jioh_302_21  
Aim: Facial soft tissue assessment in orthodontics influences diagnosis, treatment plan, treatment approach, and prediction of potential relapse. It is also paramount in facial aesthetics forethought and outcome. Thus, optimum assessment is essential for accurate diagnosis and treatment planning. This article aims to provide a broad overview of the evolution of profiles and soft tissue assessment methods established, highlighting the advantages and disadvantages of techniques available in the field. Materials and Methods: Data were obtained by an electronic search through databases of PubMed, Scopus, Web of Science, and Google Scholar. Results: Literature search in PubMed database using the free-text terms:“((facial profile) OR (soft tissue)) AND (methods orthodontic assessment)” presented with 811 articles from 1978 to August 2021. A search in the Scopus database under the same key words resulted in 1818 relevant primary documents indexed in Scopus from the year 1970 to 2021, whereby Web of Science database yielded 12 articles. A search on google scholar by “facial profile and soft tissue methods of orthodontic assessment” keywords gave out 24,200 articles published. Thirty-one significant articles were included in this review. Conclusion: This review provided simplified information on transformation of profile and soft tissue diagnosis techniques alongside technological advancement in orthodontic practice that has taken place over the years. The evolution from conventional to advanced techniques carries their own strengths and weaknesses. Cost-effectiveness, accessibility, and availability of two-dimensional methods superseded the three-dimensional systems in daily clinical practice providing practical and beneficial information as an adjunct to orthodontic diagnosis.
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Clear Aligners: Where are we today? A narrative review p. 222
Bushra Kanwal, Keerthan Shashidhar, MN Kuttappa, US Krishna Nayak, Akshai Shetty, Karishma A Mathew
DOI:10.4103/jioh.jioh_334_21  
Aim: The aim of this review article is to discuss the current role of Clear Aligners in treating various malocclusions and the effectiveness of aligners when compared with braces using recent literature. Materials and Methods: Literatures pertaining to production of aligners, efficacy and treatment outcome of aligners, root resorption in aligners, periodontal health during aligner treatment, and comfort levels during aligner treatment were reviewed from PubMed, Scopus, and Google Scholar databases and included selected systematic reviews. Results: The literature cited during the initial days of aligners showed contrasting results when compared with articles cited recently. It was mainly observed in improvement in the scope of treating various malocclusions. However, the results show that aligners still do not possess the ability to create an extensive range of movements when compared with braces. Conclusion: Despite the claims, evidence for the effectiveness of clear aligners is generally lacking. In mild-to-moderate instances, shorter treatment duration and chair time appear to be the only substantial benefits of transparent aligners over conventional systems supported by current evidence. Advantages of clear aligner therapy were reported for better aesthetics, comfort at an early stage, easier oral hygiene maintenance, and improved periodontal health. Based on the available evidence, clear aligner therapy is definitely effective in managing minor malocclusion and shows acceptable results with moderate malocclusion.
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ORIGINAL RESEARCH Top

Effect of Miswak versus standard preventive measures for caries control of young Egyptian adults: A randomized controlled clinical trial p. 230
Rania Rashad Taha, Elham Mostafa Fawzi, Shereen Hafez Ibrahim
DOI:10.4103/jioh.jioh_359_21  
Aim: To evaluate the effectiveness of Miswak in comparison with standard caries preventive measures for the prevention of new carious lesions in high caries risk patients. Materials and Methods: In this randomized control clinical trial, 26 participants per group of dental students aged from 18 to 25 years were recruited with high caries risk based on sample size calculation. The DMF score was determined. Plaque index was recorded at baseline and after 1 year. Participants were randomized into one control group and two intervention groups. The control group (Group 1) used the standard oral hygiene measures. Group 2 used Miswak only, whereas Group 3 used Miswak plus toothbrush and toothpaste. Data were collected and statistically analyzed with the significance level set at P ≤ 0.05 within all tests. Results: Caries risk assessment revealed that at baseline, there was no statistically significant difference in plaque index score distribution between the different study groups (P = 0.532). At baseline, there was no statistically significant difference in DMF counts distribution between the different study groups (P = 0.268 in D counts, and P = 0.268 in F counts). There were no new lesions detected in all groups at different evaluation times. Conclusions: Using Miswak as a natural product solely is as effective and safe as using the standard oral hygiene measures combined. The use of a time-saving preventive regimen could be promising for the compliance of the high caries risk population.
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Evaluation of the efficacy of platelet-rich plasma (PRP) and injectable platelet-rich fibrin (i-PRF) in the acceleration of canine retraction: A randomized controlled trial p. 243
Rahaf Esam Naji, Talar Simon Zeitounlouian, Eyad Alomari, Mohamed Youssef
DOI:10.4103/jioh.jioh_330_21  
Aim: To compare the effectiveness of the intra-ligament injection of platelet-rich fibrin (i-PRF) and platelet-rich plasma (PRP) on canine movement rate during its orthodontic retraction. Materials and Methods: A randomized controlled trial with a split-mouth design included 40 patients (21.3 ± 1.8 years) whose all first premolars were indicated for extraction. Twenty patients were randomly allocated to each group (PRP vs. i-PRF). The Canine retraction was performed using Ricketts spring. PRP and i-PRF were injected twice in the intervention side with a 21-day interval. Saline was used likewise in the control side. Canine movement, rotation, and molar anchorage loss were measured on dental casts, whereas canine inclination was studied on cephalograms. Shapiro–Wilk normality test was performed, and a paired t-test was subsequently used for comparison within the same group. In addition, a two-sample t-test was used to compare the two groups. Results: A significantly higher rate of canine movement was observed in the PRP intervention group during the first month, unlike the i-PRF group in comparison with the control side. Besides, canine retracting rate was higher in the PRP group during the third month than in the i-PRF group. No statistical differences in canine inclination, rotation, and molar anchorage loss were found except for mandibular canine rotation in the PRP group and maxillary canine rotation between the two groups. Conclusion: PRP injection was probably better than the i-PRF in accelerating canine movement without avoiding the unwanted effects.
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Effect of oral function problems on depression in Korean adults: Analysis of data from the National Health and Nutrition Examination Survey p. 254
Eun Gyo Son
DOI:10.4103/jioh.jioh_281_21  
Aim: To identify changes in oral function problems in Korean adults by comparing and analyzing changes before and after the expansion of dental health insurance across units of a 5-year period and to identify the relationship between oral health and depression. Materials and Methods: This research study used raw data from the 4th National Health and Nutrition Survey 2009, the 6th National Health and Nutrition Survey 2014, and the 8th National Health and Nutrition Survey 2019. A total of 26,193 participants aged 19 years or older were included in the study. The data were analyzed using SPSS Statistics 24.0. Results: The results showed that the application of dental health insurance helped in solving oral function problems and oral function problems that influenced depression. Conclusion: Thus, the use of oral supplements and customized education according to gender are required. In addition, although there was a difference in oral aids by year, it had an effect on chewing and speaking problems. To solve more oral function problems, it is necessary to expand the coverage of dental health insurance.
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Antimicrobial efficacy of Andrographis paniculata, sodium hypochlorite, and their combination with diode laser on endodontic pathogen—Enterococcus faecalis—An in vitro study p. 260
KG Malavika, Rajakumar Sekar, Kavitha Ramar
DOI:10.4103/jioh.jioh_39_22  
Aim: To evaluate and compare the antimicrobial efficacy of Andrographis paniculata and sodium hypochlorite with diode laser on endodontic pathogen Enterococcus faecalis. Materials and Methods: An in vitro study in which 40 freshly extracted single rooted anterior teeth with no root caries, apical fractures are collected. A sample size was calculated using G*Power Software. All the teeth are decoronated and prepared by using ProTaper Gold (DENTSPLY) rotary file system. The apex is then sealed and waterproofed by applying nail varnish. Precultured inoculum of E. faecalis strain is inoculated and then teeth are randomly divided into four groups with 10 teeth in each group; each group is irrigated with 0.5% of A. paniculata, 3% of sodium hypochlorite, laser-activated 3% sodium hypochlorite, and laser-activated 0.5% A. paniculata, respectively. Pre- and postirrigation colonial count is obtained. Statistical analysis of all the data was analyzed using SPSS 20.0 (Armonk, NY, USA); Analysis of Variance (ANOVA) was performed for comparing variation between groups and multiple comparison tests performed for intergroup comparison. Results: The reduction of colony count postirrigation of about 96% in group 4, 90% in group 3, 48% in group 1 with a least reduction of about 24% in group 2 is observed (P = 0.000). Conclusion: All four irrigation methods included in this study proved to be effective against E. faecalis, but A. paniculata with diode laser came off as an equally efficient method of disinfection compared to sodium hypochlorite with diode laser combination and highly efficient than plain A. paniculata and sodium hypochlorite.
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Evaluating the antibacterial efficacy and minimal bactericidal concentration (MBC) of three different herbal extracts on recalcitrant endodontic pathogens - An in vitro study p. 266
S Rajakumar, MP Revanth, Anand Kasi, P Sujitha
DOI:10.4103/jioh.jioh_5_22  
Aim: To evaluate the antibacterial efficacy, minimal inhibitory concentration, and minimal bactericidal concentrations of different herbal extracts against endodontic pathogens. Materials and Methods: The Microbiological samples were taken using sterile paper points from the root canals undergoing retreatment and samples were transferred into cultural plates containing selective media and incubated for 24hrs for the specified bacterial growth. The methanolic extracts of plant were obtained and stored in capped bottles at 4°C until use. The susceptibility of endodontic bacteria to the various plant extracts at different concentrations was analysed using disc diffusion method by measuring the diameter of the inhibition zones. Minimum inhibitory concentration (MIC) and Minimum bactericidal concentration (MBC) of the extracts were assessed to determine the efficient plant concentration against the resistant endodontic bacteria. Triplicates of all the tests were carried out. The average of three experiments were subjected to statistical analysis. Data was analysed using one way ANOVA using SPSS version 20.0 (Armonk. NY, USA) to find out the zone of inhibition of herbal extracts against microbiota. Results: Clitoria Ternatae exhibits significance (P ≤ 0.05) and higher inhibitory zones (30.33 ± 1.528, 30.43 ± 0.577, 20.33 ± 1.528) against all three micro pathogens. ClitoriaTernatea at its minimal concentration of 102 mg/ml is better against all the pathogens, the least being Veronica Officinalis (425 mg/ml). Conclusions: ClitoriaTernatea, showed better bactericidal action under lower concentrations against all pathogens followed by Altheae officinalis and Veronica officinalis.
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Comparative evaluation of the vertical and horizontal root fracture resistance of primary maxillary incisors obturated with zinc oxide eugenol, vitapex, and endoflas: An in vitro study p. 273
Nidhi Talreja, ND Shashikiran, Shilpy Singla, Shikha Mali, Nikita Agrawal, Juhi Lohiya
DOI:10.4103/jioh.jioh_206_21  
Aim: To evaluate and compare the vertical and horizontal root fracture resistance of primary maxillary incisors obturated with zinc oxide eugenol, vitapex, and endoflas. Materials and Methods: The present research is an in vitro comparative study. Eighty extracted primary maxillary incisors, selected by random sampling method were allocated to four groups depending on the type of material used for obturation, Group I: Control group. Group II: Zinc Oxide Eugenol. Group III: Vitapex Group IV: Endoflas. Specimens were loaded vertically and horizontally by a conical spreader tip affixed to an Instron testing machine until the root fractured. The load at fracture and the pattern of fracture were recorded. Results: Results were compiled and analyzed statistically by using one way ANOVA followed by Tukey’s post hoc Test and Unpaired t-test for comparison of force between amongst groups. The load at which fracture occurred was significantly higher for Endoflas followed by Zinc oxide eugenol, Vitapex, and was least in the control group. Conclusion: Within the limitations of this in-vitro research, it can be concluded that both the vertical and horizontal root fracture resistance was highest in Endoflas followed by Vitapex and zinc oxide eugenol which showed similar fracture resistance and was least in the control group. The proposed obturating materials provided resistance to occlusal load that is higher than the physiologic chewing force in children.
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Influence of prognostic factors on survival in lymphoma of oral cavity and maxillofacial region in a Peruvian population: A historical cohort study p. 281
Janet-Ofelia Guevara-Canales, Rafael Morales-Vadillo, Jaime-Enrique Montes-Gil, Carlos-Edmundo Barrionuevo-Cornejo, Carlos-Enrique Cava-Vergiú, Sonia-Julia Sacsaquispe-Contreras
DOI:10.4103/jioh.jioh_306_21  
Aim: To determine the influence of prognostic factors on the survival of patients who had been diagnosed with lymphoma of the oral cavity and maxillofacial region (OC/MR) and received care at the National Institute for Neoplastic Diseases (INEN). Materials and Methods: This was a retrospective cohort study. This type of study is classified as observational, analytic, longitudinal, and retrospective. The sample consisted of cases diagnosed with primary lymphoma of the OC/MR (151 altogether), over the 13 years included in the study (1997–2010). The sample only included patients for whom histopathological diagnosis was confirmed by re-evaluation of the histological section. Clinical histories were reviewed to retrieve the following variables as potential prognostic factors: age, sex, location of the lesion, size, signs/symptoms, diagnosis, clinical stage, international prognostic index, serum lactate dehydrogenase levels, extranodal involvement, and treatment. The study was approved by the hospital Institutional Review Board. The following statistical analyses were applied: (1) analysis by actuarial technique and Kaplan–Meier product-limit method for survival and (2) univariate analysis with the log-rank test and multivariate analysis using Cox regression model for prognostic factors and hazard function. Results: Out of the 151 patients diagnosed, 50 were included in the study. Survival at 2 and 5 years was 69% and 47%, respectively. Multivariate analysis showed that survival is influenced by presence of pain, clinical stage, extranodal involvement, and treatment type. A single significant variable was established as the best hazard function: clinical stage III/IV, with patients at these stages being 6.86 times more likely to die than patients at clinical stage I/II. Conclusion: Based on the methodology and statistical analyses used, it was mainly found that survival at 5 years was lower than specified in international reports and that prognostic factors influencing survival jointly were pain, clinical stage, extranodal involvement, and treatment. For hazard function, it was found that the probability of dying was high when the patient was at clinical stage III/IV, which had the greatest influence or created the highest risk of dying among all prognostic factors analyzed.
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Expression of Sirtuin 3 in oral cancer and oral leukoplakia: A cross-sectional observational study p. 290
Nandhini Ramesh, Chandrasekar Lakshmi Krithika, Asokan Kannan, Ganesan Anuradha, Yesoda K Aniyan
DOI:10.4103/jioh.jioh_9_22  
Aim: To evaluate Sirtuin 3, a protein-coding gene regulator that is contemporary in research and has gained importance rapidly in the recent years, and to correlate its expression in normal tissues, smokers without lesion (SWL), oral leukoplakia (OL), and oral cancer. Materials and Methods: The prospective study of sample size of 52 tissues was divided into 4 groups such as normal (n = 13), SWL (n = 13), OL (n = 13), and oral cancer (n = 13) based on simple randomization. The tissue samples of OL and oral squamous cell carcinoma (OSCC) were subjected to histologic examination. Real-time polymerase chain reaction was carried out in 52 samples to evaluate the expression of Sirtuin 3. The Shapiro–Wilk test was used for normality testing. The Kruskal–Wallis test was used for intergroup comparison of cycle threshold, followed by Dunn’s post hoc analysis. Results: The post hoc analysis showed that there was a statistically significant difference between normal group and other study groups (smokers, leukoplakia, and OSCC) (P < 0.001). A statistically significant difference was also observed between leukoplakia and oral cancer for the concentration of Sirtuin (P = 0.0004). Intergroup comparison for cycle threshold revealed no statistically significant difference between the study groups. Conclusion: Sirtuin 3 was well expressed in oral cancer and OL tissues, suggesting that it could be added to the oncogenic profile. The expression of Sirtuin 3 increases with an increase in grades of dysplasia and could aid in understanding its role in the pathogenesis of potentially malignant disorders and oral cancer and can also be an ideal evaluator of prognosis.
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Assessment of pain and intraoperative anxiety by computerized and traditional local anesthetic methods in periodontal therapies: A comparative study p. 298
Abhishek Vivek Haridas, Deepika Pawar Chandrashekara Rao, Moitri Ojha, JT Madhushree
DOI:10.4103/jioh.jioh_259_21  
Aim: To evaluate and compare the pain perception and intraoperative anxiety of patients who underwent the computer-controlled local anesthetic technique (CCLAD), as well as the conventional technique. Materials and Methods: This study included 100 individuals who required local anesthetic on both sides of the dental arch for various periodontal operations. We randomized the patients into three groups in our study (root planing, curettage, and surgery). The clinical trial was designed as a “randomized, single-center, single-blinded, parallel-arm, comparative study” with a cross-over design. Randomization was done by the computer-allotted method. Patients who received WAND during first visit in selected quadrants subsequently received “traditional anesthetic technique” during the second visit in contralateral quadrants and vice versa. The patient’s pain perception to each of the two injection procedures was assessed 5 min later using the Wong Baker’s Facial Pain Scale (WBFPS). The anxiety was compared intraoperatively by Wong Baker’s Facial Anxiety Scale (WBFAS) while the procedure was going on. Results: Results from Mann–Whitney U test using SPSS software program, version 17.0 revealed a very aim highly significant difference between WAND and traditional injection regarding pain in all the three groups with WAND showing fewer pain scores (P < 0.05). No statistically significant difference was observed when anxiety was compared in the same groups. Conclusion: In comparison to traditional local anesthetic techniques, WAND produced less pain perception.
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Assessment of proximity of the maxillary premolars roots to the maxillary sinus floor in a sample of Egyptian population using CBCT: An observational cross-sectional study p. 306
Esraa K Morsy, Sahar H El Dessouky, Enas A Abdel Ghafar
DOI:10.4103/jioh.jioh_355_21  
Aim: This research was conducted to assess the relationship between permanent maxillary premolar root apices and the maxillary sinus floor (MSF) in a sample of Egyptian population using cone beam computed tomography (CBCT). Materials and Methods: In this observational cross-sectional study, 128 CBCT scans were coded and recruited using simple random sampling method. A total of 216 upper first premolars and 232 upper second premolars were examined, according to the eligibility criteria. The scans were displayed using Planmeca Romexis® Viewer software, where image analysis was performed on corrected axial, coronal, and sagittal images. Gender of the patient was registered for each scan. The proximity between the maxillary premolars roots and the maxillary sinus floor (MSF) was determined according to Kilic et al.’s 2010 classification. The difference between the prevalence of different sinus relations in males and females was recorded, and correlation between right and left sides was determined. Categorical data were presented as frequency and percentage values and were analyzed using Fisher’s exact test and χ2 followed by multiple pairwise comparisons utilizing multiple z-tests with Bonferroni correction. The significance level was set at P < 0.05 within all tests. Results: The maxillary first premolars showed higher percentages for “No relation,” followed by type 3 than type 2. In contrast, type 2 was the most prevalent sinus relation in maxillary second premolars, followed by type 3. Conclusion: In a sample of the Egyptian population, most of the maxillary first premolars had no relation to the MSF. On the contrary, most of the maxillary second premolars were positioned much closer to the MSF where they recorded the highest percentage for type 2 sinus relation (roots contact sinus). In most cases, the palatal roots were closely related to the MSF than buccal ones in all maxillary premolars.
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Impact of COVID-19 quarantine on oral health among pediatric patients and the parental attitude towards dental treatment at King Abdulaziz University: An observational study p. 316
Narmin Helal, Ghidaa Mouawad, Lujin AlSadun, Osama Felemban
DOI:10.4103/jioh.jioh_267_21  
Aim: The Saudi government implemented a lockdown from March to August 2020 to reduce the risk of COVID-19 transmission. As a result of the lockdown, it was possible for children to improve or develop detrimental eating habits. In addition, parental fear and anxiety may change their attitude toward dental visits. The present study was conducted to assess the pandemic’s impact on oral health in pediatric patients due to dietary choices, oral hygiene, and parental fear and anxiety of getting the infection by COVID-19 from dental visits. Patients and Methods: An observational study, included children with mixed dentition and their parents who have been seen at King Abdulaziz University Dental Hospital in Jeddah, Saudi Arabia before the quarantine and came back after the quarantine to the dental clinics to continue dental treatments. Demographic data, diet evaluation, plaque index, dmfs, and DMFS scores were obtained from the electronic dental record systems from the time periods of before and after the lockdown. In addition, a retrospective diet evaluation during the pandemic and a parental fear and anxiety questionnaire were obtained by telephone interview. Results: A total of 52 children met the study’s criteria. During the quarantine, most children did not take their required amount of the basic foods. In particular, vegetable consumption deteriorated during the pandemic (P = 0.048). Moreover, there was a significant increase in the consumption of lollipops and candy bars as snacks (P = 0.039). Scores of dmft/DMFT and dmfs increased significantly during the quarantine compared to the time period before the pandemic (p=0.001). About 44.2% of parents thought the dental treatment could expose their child to become infected by COVID-19. However, 88.5% of them reported more confidence in visiting dental clinics if they were assured dental clinics are implementing high standard protective measurement against COVID-19. Conclusion: Children had more cariogenic snacks and parents’ confidence increased after knowing the protective measures in dental clinic.
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Inhibitory effect of lemongrass extract (Cymbopogon citratus) in supragingival plaque bacterial growth for gingivitis patient: A research study p. 324
Robiatul Firdaus, Carera I Harryadi, Shafira Kurnia, Agung Krismariono
DOI:10.4103/jioh.jioh_226_21  
Aim: Gingivitis is a type of periodontal disease characterized by the inflammation of the gingival. Generally, gingivitis therapy is done with scaling and root planning and antibiotic medications. However, inappropriate use of antibiotic may lead to antibiotic resistance. An alternative therapy needs to be developed; lemongrass extract (Cymbopogon citratus) has an inhibitory effect on supragingival plaque bacterial growth in gingivitis patients. Materials and Methods: The lemongrass was extracted using the maceration procedure. Eight tubes containing lemongrass extract in different concentration were taken. The other two tubes contain supragingival plaque bacteria suspension as a positive control and brain heart infusion broth media as a negative control. Ten tube samples were tested for its inhibitory effect on the growth of supragingival plaque bacteria and measured using spectrophotometry in the wavelength of 570 nm. The absorbance percentage of a spectrophotometer is used to determine the minimum inhibitory concentration (MIC). The data were analyzed using SPSS for normality test (Shapiro–Wilk test), homogeneity test (Levene’s test), and assumption one-way Analysis of Variances (ANOVA) (Welch test) that continued with post hoc test (Games-Howell test). Results: The absorbance percentage of supragingival plaque bacterial colonies in lemongrass plant extract at concentrations of 100%, 50%, 25%, 12.5%, 6.25%, 3.12%, 1.56%, and 0.78% was 78.8%, 74.6%, 70.5%, 68.8%, 45.5%, 27.3%, 16.1%, and 5.1% of the positive control, respectively. The significance of the statistical test results was of 0.00 (P < 0.05; df = 3; confidence interval 95%). Conclusions: The growth of supragingival plaque bacteria in gingivitis patients is inhibited by extracts of lemongrass (Cymbopogon citratus), with a MIC of 12.5% with 68.8% inhibition.
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