Background: To assess the periodontal status in relation to chronic kidney disease (CKD) using the regular diagnostic methods, in addition to alkaline phosphatase (ALP) enzyme and pH value as biological markers. Most evidence suggests that a bi-directional relationship exists between periodontitis and systemic diseases in general. Materials and Methods: Comparative study with the cross-sectional design having a sample size of 120 participants in Riyadh city, Saudi Arabia. CKD patients ranged from 20 to 65-year-old, dentate (≥10 teeth) are assigned in one of three study groups: (1) Pre-dialysis, (2) on dialysis, and (3) transplant with an n = 30 in each group. Exclusion criteria: Those who refused to consent, patients who have an additional systemic disease such as diabetes, hepatitis, smokers, pregnancy, patients with history of any periodontal treatment and/or antibiotic therapy in previous 6 months. The non-invasive oral examination was performed to evaluate the gingival index, plaque index, and clinical attachment loss (CAL). Salivary sample collection in 10 ml sterile test tube. Results: The mean age of the patients was 41.90 ΁ 12.08 years. There were a total of 55.8% (n = 67) males and 44.2% (n = 53) females. The highest percentage of mild gingival inflammation was found in the hemodialysis patients 70% (n = 21). Moderate and severe periodontitis were distinctly higher in the dialysis group. Kruskal-Wallis H-test showed no statistically significant difference in the ALP and pH between the groups (P > 0.05). The overall correlation between CAL, ALP, and pH value showed a positive statistical significance at the level of 0.01. Conclusion: On the basis of results of this study, it can be concluded that the activity of ALP enzyme and pH levels were Increased in the saliva of patients with dialysis therapy as a consequence of severe periodontal destruction in this group specifically.

Background: A standard Arabic questionnaire concerning the effect of health warnings on cigarette package labels is lacking in the Arabic world. This questionnaire may be useful to assess smokers' awareness of cigarette package warnings and the health risks of smoking. The aims of the current study are (i) To develop a new Arabic questionnaire that can assess the impact of cigarette package warnings on smokers relative to their awareness of the health risks of smoking, (ii) to assess its reliability, and (iii) to assess construct validity using factor analysis. Materials and Methods: A pilot cross-sectional study, including 447 Saudi smokers, was used because Gulf Council Countries (GCC) countries enforce graphic health warnings on all cigarette packages. A standard Arabic questionnaire was developed by the Ministry of Health, Saudi Arabia to measure the impact on smokers relative to the GCC graphic health warnings on cigarette packages. The questionnaire included nine items. Results: The results suggest that the questionnaire is reliable and internally consistent with Cronbach's alpha of 0.89, 0.90, and 0.92 for Picture 1 "Early Death," Picture 2 "Secondhand smoking," and Picture 3 "Diseases," respectively. The factor analysis resulted in a two-factor solution accounting for the Picture 1 "Early Death" and Picture 2 "Secondhand smoking;" however, the Picture 3 "Diseases" resulted in only a one-factor solution. Conclusions: The study suggests that the questionnaire regarding Arabic health warnings on cigarette packages is valid and reliable to communicate the health risks of smoking among smokers. Accordingly, we recommend a community-based study to include a large number of smokers across all GCC countries to assess smokers' awareness of package warnings and the health risks of smoking.

Introduction: In this article, we present a modification of the conventional inferior alveolar nerve block technique which is simple, easy to master, has high success rate and comfortable to patients as multiple needle penetrations are avoided. In the standard technique, following anesthesia of inferior alveolar nerve, the needle is redirected for lingual nerve anesthesia leading to potential complications, which is avoided in single injection straight line technique. Materials and Methods: A clinical study of alternative inferior alveolar nerve block along with long buccal and lingual nerve blocks, by injecting local anesthesia into the pterygomandibular space by single penetration without redirecting the needle was performed on 207 patients undergoing simple extractions and surgical extractions of mandibular molars. The study was conducted over a period of 2 years. Results: Among 207 patients who underwent extraction, anesthesia was completely successful in 202 patients. The remaining 5 patients needed a second cartridge of anesthesia as first cartridge did not achieve desired anesthesia. The success rate in this study was 97.5%. Conclusion: This new technique provided a high success rate and was easier to master. Moreover, this technique does not involve deflecting the needle to anesthetize lingual nerve. Discomfort due to injection of needles is reduced as there is no second injection for blocking long buccal nerve. Psychologically, the patient is better prepared too.

Background: Inadequate apical seal is a major cause of surgical endodontic failures. Therefore, the use of a suitable substance as root-end filling material that sets immediately and prevents penetration of potential contaminants into the periapical tissue is vital. The aim of present study was to compare the marginal adaptation of calcium-enriched mixture cement (CEM-cement) and CEM-cement plus calcium chloride (CaCl2) (as an accelerator) using scanning electron microscope (SEM). Materials and Methods: 24 extracted human single-rooted teeth were decoronated from the cemento-enamel junction to prepare 16 mm roots. After cleaning, shaping, and obturation, 3 mm above the apex was cut perpendicular to the long axis, and an apical cavity was prepared by an ultrasonic device. Specimens were randomly divided into two groups and were retro filled by experimental materials (CEM-cement and CEM-cement + CalCl2). Next, the roots were sectioned, and SEM examination was done to determine the gap size between cavity walls and end-root materials. The collected data were analyzed by Mann-Whitney test and using SPSS software version 18 at a significant level of 0.05. Results: The mean gap size was higher in CEM-cement + CaCl2 group in comparison with CEM-cement group. However, no significant differences were observed by statistical test (P = 0.79). Conclusion: CaCl2 as an additive substance for acceleration of CEM-cement setting cannot remarkably influence the marginal adaptation of CEM to the root canal walls.

Background: Calcium silicate cements (CSCs), if used for pulp capping or furcation repair, are covered with a restoration. The role of different time intervals of the conditioning process used for final restorations for new CSCs has not been studied. The aim of this study was to evaluate the effects of acid etching on the compressive strengths of biodentine (BD), endosequence bioceramic root repair material-fast set putty (ERRM-FSP), and ProRoot mineral trioxide aggregate (PMTA) at 24 h or 7 days. Materials and Methods: A total of 144 specimens were prepared (48 per material). For each material, 12 specimens were subjected to acid etching at 24 h or 7 days. Compressive strengths were evaluated in accordance with ISO 9917-1:2007 recommendations. Specimens were crushed along their long axis using a universal testing machine. The maximum load required to fracture each specimen was recorded in megapascals. Compressive strengths were compared with the unetched control groups. Results: For all materials, the compressive strengths were significantly higher at day 7 than at 24 h. There were no statistically significant differences between the control and etched groups at 24 h or 7 days for the materials tested. Overall, the compressive strength was significantly lower for ERRM-FSP than for PMTA and BD. Conclusion: The acid-etching procedure did not affect the compressive strength of BD, ERRM-FSP, or PMTA. However, the postponement of the acid-etching procedure until 7 days after CSC placement is suggested to reduce the possibility of displacement.

Background: Self-etching adhesives might be an effective alternative to conventional phosphoric acid etchants in conditioning the enamel surface. The objective of this in vitro study was to evaluate and compare microleakage of a fissure sealant applied following the use of two brands of self-etching adhesives. Materials and Methods: 78 sound maxillary first permanent premolars received enameloplasty and randomly distributed into 3 different groups according to enamel surface conditioning before sealant (ClinproTM) application: (1) Conditioning with 35% phosphoric acid (ScotchbondTM Etchant) (Group 1); (2) conditioning with self-etching adhesive (Xeno®V) (Group 2); and (3) conditioning with self-etching adhesive (Optibond® All-In-One) (Group 3). Samples were: Thermocycled, stained, sectioned, and examined for marginal microleakage. Results: Marginal leakage was significantly lower with conventional etching than with self-etching adhesives while Xeno®V resulted in resulted in significantly less microleakage than Optibond® All-In-One. Conclusions: Marginal leakage of the self-etching adhesives (Xeno®V and Optibond® All-In-One) was found to be significantly more compared to that of the conventional phosphoric acid etching even with enamel preparation. Etching enamel with phosphoric acid is still essential for sealing the enamel-sealant interface.

Background: There is a direct relationship of dental status and food intake. Impairment of oral health has an influence on quality of life. Baseline information related to prosthetic status and prosthetic needs will help us to undertake actions to promote the oral health. The present study was conducted to evaluate the prosthetic status and treatment needs among patients who reported to the Department of Prosthodontics in SJM Dental College and Hospital and to assess the influence of socio-demographic factors. Materials and Methods: All the patients who reported to the Department of Prosthodontics in SJM Dental College and Hospital for a period of 3-month were included. Information related to socio-demographic factors and a clinical examination was carried out according to the World Health Organization method to assess prosthetic status and needs. Results: There were a total of 314 subjects, of which 143 (45.54%) were males and 171 (55.44%) were females. 80.89% of patients had no prosthesis in upper arch 84.71% of subjects for lower arch. 67.51% of subjects required a prosthesis for the upper arch and 64.33% for the lower arch. Age has an influence with prosthetic status and needs. Gender and socio-economic status were statistically non-significant with prosthetic status and needs. Conclusion: The prosthetic status of the studied population was low with 65.92% of the patients needing prostheses.

Background: Traumatic dental injuries (TDI) commonly occur in children during school hours. However, the majority of the teachers are unaware about adequate emergency management. The purpose of the study was to assess the knowledge and attitude among private and public school teachers in urban and rural areas towards the management of TDI. Materials and Methods: A total of 609 teachers from urban and rural areas have volunteered to participate in this study. A multiple choice questionnaire was designed and given to the teachers to mark the appropriate answer. Comparative analysis between private and public teachers in urban and rural areas was carried out using Chi-square test. Results: In public schools, teachers from the urban area were found to be more knowledgeable than the rural area, whereas among private schools, rural area teachers were more knowledgeable than urban teachers with regard to management of TDI. However, there was no significant difference among total urban and rural teachers in the emergency management of avulsion injuries. Conclusion: The present study revealed that the knowledge and awareness among both urban and rural teachers were inadequate. Hence, educative programs are very essential for teachers, as they are the first responders in case of dental trauma in schools.

Background: Rheumatoid arthritis (RA) and chronic periodontitis (CP) are chronic destructive inflammatory disorders which result from deregulation of the host inflammatory response. Both conditions are potentiated by an exaggerated inflammatory response featuring an increase in local and perhaps circulating pro-inflammatory mediators, resulting in the destruction of the soft and hard tissue surrounding the synovial joints and periodontium. To detect the periodontal bacterial DNA in the subgingival dental plaque of RA and CP patients using polymerase chain reaction (PCR). Materials and Methods: In this study, 80 subjects were selected based on the inclusion and exclusion criteria and divided into four groups. Group I (healthy - 20), Group II (CP - 20), Group III (RA - 20), and Group IV (RA and CP - 20). Subgingival plaque sample was collected with sterile paper points, and micro-organisms were analyzed using PCR. Result: All four groups showed a statistical significant of (P ≤ 0.001) with the difference in the detection of the number of organisms, with the increase in the level of Tannerella forsythia in the RA + CP group. Conclusion: The results of our study suggested that periodontal bacterial DNA may have a major pathological role in the development of RA.

Background: The study was aimed to compare the efficacy of caries removal, time taken, pain threshold experienced by the patient and anxiety experienced during various caries removal methods. Materials and Methods: 80 primary molars of 40 children between the age groups of 3-7 years were selected randomly and divided into two groups of 40 teeth each: Group I treated by the mechanical method and Group II with Carie care method. The efficacy, time taken, and the pain threshold were evaluated during the caries removal by Ericson D et al. scale, visual analog scale, and modified child dental anxiety scale, respectively. Results: Highly significant co-relation was observed when the intergroup comparison was made using one-way analysis of variance. Conclusion : It was concluded that Carie care gel was efficient in caries removal and can be used as an alternative for the airotor in the management of dental caries especially in children.

Background: Pattern of palatal rugae is extremely unique to humans as are fingerprints. As genetics play a role in the determination of palatal rugae, hence these can be used in gender determination as well as population differentiation. The present study was undertaken to analyze the different rugae patterns in Ranchi and Patna population and to find whether palatoscopy is a valuable tool in person identification and gender determination. Materials and Methods: A total of 200 maxillary study models (100 males and 100 females) which consist of 100 casts from residents of Patna and 100 casts from residents of Ranchi within 15-30 years age group were analyzed. Rugae pattern were examined for the analysis of the quantitative and qualitative characteristics of rugae. Statistical analysis was carried out using Chi-square test and unpaired t-test. Result: Quantitatively, rugae were significantly (P < 0.05) more in females than males. No significant difference was established in rugae pattern between the two populations. In reference to shape, wavy pattern preponderated in females and curved pattern in males, followed by a straight, divergent, convergent, and circular pattern. Circular pattern was more in males than females. Conclusion: The present study concluded that rugae patterns are extremely unique and hence can be used as a supplementary method for human identification and gender determination.

Background: Fluorosis is one of the causes for intrinsic stains, which also influences gingival and periodontal health. The study of dental esthetics is a relatively new area of interest in dentistry. Direct composite veneers are one of the treatment modalities for intrinsic stains; it would be of interest to check its effect on gingival health. The present study was aimed to evaluate clinically and microbiologically the gingival margins around direct composite veneers. Materials and Methods: A total number of 30 patients were recruited in the study. All subjects with mild to moderate fluorosis rendered initial Phase I therapy, oral hygiene were given. Patients were recalled after 15 days for recording baseline gingival crevicular fluid (GCF) samples, clinical parameters, and collecting plaque from the tooth where direct composite veneers were indicated. Afterward placement of direct composite veneers following a standard protocol where all the margin of restoration was placed supragingivally and proper polishing was done. After 8 weeks of placement of direct composite veneers, GCF was collected and a sample of plaque from gingival margin around the direct composite veneers. Volumetric analysis of GCF was done using Periotron 8000,TM and plaque samples were analyzed by real-time polymerase chain reaction-analysis. Results: After 8 weeks veneer placement there was a significant reduction in clinical parameter was seen. At the baseline, the plaque index was recorded (0.58 ± 0.20) compared to post-veneer placement (0.35 ± 0.15) with a mean difference of 0.23, which was statically significant. Similarly, at the baseline, higher mean gingival index (GI) was recorded (0.50 ± 0.19) compared to post-veneer placement after 8 weeks (0.33 ± 0.0.12), with the mean difference of 0.16, the difference was statically significant. The gingival bleeding index (GBI) at the baseline, higher mean GBI was recorded (54.53 ± 4.26) compared to post-veneer placement after 8 weeks (32.72 ± 16.84018) with a mean difference of 21.80. The volumetric analysis of GCF at the baseline showed lower mean GCF (39.43 ± 29.23) compared to post-veneer placement after 8 weeks (70.46 ± 29.23), which was statically significant. Microbiologically, there was no statically significant difference was seen at the baseline and 8 weeks after veneers placement. There was a slight decrease in the number of An was observed after 8 weeks of veneer placement. Conclusion: Therefore, in the present study, there was a significant difference in the clinical outcome after placement of direct composite veneers was seen. There was no significant difference in microbiological parameters. Therefore, direct composite veneers can be used as a treatment modality for mild to moderate fluorosis cases.

Background: In this contemporary time, a search for naturotherapies is on the rise due to various side effects of allopathic medications used for periodontal disease. Contemplating this the present study was undertaken to compare the improvement in clinical parameters by evaluating the efficacy of Aloe vera to metronidazole, as an adjunct to scaling and root planing (SRP) in chronic periodontitis patients. Materials and Methods: 60 sites were selected from 20 patients diagnosed with chronic periodontitis, 40 were test sites (20 in each test group), and 20 were control sites. Group I comprised 20 sites which was followed by local application of A. vera gel (Curagel), Group II comprised 20 sites which was followed by local application of metronidazole gel (Elyzol) after SRP, and Group III comprised 20 control sites that were only treated with SRP. Clinical parameters were evaluated at 30, 60, and 90 days and compared. Result: The mean reduction in clinical parameters was statistically significant (P < 0.0001). On intergroup comparison of plaque index score, values of Group I with Group II were not significant with P = 0.86, of Group I with Group III was statistically significant (P < 0.05), and of Group II with Group III was statistically significant (P < 0.05). On intergroup comparison of the gingival index, of Group I with Group II was not significant with P = 0.54, of Group I with Group III was statistically significant (P < 0.05), and of Group II with Group III was statistically significant (P < 0.05). On intergroup comparison of probing pocket depth, of Group I with Group II was not significant with P = 0.25, of Group I with Group III was not significant with P = 0.15, and of Group II with Group III was statistically significant (P < 0.05). Conclusion: As the results of both test groups (A. vera and metronidazole) are comparable, local application of A. vera can be an effective and affordable herbal substitute for metronidazole.

Background: Adhesive procedures have become an integral part of today's restorative dental procedures. This study was carried out to evaluate the effect of contaminants such as saliva, blood, and hemostatic agents on the shear bond strength of a self-etch adhesive system Clearfil SE Bond, one-step, self-etch adhesive system Adper™ Easy One and a total-etch adhesive system Adper™ Single Bond 2. Materials and Methods: A total of 111 extracted sound human molars were collected and divided into 5 groups for each of the 3 bonding agents. For each adhesive, specimens were divided as follows 5 teeth (control group), 8 teeth contaminated by saliva, 8 teeth contaminated by blood, 8 teeth where Viscostat was used, 8 teeth where Viscostatclear was used. For the control group of Groups I, II, and III adhesive application was done directly followed by composite build-up. Specimens in each group were tested in shear mode using a chisel-shaped rod in a universal testing machine at a cross head speed of 0.05 cm/min. The data for each group was subjected to one-way ANOVA followed by Studentized Newman- Keuls test to make comparisons among the groups. Results: The total-etch adhesive system Adper™ Single Bond 2 showed better bond strength when compared to the one-step self-etch adhesive system, Adper Easy One and self-etch two-step adhesive system, Clearfil SE when contaminants like saliva, blood, hemostatic agents are used. Conclusion: When bonding to contaminated surfaces the total-etch system, Adper™ Single Bond 2 showed better results when compared to the one-step self-etch adhesive system Adper Easy One and self-etch two-step adhesive system, Clearfil SE.

Amelogenesis imperfecta is a real problem from both functional and esthetic points of view. An esthetic treatment may improve the quality of life and strengthen the self-esteem. This clinical report demonstrates the oral rehabilitation of a 26-year-old woman diagnosed with amelogenesis imperfecta. The aim of this interdisciplinary treatment was to restore esthetics and at the same time, to improve masticatory function. The expectations in regard to a new esthetic pattern of the patient were successfully reached by proper alignment of gingivo-cervical line, crown lengthening, and placing all-ceramic crowns from molar to molar in both maxillary and mandibular arch, 28 crowns in total. A plan to improve her low self-esteem, because of her poor appearance, was accomplished with an interdisciplinary approach in a short period of time. The full mouth rehabilitation eliminated tooth sensitivity, improved esthetics, and function restoration.

Persistent microorganisms, which are not decontaminated form root canals easily, might bring about endodontic failure. A 51-year-old man with endo-perio lesion was considered for endodontic retreatment. The existing root filling was removed with a solvent, hand, and rotary files. The working length was determined, and the canals were cleaned and shaped with ProTaper files. During each instrumentation, root canals were subjected to photodynamic therapy with attached Endo tip. Finally, the dried canals were filled with AH Plus sealer and gutta-percha cones. 9 months follow-ups were taken to order.

Mandibular molars can possess a supplementary root located lingually known as radix entomolaris (RE) or buccally known as the radix paramolaris. If a dentist has an awareness and understands root canal morphology of this unusual supplementary root, subsequently can result in the successful outcome of root canal treatment. This present report discusses two mandibular molars with an RE or paramolaris treated endodontically along with the prevalence, the external morphological variations, and internal anatomy. Both of these macrostructures are rare in the permanent human dentition.

Rampant caries is a suddenly appearing, rapidly burrowing type of caries resulting in early pulp involvement, in which more than 10 new lesions appear every year on healthy teeth surfaces which are generally immune to caries. This report aims to provide an aid to different diagnosis methods and treatment modalities for esthetical and biologically compromised cases. The treatment included-iron supplements, scaling, and polishing, extraction, caries intervention, tooth colored restorations, root canal treatment, orthodontic treatment, post and cores, periodontal surgery, root end surgery with mineral trioxide aggregate filling material, full ceramic crowns and fixed partial dentures. The treatment provided took about 1 year with total 45 visits and few of them unattended. The patient showed a great improvement in esthetic and function.

Oral cancer is a common disease of global concern. It is known to be a devastating disease of tremendous consequence to the individual, to family, and to society. Early detection is the key in fight against oral cancer and has the potential to significantly reduce oral cancer deaths and morbidity. Screening for oral cancer by visual examination is simple, inexpensive and causes little discomfort. Adjunctive screening tools may be of added value and could be considered in conjunction with the annual oral cancer screening examination or at the time of identification of any suspicious lesion. The integration of an oral cancer screening examination into daily practice requires little additional time or expense in an already busy practice. The challenge to the dental profession is to ensure that all adult patients have a brief but regular oral cancer screening examination. A standardized step-by-step approach to oral cancer screening and to the evaluation of any mucosal lesion suspected to be premalignant or malignant is highly recommended.

Probiotics are dietary supplements composed of healthy beneficial bacteria, which has only recently been introduced in dentistry after years of successful use in gastrointestinal problems. The development of bacterial resistance to the broad spectrum antibiotics has raised the possibility of a return to the pre-antibiotic dark ages. Time has approached to shift the paradigm of treatment from elimination of specific bacteria to alteration of bacterial ecology by probiotics. The concept of bacteriotherapy to heal diseases or to support immune function was the first introduced in the beginning of 20th century. Its use has been proven in strengthening immune function, to combat allergies, stress and exposure to toxic substances. Commensals delivered in this manner have been found to inhibit pathogenic microflora. Evidence suggests that probiotics not only function by direct inhibition or enhanced competition with pathogenic flora, but also by more delicate mechanisms including modulation of the immune system. The mechanisms of probiotic action are mainly unknown, but inter microbial species interactions are believed to play a key role with their immune stimulatory effects. Less evidence exists on their role in periodontal therapy. A mere change in daily diet by including probiotic enriched food may always halt, retard or even delay the pathophysiology of periodontal diseases, promoting a healthy lifestyle to fight periodontal infections. So far, mainly dairy products have been investigated, but other means like probiotics in chewing gum or lozenges have also been studied. The most suitable vehicles for oral probiotic applications are yet to be found. The introduction of probiotic bacteria in the mouth calls for the ascertainment of their safety considerations. Prebiotics have also been found to promote the growth of beneficial bacterial species. A fulfilled understanding of the broad ecological changes induced in the mouth by probiotics or prebiotics is highly essential to assess their long-term consequences for oral health and disease. Through this review article, we have tried to highlight the impact of probiotics in improving oral health.

The restoration of the endodontically treated tooth is an important aspect of dental practice involving a range of treatment options of varying complexity. Modern dentistry aims at preserving pulpal vitality. However, if endodontic therapy is unavoidable, then the conservation of the remaining tooth structures is most important. In general, endodontically treated teeth have already undergone significant coronal destruction, loss of radicular dentin, reduced level of proprioception and an overall reduction in the capability of the tooth to resist the myriad of intraoral forces. The aim of this review article is to outline the important aspects while choosing an appropriate post and core system in endodontics.

The restoration of the endodontically treated tooth is an important aspect of dental practice involving a range of treatment options of varying complexity. Modern dentistry aims at preserving pulpal vitality. However, if endodontic therapy is unavoidable, then the conservation of the remaining tooth structures is most important. In general, endodontically treated teeth have already undergone significant coronal destruction, loss of radicular dentin, reduced level of proprioception and an overall reduction in the capability of the tooth to resist the myriad of intraoral forces. The aim of this review article is to outline the important aspects while choosing an appropriate post and core system in endodontics.