Dentinal microcracks are a diagnostic challenge, which determines the longevity of the tooth structure. A few etiological factors of dentinal microcracks are traumatic occlusion in aging teeth and also the effect of rotary files, heavy spreader pressure during condensation, and post-placement during root canal treatment. This article describes the various in vivo and in vitro diagnostic aids and describes in detail various recent methods used for the detection of microcracks in vitro with special emphasis on micro-computed tomography (micro-CT). Micro-CT has wide applications in medical imaging. Micro-tomography scanners offer isotropic resolution, and therefore three-dimensional images can be displayed. Also, micro-CT is very precise, has remarkable space resolution, and requires a shorter capture time than cone beam computed tomography.

Odontomas are thought to be hamartomatous malformations in which enamel, dentin, and pulp, and occasionally cementum, is present in a disorganized form. It develops by the completely differentiated epithelial and mesenchymal cells that form ameloblasts and odontoblasts respectively. With no gender predilection and often asymptomatic, it is usually discovered accidentally on a routine radiographic study. They may be related with malformation, aplasia, malposition, delayed eruption of associated teeth and sometimes cystic changes. In these cases, Cone Beam Computed Tomography (CBCT) provides several advantages over conventional radiographs regarding diagnosis and treatment planning. Enucleation is the treatment of choice for these tumors and relapse is very uncommon. This paper highlights the etiology, classification, clinical/radiologic/histopathologic features and treatment options available for odontomas. Although much is known about odontomas but sometimes it presents as an enigma to a dental practitioner that needs to be unfolded with the use of radiography that acts as an indispensable tool in routine dental clinical examination.

Background: Thailand has been facing maldistribution of dentists for decades despite its continuous increase in total numbers. Aims: The objective of this study was to analyze spatial inequality of dentist distribution patterns in Thailand. Materials and Methods: Data on dentist in public sector profiles between 2007 and 2015 were retrieved from the Ministry of Public Health, Thailand, to analyze the distribution patterns and spatial relationships. The distribution of dentists was visualized on a map using Quantum Geographic Information System. Global Moran I and local indicators of spatial association were analyzed using GeoDa software to determine the distribution of spatial relationship. Results: The total number of dentists has been increased annually from 2007 to 2015. Initially, the high–high (population-to-dentist ratio) spatial clusters were common in the Northeast (NE) region, whereas there were many low–low spatial clusters in Central region. In 2015, the high–high spatial clusters persisted in the NE region, but the low–low spatial clusters were hardly found in the Central region. Conclusions: Unequal geographical distribution of dentist still existed in Thailand, especially in the NE region. Both supply side concerning administrative factors related to resource allocation, and demand side of socioeconomic development and population changes from migration had influences on inequality in dentist distribution.

Aims and Objectives: Celiac disease (CD) is characterized by oral manifestations in the soft tissues. The introduction of a gluten-free diet (GFD) may be related to change in the prevalence of oral changes and symptoms. The aim of the study was to evaluate the prevalence of oral soft tissue lesions in a pediatric Portuguese population with CD compared with healthy controls, and secondarily to assess the relationship between the onset of the GDF and the prevalence of oral manifestations. Materials and Methods: A case–control study was performed: 80 patients with CD and 80 healthy subjects as controls, aged 6–18 years. Data were gathered through a structured protocol, consisting of a clinical record (questionnaire) and an intraoral observational examination. For the descriptive analysis of the results, relevant summary statistics were applied. Descriptive and inferential (mainly nonparametric tests) analyses were carried out with the Statistical Package for the Social Sciences software (IBM SPSS) version 24.0. P < 0.05 was considered as significant. Results: Although soft tissue changes such as angular cheilitis, atrophic glossitis, and geographic tongue were found to be more common in the CD group, no differences were found between the two groups. The prevalence of aphthous ulcerations was higher in the CD group, with a highly significant difference between the two groups (P < 0.001). One-third of the patients with CD with aphthous ulcers refer that the beginning of the GFD influenced the improvement of this oral mucosa alteration, with a statistically significant difference (P = 0.007). Conclusion: The Portuguese population with CD had a higher prevalence of aphthous ulcerations and this oral manifestation decreased with the introduction of a GFD.

Aims and Objectives: Maximum mouth opening (MMO) is an important diagnostic reference for dental clinicians as a preliminary evaluation and an indicator of function of masticatory system and temporomandibular joints. This aim of this study was to describe the normal mouth opening of Pakistani population and its possible correlation with sex and age. Materials and Methods: This cross-sectional study randomly selected visitors to the Pakistan Institute of Medical Sciences, Islamabad, Pakistan. Each subject was asked to open his/her mouth as wide as possible while sitting in an upright position, then the distance between the incisal edges of upper and lower right central incisor was measured. Independent t-test and analysis of variance were used, and significant level was set at 5% in all analysis. Results: Of the 497 subjects examined, 52.3% were males and 47.7% were females with age between 15 and 65 years. The mean MMO for all subjects was 58.2mm (standard deviation = 7.92) and ranged between 35 and 71mm. Statistically, the MMO was significantly wider in the males than in females (mean difference = 10.9mm, 95% confidence interval: 9.60, 12.2, P < 0.001). The difference between sexes was also significant in all age groups except in the 56–65 years old. The mean width of MMO declines with increasing age. Conclusion: It is concluded that the mean MMO of Pakistani males is significantly higher than the Pakistani females, and it is influenced by gender and age. The mouth opening reduces with age, and the results of this study are in agreement with the different studies in different countries.

Aims and Objectives: To analyze the microleakage of nano-hydroxyapatite-silica glass ionomer cement (nano-HA-SiO₂-GIC) and compare it with conventional glass ionomer cement (cGIC). Materials and Methods: Twenty caries-free human premolar teeth were used. A standardized box-shaped class V cavity was prepared on the buccal surfaces at the cemento-enamel junction, with the occlusal margin (OM) set on enamel and gingival margin (GM) was placed on the cementum. Teeth were randomly assigned to two experimental groups of 10 teeth each and restored as follows: group 1, cGIC (Fuji IX) and group 2, nano-HA-SiO₂ GIC. After 24h of immersion in distilled water, the teeth were thermocycled (500 cycles and 5°C–55°C). Following that, the teeth were placed in 2% methylene blue solution and stored at room temperature for 24h. The microleakage along the tooth-restoration interface was recorded. Independent sample t-test (two-tailed) was used to analyze the data. Results with P < 0.5 were considered statistically significant. Results: Microleakage in general was greater at GMs as compared to OMs for both the materials. Nano-HA-SiO₂-GIC exhibited lower microleakage at occlusal level (0.2 ± 0.42) as compared to cGIC (0.5 ± 0.71), whereas, at GM nano-HA-SiO₂-GIC displayed significantly less microleakage (2.7 ± 0.67) compared to cGIC (3 ± 0.00). Conclusion: Nano-HA-SiO₂ glass ionomers showed less microleakage both at OMs and GMs compared to that at cGIC (Fuji IX).

Aims and Objectives: The aim of this study was to investigate the effect of exposure times of Coca Cola on enamel’s microhardness, mineral weight, and rate of calcium and phosphate ions discharging from it. Materials and Methods: Thirty-two enamel blocks were randomly divided into four groups and exposed to 10mL of their respective solution daily for 7 days, with each group containing eight specimens: Group 1 (enamel blocks exposed to artificial saliva, control group), group 2 (enamel blocks exposed to Coca Cola for 5 minutes), group 3 (enamel blocks exposed to Coca Cola for 10 minutes), and group 4 (enamel blocks exposed to Coca Cola for 30 minutes). Microhardness data (Vickers hardness number [VHN]) and mineral weight were calculated at baseline (sound enamel) and postexposure to Coca Cola. Inductively coupled plasma–optical emission spectrometry (ICP-OES) was utilized to study calcium and phosphate ion percolation from enamel surfaces. Results: Decrease in VHN was directly proportional to exposure time for all experimental groups. Comparison of baseline and postexposure values between control and experimental groups was statistically significant (P < 0.05). Mineral weight of enamel blocks decreased as the exposure time increased for all experimental groups. ICP-OES analysis revealed linear relationship between release of calcium and phosphate ions at 5 and 10 minutes, but at 30 minutes, a decrease in concentration of both ions was observed. Conclusion: The microhardness and mineral weight of enamel decreased linearly with exposure time. The release of calcium and phosphate ions from enamel increased initially but gradually decreased as the exposure time increased.

Aim and Objectives: The objective of this study was to illustrate the link between periodontitis (PO) and endothelial dysfunction in hypertensive patients. Materials and Methods: This cross-sectional study involved 53 hypertensive patients with or without PO compared with 28 healthy controls. On the basis of the study protocol, the participants were divided into three groups: Group (1): 24 patients with hypertension only, Group (2): 29 patients with hypertension and PO, and Group (3): 28 healthy controls. Lipid profile, endothelin-1 (ET-1), and high-sensitivity C-reactive protein (hs-CRP) were measured. Blood pressure and body mass index (BMI) were evaluated. Diagnostic criteria of severe PO periodontal indices including plaque index, gingival index, and community periodontal index were estimated. Data collected during the study were analyzed using analysis of variance followed by Bonferroni post hoc test and unpaired t-test (IBM SPSS Statistics for Windows, version 20.0, 2014, IBM, Armonk, NY). Results: BMI was not differed in both groups, P = 0.08. Systolic blood pressure and diastolic blood pressure were high in hypertensive patients with PO compared with hypertensive patients only, P = 0.04 and P = 0.03, respectively. Moreover, hypertensive patients with PO showed significant dyslipidemic status compared with hypertensive patients only (P < 0.05). Biomarker of endothelial dysfunction (ET-1) was elevated in patients with PO (67.54 ± 13.56 pg/mL) compared with hypertensive patients only (23.67 ± 9.63 pg/mL), P = 0.0001. hs-CRP serum level was increased patients with PO compared with hypertensive patients only, P = 0.002. PO indices were high in patients with PO compared with hypertensive patients only, P < 0.01. Conclusion: ET-1 serum level is elevated in hypertensive patients with severe PO and correlated with cardio-metabolic complications, mainly endothelial dysfunction. Therefore, ET-1 serum level is regarded as a surrogate biomarker link PO with risk of endothelial dysfunction.

Aims and Objectives: Enhancement of the therapeutic properties of glass ionomer cements with antimicrobials, without alterations in its existing physical properties is of current research interest. One such innate property is microhardness. The aim of this study was to compare the microhardness of chlorhexidine-modified glass ionomer cement (CHX GIC) and chitosan-modified glass ionomer cement (CHT GIC) with an unmodified glass ionomer cement (FUJI IX GIC) and to study the variations in their microhardness when stored for a year. Materials and Methods: In an experimental analytic study, Fuji IX GIC liquid was modified with chitosan to form 10% vol/vol of CHT GIC. Fuji IX GIC powder was modified with chlorhexidine diacetate powder to form 1% wt/wt CHX GIC. Fuji IX GIC was used as control. Forty cylindrical samples each of the control and experimental cements were prepared, embedded in resin and stored in distilled water. Vickers microhardness testing was performed at stipulated time periods. The mean and standard deviation of each group were calculated. The data were analyzed using analysis of variance and post hoc Tukey test for multiple comparisons. Results: Materials showed significant difference in microhardness (P <0.000) at all time periods chosen for the study. FUJI IX GIC had the highest microhardness values at all time periods. CHT GIC showed the lowest microhardness and CHX GIC showed excellent stability over time. Conclusion: Although the therapeutic effects of modified GICs are proven, these additives can significantly and negatively alter the existing microhardness of the parent material.

Aims and Objectives: The aim of this study was to assess the prevalence of malocclusal traits among male schoolchildren aged 6–9 years in Rass, Saudi Arabia. Materials and Methods: A descriptive cross-sectional study was conducted among randomly selected 304 male children in Rass, Qassim Province, Saudi Arabia. The molar relationships were recorded using Angle’s classification system and other occlusal traits, such as overjet, overbite, and crossbite, based on the methods of Bjoerk et al. for registration of malocclusion in centric occlusion. Descriptive statistics were used to check occlusal discrepancies and a chi-squared test was used to compare the malocclusion prevalence in three different age groups. Results: The frequencies of Angle’s Class I, Class II, and Class III molar relationships were 81.91%, 11.18%, and 6.91%, respectively. A total of 85.86% cases had normal overjet, whereas 90.13% of cases had normal overbite. The most prevalent malocclusion of the participants was increased overjet in 9.21%, followed by deep bite in 5.92%, deficient overjet in 4.93%, posterior crossbite in 3.95%, anterior open bite in 3.95%, and an anterior crossbite in 2.96%. No statistically significant difference was found age wise. Conclusion: The most frequent findings among Saudi male schoolchildren in the early mixed dentition were Class I molar relationship, normal overbite, and normal overjet. The most prevalent malocclusion trait was increased overjet followed by deep bite. Therefore, it is important to take children for an early orthodontic assessment.

Aims and Objectives: Hormonal changes in women that occur in the menstrual cycle is one of the systemic factors that causes gingivitis, namely the menstruation gingivitis. Women with this condition will experience the same signs and symptoms as gingivitis in general. This study observed the description of the occurrence of gingivitis as well as its correlation to the level of dental and oral hygiene at female dental students, in which they have knowledge about how to keep dental and oral hygiene properly. The purpose of this study was to determine the profile of the occurrence of gingivitis as well as its correlation to the level of oral hygiene in female students of dentistry program. Materials and Methods: This was a descriptive analytic study with 318 samples, which were divided into three groups according to the menstrual cycle. Gingivitis examination was performed with the gingival index and oral hygiene examination with Oral Hygiene Index-Simplified. The statistical analysis was carried out for this study using Statistical Package for the Social Sciences (SPSS), version 17 software. Results: In the premenstrual period group, 94.3% had good oral hygiene and 24.5% had gingivitis. In the menstrual period group, 88.7% had good oral hygiene and 4.7% experienced gingivitis. In the postmenstrual period group, 88.7% had good oral hygiene and 100% of the samples had normal gingiva without inflammation. Conclusion: Menstruation gingivitis occurs higher in the premenstrual period (proliferative phase) although with good oral hygiene conditions.

Aims and Objectives: Temporomandibular joint (TMJ) clicking has been considered as the most important clinical features of many TMJ disorders, so that the early diagnosis of TMJ clicking could be considered an important value for early treatment. The knowledge and study of the factors that have an adverse effect on the TMJ are necessary for the proper diagnosis, treatment, and prognosis of TMJ disorders. This aim of this study was to observe whether there was a relationship between the presence of impacted third molars and the development of TMJ clicking. Materials and Methods: The study was undertaken on 189 patients with bilateral maxillary and mandibular impacted third molars aged between 18 and 25 years, in regardless of genders that were referred to the radiology department of some dental centers in Baghdad for taking orthopantomograms (OPGs) from June 2017 to December 2018. The patients were examined clinically for detecting the temporomandibular clicking by using a stethoscope for hearing clicking sounds during mouth opening and mandibular excursion. Results: The statistical analysis showed that there was no significant relationship between the presence of impacted third molars and development of TMJ clicking (χ² = 1.04; P = 0.3). Conclusion: According to this study, impacted third molars were not considered to be an effective factor in the occurrence or development of TMJ clicking or sound.

Aims and Objectives: The blood pressure (BP) variability is a useful method to assess cardiac autonomic modulation in patients undergoing dental procedures because the knowledge of physiological conditions provides greater security to the professional as well as the possibility of a better plan treatment to patient benefit. The aim of our study was to study the association between BP and nonsurgical periodontal treatment. Materials and Methods: The research was carried out on 150 patients in Baghdad, all of them divided into two groups, first group: 75 patients, periodontal treatment for those groups was carried out by air scaling, second group: 75 patients, periodontal therapy for those groups was carried out by manual scaling. After the participants rested for ≥5min, we measured the systolic BP (SBP) and diastolic BP (DBP) three times (1–2min) in between for each participant in both groups by using mercury sphygmomanometer and bell stethoscope on the right arm of the patients while they were in sitting position. We used Community Periodontal Index for Treatment Need (CPITN) to determine the periodontal health status and the treatment needed for the study groups. Results: The results of this study revealed that the SBP and DBP mean values for the manual and air scaling groups had a significant increase after the scaling due to the pain and anxiety during therapy. The association between BP and CPITN was even stronger among participants with the time. Conclusion: This study showed that nonsurgical periodontal treatment led to elevated BP levels during therapy in correlation to the time and CPITN.

Aims and Objectives: This study aimed to evaluate and compare the clinical effectiveness of dentifrices containing fluoro calcium phosphosilicate, calcium sodium phosphosilicate, and strontium chloride hexahydrate for the treatment of dentin hypersensitivity (DH) when applied twice daily. Materials and Methods: Participants with a history of DH and with visual analog scale (VAS) score of ≥5 to a painful test stimuli response (dental explorer) in at least one tooth at the qualifying baseline visit were enrolled in this four-week randomized study. Participants (n = 93) were randomly allocated to one of the following groups: Group 1––fluoro calcium phosphosilicate (BioMin™), Group 2––calcium sodium phosphosilicate (NovaMin^®), and Group 3––strontium chloride hexahydrate. Clinical effectiveness (VAS), perceived sensation score (verbal rating scale [VRS]), participants’ subjective assessment (four-item questionnaire) and oral health-related quality of life (Oral Health Impact Profile-14 [OHIP-14]) questionnaire) were assessed. Results: A significant (P < 0.0001) reduction in symptoms over a period of four weeks (from baseline) was noted in all groups; however, the intergroup difference was not statistically significant. At week 2, the percentage reductions in VAS (Group 1: 58.19%; Group 2: 49.18%; Group 3: 52.69%) and VRS (Group 1: 58.19%; Group 2: 47.16%; Group 3: 49.05%) scores were higher in Group 1 as compared with other groups. Subjective assessment results and oral health-related quality of life were comparable in all the three groups at the end of four weeks. Conclusion: Fluoro calcium phosphosilicate bioactive glass containing desensitizing dentifrice treatment may provide better treatment response for the treatment of DH because of its early onset of action in relieving hypersensitivity symptoms as compared with other dentifrices (CTRI/2018/04/013481).

Aims and Objectives: This study aimed to analyze the color and translucency of a recently introduced bulk-fill resin composite with enhanced opacity. Materials and Methods: Twenty A3 shade composite disks, each of Filtek Bulk Fill (BF) and Filtek One Bulk Fill (OBF), were prepared with 4mm thickness. Two different backgrounds (white and black) and an intrinsic color for each material were used to ascertain the translucency parameter (TP) between white and black backgrounds, and to simulate oral environment darkness (between the black background and the intrinsic color of resin composite). Data collected were analyzed by the Mann–Whitney U test (P < 0.05). Results: The OBF disks showed significantly higher TP values (P < 0.001) than those of the BF. Regarding the ΔE* values for the masking ability of the oral cavity darkness, although OBF showed a statistically better masking ability than BF at 4mm thickness (z = 2.63, P = 0.009), none of them recorded the clinically acceptable threshold. Conclusion: The composition of the resin was shown to have a clear effect on the translucency and masking ability. The clinical significance is that whereas OBF appears to outperform BF, neither of their performances reach clinical acceptability.