Aim: In situ gel systems present the unique property of converting from sol–gel upon biological stimulus. This study aimed to find various oral lesions treated with in situ gels and their outcome assessment. Materials and Methods: In this study, electronic and manual search was done to find the studies concerning the use of in situ gels as a single method of treatment and adjunct to oral lesions. A total of 22 articles were collected of which three clinical trials which fulfilled the inclusion criteria and published from 2011 to 2019 were included in the study. Literature review search revealed that there are no sufficient clinical trials performed on in situ gel treatment for oral lesions from 2011 to 2019. Results: The results of the study show that fluconazole can be used for oropharyngeal candidiasis, curcumin solid–lipid nanoparticle-loaded gels is more effective for oral erythroplakia, and 4% hyaluronic acid-containing topical gel formulation is effective in treating recurrent aphthous stomatitis. Quality assessment was done using Revman 5.3 for three studies, of which one study proved to have low risk of bias. Conclusion: It is concluded that using formulated in situ gels can be an alternative approach to treat various oral lesions locally by improving patient’s compliance. Further clinical trials concerning efficacy of in situ gels for treating oral lesions are still required.

Aim: Biofilm bacteria show coordinated behavior with heterogeneous bacterial communities and complex three-dimensional structures. Biofilm formation on dental implants occurs in a manner similar to that of a natural tooth. Bacterial adhesion occurs after pellicle formation. Therefore, to reduce bacterial adhesion, the biomaterial surface can be modified, thereby lowering the scope of biofilm formation. This review aimed to understand the mechanism of biofilm formation; the most common microorganisms associated with a biofilm, nature of the bonds to the host tissue, and the methods to overcome biofilm formation and associated infectious diseases from dental materials and implants. Materials and Methods: A comprehensive literature search was conducted on published articles using internet search databases such as PubMed, EBSCO, Cochrane library, Embase, HMIC, Web of Science, Google Scholar, and Directory of Open Access using keywords such as biofilm, quorum sensing, implant-related biofilm formation, and biofilm control. Results: A total of 121 articles published from March 2007 to May 2020 were screened during the review process, of which only 33 articles were selected for this study. Surface roughness is directly proportional to bacterial aggregation. PEEK is a modified functional peptide nanoparticle-coated biomaterial that manifests antibacterial activity against gram-negative Escherichia coli and gram-positive Staphylococcus aureus. Conclusions: New strategies are to be followed to control biofilm-mediated implant infections. Clinicians should extensively adopt newer techniques to deal with biofilm-mediated therapeutic challenges.

Aim: To determine the risk factors and the prevalence of musculoskeletal disorders in dental students in a Peruvian University. Materials and Methods: A descriptive, cross-sectional, observational study was performed. The Nordic Musculoskeletal Questionnaire was used to determine the prevalence of musculoskeletal disorders. A total of 149 randomly selected Peruvian last year dentistry students were included. The sample size was obtained using the proportion estimation formula. To determine the associations, χ² test was used. In addition, odds ratio (OR) was used to quantify the strengths of associations between the variables studied. All the analyses were performed with the Stata software, version 12.0, establishing a level of significance of P < 0.05. Results: In relation to the prevalence of risk factors for musculoskeletal disorders according to gender, the logistic analysis showed that only the variables, such as work change, pain during the last year, pain episode duration, and treatment, were not associated with the risk factors in the crude logit model made with OR = 3.5, confidence interval (CI) (0.6–4.7); OR = 0.9, CI (0.6–1.5); OR = 1.5, CI (0.9–2.5); and OR = 1.5, CI (0.7–2.5), respectively. Besides, according to the academic semester (Internship, Clinic I, II, III, and IV), only the variables such as work change, pain during last year, duration of the painful event, and treatment were not associated with the risk factors with an OR = 2.6, CI (0.4–3.7); OR = 0.9, CI (0.6–1.5); OR = 1.3, CI (0.7–2.7); and OR = 1.3, CI (0.6–2.3), respectively. Conclusion: Pain in the previous year was reported by 95.2% of undergraduate dentistry students studied; however, only 27.7% received treatment to alleviate the pain. So dentistry students report musculoskeletal pain due to inadequate body and postural positions. Thus, the study has a clinical impact because the main factors associated with musculoskeletal disorders of Peruvian dental students were known to establish therapeutic strategies and improve these conditions.

Aim: While obstructive sleep apnea (OSA) is among the commonest of sleep disorders, morning headache is notoriously associated with OSA. This study was conducted to assess the prevalence of reported morning headache in diagnosed cases of OSA. Materials and Methods: This was an observational cross-sectional study on 160 subjects with and without OSA, who were conveniently recruited and instructed to complete the Stop-Bang questionnaire, Diagnostic Criteria of Temporomandibular Joint Disorder screener and symptom questionnaire, as well as an Operator-designed demographic questionnaire. SPSS statistics on bivariate analysis and odds ratios were conducted. Results: Morning headache was significantly associated with those having OSA when compared with non-OSA subjects (P < 0.001). Also those who had OSA and noticed they quit breathing during sleep were nearly four times as likely to have morning headache (P < 0.027) than those with OSA who did not notice they quit breathing during sleep. Conclusion: Headache is common, but the strongest and most significant predictor of headache in OSA subjects is noticing that they quit breathing.

Aim: Miswak is a chewing stick used for oral hygiene and has both cultural and religious heritage. Concerns have emerged about the limitation of evidences on its effectiveness and guidance to practice. This study aims to explore dental educators’ perceived level of knowledge and awareness of Miswak practice and teaching as oral hygiene tool. Materials and Methods: Dental educators with various socio-religious demographic backgrounds at International Islamic University of Malaysia(IIUM) University were invited to participate in an audio-taped focus group discussion in 2017, conducted in English using a pre-tested topic guide. The qualitative data were recorded, transcribed, and analysed using a Framework Analysis. Results: The dental educators (n = 11) from various socio-religious and educational backgrounds demonstrated low-medium level of knowledge on Miswak given there are limited, restricted, and localized evidences, influenced by their culture, religious values, and past educational training and several domains of practice. This has an implication on their low level of awareness to practice Miswak considering the fact that the barrier identified is more than its benefit. Furthermore, there was a strong mixed sense of valuing evidence-based knowledge and cultural–religious belief among dental educators of postmodern society in meeting both oral health needs and social expectations. Conclusions: Educators of postmodern society with western educational background view metaphorically the level of knowledge and awareness of Miswak usage, although most of them are Asian and Muslim. A flexible strategy is needed to overcome the poor dissemination of Miswak evidence to further educate dental educators in order to frame a Miswak educational guideline for the benefit of society.

Aim: To describe the teeth, normal variants of the mucosa, and taste sensitivity as predictors of oral health among the elderly. Materials and Methods: Thirty-six elderly patients participated in this study. The oral health status was screened by decay, missing, and filling teeth index (DMF-T), and salivary flow rate was measured with a spontaneous drooling method. Taste sensitivity was done using filter paper disk (FPD) taste testing, composed of four taste solutions: sucrose, tartaric acid, sodium chloride, and quinine hydrochloride (level 1–5). The differences between taste sensitivity and salivary flow rate were analyzed using one-way analysis of variance (ANOVA), and least significant difference (LSD) for post hoc test with P < 0.05. Results: The DMF-T index in the elderly was in the high category with score >6.6 (83.33%). The most sensitivity taste was bitter (94.44%), followed by salty (91.67%), sweet (81.00%), and sour (75.00%). Only salty and sweet taste, in most of subjects, able to detect in the left of anterior (P = 0.011) and right of posterior tongue (P = 0.038). Subjects with flow rate 0.1–0.5 mL/min were able to detect lower concentration of sweet taste than those with salivary flow rate 0.6–1.0 mL/min (P = 0.029). Normal variants of the oral mucosa most commonly found in the elderly were coated tongue (55.56%) and fissured tongue (50.00%). Conclusion: The elderly community in this study had a poor oral health index with most subjects in the DMF-T high category with score >6.6, but most salivary flow rates were still relatively normal. No significant taste sensitivity impairment was found in the elderly.

Aim: To explore the effectiveness of physical therapy approach on quality of life in patients with temporomandibular disorder (TMD). Materials and Methods: This was an experimental study with a randomized control trial design. We recruited 90 subjects with both the gender, aged between 18 and 50 years who were clinically diagnosed with TMD. They were randomly divided through the lottery method into two groups: the control group and the experimental group. For outcome measurement, a short form of health-related questionnaire (SF-36) was used to assess the quality of life. In this study, the control group received normal home-based exercise, and the experimental group received physical therapy approach, consisting of dry needling and muscular inhibition combined with home-based exercise. Statistical analysis was carried out using a Student’s t test and using the Statistical Package for the Social Sciences (SPSS) software program, version 16.0. Results: The experimental group who performed dry needling and 4 weeks of exercises was shown significantly higher scores in all the domains of the questionnaire (P < 0.05). In the control group, conventional physiotherapy was applied, and improvement was shown only in the pain domain but not in the other parameters in comparison with the experimental group. The level significant level was considered as P < 0.05 for the analysis of data. Conclusion: The results of this study claimed that the application of a physiotherapy protocol in association with dry needling was able to improve health-related quality of life in patients with TMDs.

Aim: To assess the benefits of comprehensive oral care in improving the psychological well-being of young adult smokers and tobacco chewers. Materials and Methods: A prospective, clinical study of 60 young adult smokers/tobacco chewers or both were carried out. This study was conducted to assess the psychological well-being at the first dental visit, and then after the completion of comprehensive oral care using Bradburn scale of psychological well-being (Affect Balance Scale). Comprehensive oral care included oral prophylaxis, simple restorative care, preventive procedures, and health education. Health education was given before the appointment, during the stage of diagnosis and treatment planning, in the operatory during the various stages of treatment. Results: A total of 60 males were participated in this clinical study, with a minimum age of 18 years to the maximum age of 25 years. A total of 20 (33.3%) were using both smokeless and smoking tobacco. The majority of them were school educated (74%) and semi-skilled (86%). The overall oral hygiene status was fair. The mean decayed, missing, and filled teeth (DMFT) ranged from 0 to 9. The Bradburn scale of psychological well-being score was 1.55 ± 2.54 at the first visit to the dentist and after completing the comprehensive oral care there was an improvement in the score (3.20 ± 1.29). This was statistically significant. Conclusion: This study findings showed improvement in the psychological well-being of young adult smokers and tobacco chewers after the completion of comprehensive oral care.

Aim: In orthodontic treatment, the high levels of friction may reduce the effectiveness of the mechanical and decrease tooth movement efficiency. The use of active self-ligating brackets is claimed to possibly reduce friction in orthodontic treatment. The aim of this study was to investigate the three-different active self-ligating orthodontic brackets in frictional coefficient and surface roughness. Materials and Methods: This study was true-experiment laboratory with posttest group design to collect the frictional coefficients data from three different active self-ligating brackets. Friction tests were performed on three different active self-ligating brackets—In-Ovation R, Empower, and BioQuick. Each group consists of seven samples of active self-ligating brackets—and stainless steel wire which has been stored in artificial saliva solutions for 14 days. After the friction coefficients of every sample obtained, the bracket clips were separated from the bodies and set on resin acrylic medias. Surface roughness of the bracket clips was evaluated using the atomic force microscope (AFM). A one-way analysis of variance (ANOVA) followed by Scheffe test for comparisons was performed statistically (P < 0.05). Results: BioQuick and Empower orthodontic brackets produced lower frictional coefficients compared to In-Oviation-R brackets. BioQuick showed least frictional coefficients. Based on the statistical analysis, there was no significant difference of frictional coefficients between Empower and BioQuick. Surface roughness test showed that the clip surface of In-Ovation R produced the maximum roughness, followed by Empower and BioQuick. Conclusion: In-Ovation R brackets offered more frictional coefficients and surface roughness than Empower and BioQuick brackets, whereas BioQuick brackets offered the least among all the brackets studied.

Aim: To determine that okra fruit extracts are effective in inhibiting growth and killing the Aggregatibacter actinomycetemcomitans (Aa) bacteria that cause aggressive periodontitis. Materials and Methods: Aa ATCC 4371 strain Y3 serotype b bacteria obtained from the Stock Research Center of the Faculty of Medicine, Airlangga University, Jawa Timur, Indonesia, were bred on the Mueller Hinton media with the inclusion criteria that identification of bacteria from the stock shows that the bacterium is Aa, and the growth of bacteria in the Mueller Hinton media is with a number of colonies between 30–300 colony forming units (CFU)/mL. Culture media containing Aa bacteria were incubated for 1 × 24h at 37°C, after it was diluted according to McFarland standard 0.5 (1.5 × 108 CFU/mL). Fresh okra fruit derived from Materia Medica was prepared for extract. Serial dilution or dilution methods of 1:2 (wt/vol) are used for the detection of minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC). Results: One-way analysis of variance test showed a difference with significance (P = 0.000), whereas, Tukey honestly significant difference (HSD) test showed a significant difference between okra fruit extract group with positive control concentrations of 100%, 3.125%, and 1.565%. Conclusion: The okra fruit extract effectively kills the Aa bacteria that causes aggressive periodontitis, as indicated by MIC at a concentration of 3.125% and MBC at a concentration of 6.25%.

Aim: To examine the effect of seven irrigants on surface topography and cutting efficiency of Mpro files when files are immersed for 10 min. Materials and Methods: This was an in vitro study; sixty-three MPro files were used divided into seven groups (nine each). Groups were immersed in irrigants for 10 min: Group 1 Saline, Group II Curcumin, Group III EDTA 17%, Group IV Lycopene, Group V Chitosan 0.3%, Group VI Chitosan 0.5% and Group VII sodium hypochlorite. Files were inspected by scanning electron microscope and all photomicrographs were reviewed and scored according to the defects found. All previously immersed files were used to prepare plastic blocks with simulative canals to assess cutting efficiency by weight loss technique Data were analyzed using chi-square, one-way analysis of variance (ANOVA)/Tukey’s test and linear regression. Results: Groups I, V, and VI showed no defects. Group II showed pitting, fretting blunting, and disruption of cutting edge and residues. Group III showed pitting, blunting, and disruption of cutting edges. Group IV showed pitting, blunt cutting edges, and residues. Group VII showed fretting blunt and disruption of cutting edges, micro fractures, and metal flash. None of groups showed corrosion. Results for the cutting efficiency study showed a significant difference between all groups among which the highest mean of debris cut was recorded by Group V chitosan 0.3%Conclusion: Chitosan 0.3 and 0.5% did not affect the surface topography of Mpro file. Chitosan 0.3% enhanced the file’s cutting efficiency, so can be recommended to be used as irrigation.

Aim: Dental cements are used extensively in various dental restorative procedures and are susceptible to bacterial adhesion and biofilm formation. Streptococcus mutans are the causative organism for dental caries and associated problems. This study aimed to develop an antibacterial activity for four types of dental cements by incorporating the leaves, fruit, and bark extract of the Ziziphus spina-christi, a well-known medicinal plant found mainly in the Middle East region. Materials and Methods: This in vitro study was conducted by using a systematic sampling method. A total of 312 samples were prepared for both control and test groups for this study. Negative control samples were prepared using four dental cements alone (n = 24) and positive control (n = 72) using gentamicin incorporated into these four different types of dental cements. The collected plant materials were extracted using Soxhlet apparatus with methanol as a solvent. Obtained extracts were incorporated in various percentages (5, 10, and 15 wt%) into dental cements to prepare test samples (n = 216). Antibacterial efficacy of the extracts selected was measured by using well diffusion method. The antibacterial activity of all the prepared samples was measured using the disk-diffusion method. The null hypothesis was that the extract incorporation did not inhibit bacterial growth on the selected dental cements. Results were analyzed statistically using one-way analysis of variance (ANOVA) followed by Tukey–Kramer multiple comparison tests using GraphPad InStat software. Level of significance was set at P = 0.05. Results: All extracts showed antibacterial activity for gentamicin. Zone produced was superior for leaf extract compared to stem and fruit extract (P < 0.001). Negative control samples showed bacterial growth. The test samples did not support bacterial growth. However, the inhibition zone was absent. Conclusion: Ziziphus spina plant extracts can inhibit the growth on S. mutans. The efficacy of each extracts against the bacteria was varied.

Aim: To assess in vivo the immediate and delayed disinfecting efficacy of erbium,chromium:yttrium scandium gallium garnet (Er,Cr:YSGG) laser against Enterococcus faecalis at the output powers 1, 1.5, and 2 W with a 20s period of time. Materials and Methods: Study criteria include 45 single-rooted teeth. Patients were randomly divided into three groups (gps) (n = 15/gp) according to the output powers selected in this study. After access opening, first microbiological samples (S1) were collected immediately before Er,Cr:YSGG laser treatment. Second microbiological samples (S2) were taken immediately after instrumentation and laser disinfection at the output powers 1, 1.5, and 2 W with 20s period of exposure time. Third samples (S3) were collected after 1 week of irradiation. The obtained samples were transferred to an agar plate and incubated for 48h at 37°C. The colonies of E. faecalis formed were then counted. The collected data were analyzed using one-way analysis of variance (ANOVA) analysis and Duncan multiple range tests at level P ≤0.05. Results: The result showed no significant difference between number of bacteria before laser treatment and after 1 week of laser application at the output power 1 W. However, significant difference was detected immediately after laser application. At 2 W a significant difference was observed between number of bacteria before laser treatment and after treatment with no difference between number of bacteria immediately after treatment and after 1 week of irradiation. Conclusion: Er,Cr:YSGG laser at high output power (2 W) detected a maximum reduction of E. faecalis in the infected root canals, but bacteria were not eliminated completely.

Aim: Scaling is important for maintenance of gingival and periodontal conditions. These procedures have a harmful effect on the dental hard tissues. The aim of this study was to investigate the effects of hand and ultrasonic instruments made of stainless and titanium on the surface properties of enamel. Materials and Methods: Forty extracted premolars were used in this in vitro study and were randomly divided into four groups (n = 10). Group I received ultrasonic scaling with stainless steel tip, group II received ultrasonic scaling with titanium tip, group III hand scaling with stainless steel tip, and group IV hand scaling with titanium tip. Scanning electron microscopy (SEM) was used to examine the enamel surface morphology. Surface roughness of enamel was measured at baseline and after the scaling simulation using atomic force microscopy (AFM). Differences between initial and final measurements of surface roughness (ΔRa) were analyzed using two-way analysis of variance (ANOVA) followed by post hoc pairwise comparisons between groups. Results: SEM revealed deeper scratches and more destructive changes on enamel surface in group IV, whereas other groups revealed less change. AFM revealed that a mean surface roughness difference (ΔRa) had the highest value with hand instruments using titanium curettes, whereas the lowest difference was found with ultrasonic tips using stainless-steel tips. Hand titanium curettes showed a statistically significant increase in ΔRa when compared to hand stainless steel curettes (P = 0.02) and ultrasonic titanium tips (P = 0.01). Hand stainless steel tips showed a statistically significant increase in ΔRa when compared to ultrasonic stainless steel tips (P = 0.02) and hand titanium curettes (P = 0.02). Conclusion: Scaling using ultrasonic stainless steel tips produce the least amount of surface roughness and damage to the tooth surface.

Aim: To compare the abilities of computed tomography (CT), cone beam computed tomography (CBCT) with X-resin and ridge mapping and to measure the thickness of bone and soft tissue during implant planning, which allows increasing the success criteria of implant placement. Materials and Methods: This validity study included a total of 96 samples chosen from 20 patients undergoing implant surgeries (mandible and maxilla) aged between 25 and 50 years. Measurements of bone and mucosa were done by using three techniques, which are the CT, CBCT with X-resin, and finally ridge mapping at 4 points that are 3, 4, 5, and 6 mm from the alveolar crest. The analysis of variance test was used for statistical analysis, establishing a level of significance at P ≤ 0.05. Results: A comparison between the different techniques was done using Freidman’s test with the Wilcoxon signed-rank test for paired (matched) samples as multiple 2-group comparisons. Two-sided P < 0.05 were considered statistically significant. For bone measurements, results showed that there was a statistically significant difference between CBCT and CT and between CBCT and ridge mapping, whereas for soft tissue measurements; results showed that there was no statistically significant difference between ridge mapping and CBCT using the X-resin stent and there was a slight statistically significant difference between the ridge mapping and the CT. Conclusion: The study reveals the ability of CBCT with the X-resin to give accurate measurements not only to the bone but also for the soft tissue in different cases with the least radiation dose and low cost.

Aim: Poor public health services are one of the reasons behind the high maternal mortality rate. Meanwhile, the prevalence of gingivitis in Indonesia shows 96.58% in all circles, including pregnant women. Complications of pregnancy that have been associated with periodontal disease include preeclampsia. The study was aimed to develop and analyze the psychometric features of an instrument that evaluate women in their pregnancy behavioral factors regarding their need of dental program by applying the Lawrence–Green’s behavioral theory in the two biggest tribes in East Java. Materials and Methods: This was a cross-sectional study with analytical approach. This study was conducted among 187 pregnant women in Purworejo (representing Javanese tribe) and village Omben (representing Madurese tribe), East Java Province, Indonesia. The sample was obtained by simple random sampling technique. They were asked to fill out the questionnaire tested, which contains 46-item questions based on Lawrence–Green’s theory. The data obtained were then tested for validity and reliability using confirmatory factor analysis and linear regression analysis. Results: From the 46 items, the final Lawrence–Green-based questionnaire with 11 items was associated with individual needs of dental health program (P = 0.001 and B = 0.4). The overall Cronbach α was 0.78 and intraclass correlation coefficient ranged between 0.84 and 0.99. Conclusion: This questionnaire may identify the need of dental health program in pregnant women with low income attributes.