Dental education in Malaysia has been struck badly by the novel SARS-CoV2 coronavirus (COVID-19). This has brought to a halt all teaching and learning activities, aimed at stopping the spread of COVID-19, forcing students and lecturers to shift to online teaching and learning activities. However, dental education teaching and learning is unique in nature as it involves close contact with patients and aerosol-related procedures. This article discusses the challenges faced by the lecturers and students during this pandemic and offers some alternative strategies to bridge the gap in dental education during an unprecedented time. Although COVID-19 has ceased all clinical teaching and learning activities in most universities, it is imperative for the delivery of dental education to continue to ensure students are always engaged in learning activities. Although for many dental lecturers this change to online learning is a steep learning curve, they need to be fast learners, embrace the incorporation of technology into learning programs, and adapt to the new norms. They need to familiarize themselves with online learning to ensure that the course syllabus is covered comprehensively. For students, they must have the right mindset that this change is bound to exist until COVID-19 has been brought under control and lockdown is no more relevant.

Aim: Ample evidence is available regarding the potential synergistic and bidirectional association between periodontal disease and systemic inflammatory diseases. However, the link between periodontal disease and autoimmune bullous diseases remains unclear in the literature. The present review aimed to investigate the association between periodontal disease and two major subgroups of autoimmune bullous diseases—pemphigus and pemphigoid. Materials and Methods: We performed a systematic review and meta-analysis on data extracted according to PRISMA. Relevant articles were selected from a literature search using MEDLINE, EMBASE, and CENTRAL from inception until December 7, 2020. Both randomized and non-randomized controlled studies were included. Non-systematic reviews and trials published as abstract, case series, and case reports were excluded. The meta-analysis was conducted with RevMan 5.3. Results: Three articles (199 subjects) were included for the analysis. Of the 199 participants, 99 patients with bullous disease were compared with 100 healthy controls. In comparison to the healthy cohort, the group with bullous disease had a statistically significant increase in clinical attachment loss (mean difference (MD) 0.82, 95% confidence interval (CI): 0.21–1.43, ρ=0.008, I² = 92%) and probing depth (MD 0.79, 95% CI: 0.71–0.87, ρ<0.00001, I² = 0%). No difference was demonstrated in the plaque index (MD 20.57, 95% CI: ‒3.35–44.5, ρ= 0.09, I² = 98%) and gingival index (MD 6.87, 95% CI: ‒6.15–19.89, ρ=0.3, I² = 98%) for both bullous and healthy groups. Conclusion: Both autoimmune bullous diseases, pemphigus and pemphigoid, are significantly associated with periodontal disease. However, the findings need to be interpreted cautiously as there is significant heterogeneity. Additional prospective studies are required to strengthen the evidence.

Aim: The aim of this paper was to assess the clinical performance of self-assembling peptide (SAP) in comparison to fluoride varnish in treatment of early enamel lesions. Materials and Methods: The literature search covered the electronic databases such as PubMed, Google Scholar, EBSCOhost, and Cochrane from 2010 to 2020. Only articles published in English were included. In vivo studies, involving human subjects in whom SAP was delivered, were included. Results: Eight hundred and sixty articles were identified from the search after excluding duplicates. Abstracts of articles were reviewed independently. Eight hundred and twenty-four articles were excluded after reading the abstracts. Full-text articles were retrieved for 36 relevant studies. After reviewing articles independently, 25 were excluded after full-text reading. Finally, 11 studies were selected based on the eligibility criteria. All 11 articles reviewed SAP, seven of them compared SAP to fluoride, one compared SAP to no treatment, and three were case series studies. Conclusion: For the treatment of early enamel lesions, non-classical remineralization using SAP whether used alone or in combination with fluoride showed a positive outcome that was superior to that of fluoride varnish. Future studies are speculated to show higher probability to detect a positive effect with SAP.

Aim: Clinical evaluation of aspartate aminotransferase (AST) in gingival crevicular fluid (GCF) with and without laser biostimulation as an adjunctive to non-surgical periodontal therapy (NSPT). Materials and Methods: This is a split-mouth randomized trial. Ten patients (20 sites) were diagnosed with chronic periodontitis as per the American Academy of Periodontology (AAP) classification (1999), and radiographic evidence of horizontal bone loss was provided. Scaling and root planning (SRP) was performed in both the test groups. One of the test groups was treated with low-level laser therapy (LLLT) along with SRP and another with only SRP. GCF collection was done at baseline, during the third and sixth months by using microcapillary tubes for the estimation of AST. Quantification of AST was done by a Semi-automated Clinical Chemistry Analyzer. The data were subjected to statistical analysis by an independent t-test, Kruskal–Wallis test, Mann–Whitney U test, Wilcoxon signed-rank test, and post hoc pairwise comparison. Results: The results revealed a statistically significant reduction in pocket probing depth (PPD) (P < 0.001) and relative attachment gain (P < 0.001) at the test sites when compared from baseline till six months. Similarly, there was a statistically significant reduction in AST levels in GCF at the sites treated with laser biostimulation along with NSPT (P < 0.001). Conclusion: Laser biostimulation along with NSPT has shown propitious results as per clinical and biochemical marker analysis and evaluation.

Aim: To compare the dentoskeletal changes of patients diagnosed with skeletal class II (14–16 years of age) treated with Forsus fatigue resistant device (FFRD) and Powerscope class II corrector (PS). Materials and Methods: The study is a prospective clinical study, with a sample of 12 patients who were diagnosed with skeletal class II with a CVMI stage IV and at the end of the leveling and aligning phase of a fixed multibracket orthodontic therapy. A total of 17 patients were included in this study by using a simple randomization method, which used sealed opaque envelopes; five patients dropped out during the course of the study. Data were analyzed for 12 patients, and each group comprised six patients. The FFRD was compared with the PS. Lateral cephalograms, photographs, and study models of the patients were obtained for the analysis. Statistical analysis was done by using SPSS software. The statistical analysis performed comprised Dahlberg’s error test, paired T test, and independent T test. Results: Treatment effects demonstrated that the Forsus and Powerscope had significant restraint of the maxilla. Vertical changes as seen by assessing FH-MP and OP-SN angles were found to be increased in both groups. Lower incisors moved labially by 2.5 mm in the Powerscope group and 1.98 mm in the Forsus group, which also contributed to the correction of the overjet. Linear measurements showed that the Powerscope led to a greater mandibular lengthening (4.06 mm) as compared with that of Forsus (3 mm). Anterior mandibular displacement accounted for 3.23 mm of 5.10 mm by using Powerscope appliance and 3.16 mm of 4.90 by using Forsus appliance. Conclusions: Pre- and posttreatment changes were statistically significant for both FFRDs and PS. Both the PS and FFRD are acceptable compliance-free appliances for class II correction. The PS has a greater restraint on the maxilla, more forward displacement of mandibular molars, and lower incisor proclination as compared with the Forsus appliance.

Aim: By using the research diagnostic criteria (RDC) and Fonseca’s questionnaire, the present study aimed at assessing the number of self-reported temporomandibular disorders (TMDs) discovered accidentally on routine dental examination and also at knowing the prevalence, severity, and awareness of patients toward TMD in Sakaka, Saudi Arabia. Materials and Methods: This is a descriptive cross-sectional epidemiological study. A sample of 100 patients with a chief complaint of pain in the temporomandibular joint (TMJ) was collected randomly; a routine examination of the TMJ using RDC was done. Fonsecas Anamnestic Index (FAI) questionnaire was used to collect and record the data. Later on, by using the SPSS software, sample t-test and ANOVA test were used; data analysis was conducted, and results were created. Results: The study revealed that 74% of participants belonged to the significant age group of 30 to 60 years (P < 0.05), with 79% male prevalence. The most common cause noted was psychological stress, filling of tooth, root canal treatment (RCT), and chewing gum. Based on the FAI questionnaire, the severity of TMD was moderate with 44% and RDC revealed 46% tenderness in masticatory muscles and 59% of clicking sound on auscultation. Orthopantomograph (OPG) evaluation showed flattening and condylar irregularities of bone. Conclusion: The number of self-reported cases of TMDs were very less. The severity of TMD was moderate, but the average population was not aware about it.

Aim: To determine whether discrepancies exist between orthodontists, prosthodontists, and maxillofacial surgeons regarding their knowledge, attitudes, practices, and experiences around temporomandibular joint disorders (TMDs). Materials and Methods: A cross-sectional study was conducted, and a convenient sample was used. An invitation with a link to the questionnaire was sent to orthodontists, prosthodontists, and maxillofacial surgeons. A total of 126 individuals agreed to take part, of whom 57 were orthodontists, 37 were prosthodontists, and 32 were oral and maxillofacial surgeons. Participants were asked to answer questions about their knowledge of TMDs, the relationship between orthodontics and TMDs, and how TMD awareness and number of referrals can be increased. Descriptive statistics, such as frequencies and descriptive measures, were obtained. Comparisons between groups were performed by using the chi-square test. Results: There was general agreement across all groups that identification and removal of occlusal interferences is effective in the management of TMDs, with the highest level of agreement found among prosthodontists. In addition, there was overall agreement among the groups that the best treatment of TMD cases involves multidisciplinary teamwork. All groups suggested more than one approach to enhancing TMD awareness and increasing referral rate. Conclusion: There is a general consensus that identification and removal of occlusal interferences is effective in the management of TMDs. Multidisciplinary teamwork is broadly considered to be the optimal approach for the management of TMDs. There is a discrepancy between orthodontists, prosthodontists, and maxillofacial surgeons in terms of their knowledge and experience around the treatment of patients with TMDs.

Aim: The trend of cleaning teeth with miswak amidst the modern technological developments can be found in the majority of large countries. Many advantages of miswak increase its trade throughout the world, causing it to be easily obtainable on the market. However, until now, there have not been many studies that explain the active substances in miswak sold on the market. This study aims to analyze the content of active substances from various types of miswaks, which are sold freely on the market. Materials and Methods: A total of five miswaks from Saudi Arabia and Pakistan were taken as the study sample. The miswak was divided into three types of samples: powder, extract, and evaporated extract samples. All miswaks were extracted using maceration method. The chemical content was tested using Fourier-transform infrared (FTIR) spectroscopy and an ultraviolet–visible (UV–Vis) spectrophotometer. The research results were analyzed using Origin software. Results: FTIR test of the miswak powder showed that miswak B had a dominant phosphoric acid (PH) group and pH ester with a wave range of 2425-2325 cm^‒1. The FTIR test of the miswak extract showed phosphorus atoms at wavenumber 867.96 cm^‒1 with PO groups and 430.01 cm^‒1 with the P-Cl group in the compound. UV–Vis test of the miswak extract showed that miswak B and miswak E had higher absorbance values than other miswaks. The UV–Vis test of the evaporated miswak extract resulted in the breakdown of molecular bonds in miswak E after going through the evaporation process, causing more than one wave peak to be produced. The FTIR test of the evaporated miswak extract showed that miswak R had a strong bond between molecules. Hence, the PH group is not broken during the evaporation process. Conclusion: Miswaks which are sold freely in the market contain an active substance in the form of phosphoric acid which consists of phosphorus atoms which are beneficial to human teeth and bones.

Aim: Periostin is an extracellular matrix protein secreted in the tumor microenvironment. It is frequently overexpressed in various human cancers, including oral squamous cell carcinoma (OSCC). The role of periostin in carcinogenesis of OSCC is yet to be established. The present study was aimed at determining “Periostin” expression in leukoplakia and the oral submucous fibrosis (OSMF) to relate with its role in malignant transformation of these disorders to OSCC. Materials and Methods: A total of 63 cases were categorized into three groups, namely Group I: OSCC (n = 21), Group II: Leukoplakia (n = 21), and Group III: Oral submucous fibrosis (n = 21); these groups were subjected to immunohistochemical analysis by using the periostin antibody. Kruskal–Wallis test and Mann–Whitney U tests were used to assess the significant differences in the periostin expression between groups (SPSS software version 23.0). Results: Results indicated that there was significant difference in the periostin levels between the groups (P < 0.005), indicating a fairly strong relationship between periostin expression among groups. A significant difference between the different grades of leukoplakia was observed, whereas there were no significant differences between subgroups of the OSCC and OSMF. Conclusion: The present study justifies periostin as a key stromal element in tumor progression of OSCC. The potential role of periostin in malignant transformation of oral potentially malignant disorders (OPMD) has been suggested.

Aim: Managed care is considered a cost-control measure to prevent skyrocketing health-care expenditure. The Indonesian government launched National Health Insurance (NHI) at the beginning of 2014, with financial management for dental services that differs based on whether a fee-for-service or capitation scheme is used. This difference in financial schemes may financially affect community health centers (CHCs) that implement NHI. The aim was to compare the adequacy of funds for CHCs based on fee-for-service and capitation revenue in the implementation of Indonesian NHI for dental services. Materials and Methods: This is an observational study with a retrospective research design. Fee-for-service and capitation revenue data were obtained from NHI participants’ dental records at selected CHCs in Yogyakarta Province. The unit analysis included dental services data from January 2014 until December 2014 collected from 30 CHCs selected from rural, suburban, and urban areas. Purposive sampling was used to define the CHC included in the research. Results: The utilization rate and the number of participants affected the adequacy of financial revenue at each CHC sampled. Rural and urban areas had statistically significant differences (independent t-test, P < 0.05) between their fee-for-service and capitation revenues. Only the CHCs in suburban areas exhibited no significant difference in their fee-for-service and capitation revenues (P > 0.05). Conclusions: The capitation funding scheme for dental treatments in the Indonesian NHI can sufficiently provide a benefit package of eight dental treatments in rural and suburban areas, but not in urban areas.

Aims and Objectives: The aim of this article is to assess the efficacy of red betel leaf against Candida albicans over acrylic denture surface. Materials and Methods: This research used an experimental design. The efficacy of red betel leaf was assessed through minimum inhibitory concentration (MIC) and immersion tests. The results of MIC test using microdilution method were determined using turbidimetric and spectrophotometric methods. The immersion test used 30 sterilized identical heat-cured acrylic resin plates (10×10×2 mm), five each for six groups contaminated by Candida albicans and immersed in different denture cleansers (red betel leaf extract with concentrations of 10%, 20%, 30%, and 40%, alkaline peroxide denture cleanser “fitty dent”^® as positive control, and sterile distilled water as negative control). The number of microorganisms was calculated and analyzed using analysis of variance followed by post hoc test. Results: MIC of red betel leaf extract was 2.34% (turbidimetric method) and 0.29% (spectrophotometric method). The immersion test showed that the statistical analysis of the six groups was significant (P<0.01). The more the concentration of red betel leaf extracts (10%, 20%, 30%, and 40%), the lesser the number of colonies of C. albicans (48, 8.6, 4.4, and 4.2 ×10³ CFU/mL); meanwhile, the reduction value increased to 62.09%, 93.21%, 96.53%, and 96.68%. There were no significant differences between 30% and 40% red betel leaf extract concentration (P = 0.89). The highest number of colonies was in negative control (126.6 × 10³ CFU/mL) and the smallest was in positive control (1.3×10³ CFU/mL). Conclusion: Red betel leaf had efficacy against C. albicans over acrylic denture surface at 30% concentration.

Aim: To compare microleakage in premolar class I restorations between nanohybrid and microhybrid composites in an in vitro study. Materials and Methods: Overall, 32 healthy premolar permanent teeth extracted for reasons unrelated to the study were used. Class I Black restorations were performed and divided into two groups. Group A: microhybrid resin, Group B: nanohybrid resin. Both groups were subjected to manual thermocycling (300 cycles at 5, 37, and 55°C), and they were then immersed in 2% methylene blue during 24h. Subsequently, the samples were washed, dried, sectioned, and observed under a stereoscopic microscope. Results: In the microhybrid resin composite (MRC) group, only two teeth (28.8%) did not show filtration (Grade 0), whereas eight of the specimens evaluated (80%) showed Grade 3 filtration (dye penetration to the pulpal floor). On the other hand, in the nanohybrid resin composite (NRC) group, the highest prevalence was found in Grade 1 (no dye penetration) in eight specimens (66.7%). There was no statistically significant association between the degree of filtration and the type of resin composite used (P = 0.089). Conclusions: Both materials showed microleakage, but the microhybrid resin presented a higher degree of filtration compared with the nanohybrid resin. No statistically significant association was found with the degree of microleakage between the resins.

Aim: Biomedical and psychosocial factors are crucial in ensuring overall positive patient outcomes after any treatment. Patients diagnosed with cancer often suffer from decreased morbidity due to fear, social stigma, and the side effects of various treatment modalities, including radiotherapy (RT). This study aims at assessing the Quality of Life (QOL) among patients suffering from cancer who are undergoing RT. It seeks to elucidate the factors affecting QOL during RT. Materials and Methods: A cross-sectional observational study was conducted at four cancer tertiary centers in Chennai city. Hundred and six patients undergoing RT were randomly selected. They were further grouped into three groups based on their treatment phase. The study used the Functional Assessment of Cancer Therapy - General questionnaire (FACT-G) to determine family, emotional, physical, and functional well-being of the patients. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS 20.0) software. Chi-square test was done to assess the relationship between QOL with gender and different treatment phases. The study used Kendell’s tau b test to evaluate the relationship between age and QOL. Results: Overall QOL scores showed that the majority (46%) of the patients experienced a good QOL. Statistical analysis showed no significant relationship between different phases of treatment and sexes with QOL. There exists a statistically significant negative relationship between age and QOL. The assessment of the QOL subscales revealed that all the patients received an excellent safety net from family, but physical well-being was the most affected. Conclusion: This confirms the aim that QoL wanes during the course of RT. Physical well-being was the most affected among the patients. Sex and treatment phase did not affect the QOL in patients, whereas there was a negative correlation between age and QOL. A routine QOL assessment as part of the treatment and prognosis is indispensable in the future.

Aim: This in vitro scanning electron microscopic (SEM) study was planned to assess and compare the effect of ozone gel versus nano-silver mouthwash when used as a root bio-modifier on the surface of the periodontally affected extracted roots. Materials and Methods: Twenty single-rooted teeth were selected for this in vitro cross-sectional study. The teeth were decoronated and split longitudinally to form 40 radicular halves. They were randomly allocated to four groups of 10 fragments each. Then, the other groups were scaled. Group 1: left untreated (non-scaled) (Negative control group). Group 2: treated with saline (Positive control group). Group 3: treated with ozone gel 20:25 µgm/ml concentration. Group 4: treated with nano-silver mouthwash. The specimens were prepared to undergo scanning electron microscopy and elemental analysis (SEM-EDX) to determine the percentage of calcium (Ca) atom. Further, the acquired photomicrographs were evaluated for the presence of calculus, smear layer, and product residues and they were analyzed using Fisher Exact test followed by Dunn’s test. SEM-EDX were analyzed by ANOVA test followed by Tukey’s post hoc test for a pairwise comparison between groups. Results: The nano-silver mouthwash treated group showed the absence of the smear layer and calculus and had significantly higher residue levels than ozone-treated specimens (P = 0.001), whereas the ozone group showed that the smear layer was not completely removed with the absence of remnant of the material. The negative control group scored the highest level in the presence of calculus compared with other examined groups (P = 0.001). Interestingly, the nano-silver treated group showed a significant decrease in Ca levels compared with all other experimental groups. Conclusion: The nano-silver mouthwash removed the smear layer effectively and provided notable substantivity, as evidenced by the presence of the material remnant after application. Moreover, it decreased Ca level significantly compared with all other experimental groups, which is expected to increase cellular attachment and proliferation. Thus, using the nano-silver mouthwash as a root bio-modifier could yield better results in periodontal reattachment.

The rehabilitation of patients with disabilities secondary to acquired or congenital defects continues to be a challenge. In contrast to the small maxillofacial defect that can be properly restored surgically, large defects are challenging. When surgical reconstruction is not possible, prosthetic restoration of the facial defect is a treatment of choice. The objective of this clinical report is to present a case of rehabilitation of hemimaxillectomy in which the standard treatment procedure was modified to acquire desirable results. The treatment plan included the fabrication of a two-piece cast partial maxillary obturator with magnetic attachment. The prosthesis was evaluated for retention and stability on mastication. The assessment of subjective pain and discomfort, as well as aesthetics, was carried out. Speech intelligibility was assessed by audio–visual aid. To reduce the weight of the prosthesis, the bulb of the obturator was made hollow. Post-insertion of prosthesis, there was a significant change in clarity of speech and resonance in voice. Improvement in masticatory function and overall well-being was achieved. This boosted the confidence of the patient while communicating in society. Routine checkups after two years revealed a patient who was satisfied with the prosthesis in function and without any deleterious effect. The fabricated prosthesis improved the cosmetic as well as the functional ability of the patient, thereby giving him mental peace.