Formation of white spot lesions (WSLs) has remained a common occurrence during fixed orthodontic treatments, particularly in patients with poor oral hygiene. Such lesions, if not addressed, may progress to caries, thereby leading to poor aesthetics and patient dissatisfaction. Given the complexities and the alarming rise in the prevalence of WSLs in orthodontic patients, there is a need to develop a set of recommendations based on the Indian scenario to address unmet patient needs in managing WSLs. This paper is an outcome of expert group discussion convened with the primary objective to discuss the knowledge–practice gaps in the field of orthodontics, to understand the prevailing clinical practice patterns in managing WSLs in Indian settings, and to facilitate information exchange among subject matter experts. In brief, patient education and motivation regarding the importance of maintaining good dietary compliance and excellent oral hygiene are the cornerstones for the prevention and management of WSLs. Moreover, identification and management of various risk factors could prove beneficial. Noninvasive treatment of early or active WSLs by means of remineralizing agents could ensure better prognosis and could help prevent WSL progression.

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Esthetic smile design is a conceptual tool that can reinforce diagnosis, improve communication, and enhance certainty of the treatment. Analysis of the facial and gingival features in relation to the teeth can be achieved by evaluating facial, dento-labial, and dentogingival parameters, which are crucial steps in smile designing. Following this, diagnostic wax-up, which is an imperative tool, was carried out on maxillary anterior teeth to satisfy the smile design and to establish an anterior guidance. Diagnostic wax-up allowed the dentist to effectively communicate with the patient concerning the final esthetic outcome with improved smile line. Esthetic pre-evaluative provisional prepared from the diagnostic wax-up permits the dentist and the patient to appraise the appearance of the future restorations during smile and function. Hence, the aim of this case report was to highlight smile enhancement with the aid of anatomic diagnostic wax-up following principles of esthetic smile designing.

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Aims and Objectives: The purpose of this study is to assess the use of low-level laser therapy (LLLT) on pain, discomfort, bleeding, and clot formation inside the socket after extraction the upper anterior teeth of healthy adult patients. Materials and Methods: Twenty patients, their age 15–60-year-old, were used in this current study. Patients were randomly separated into two groups; each group has 10 patients using the same surgical protocol for both groups. Immediately after the extraction, the laser group received low power laser therapy intraorally using a diode laser 940nm and 0.8 W power output in continuous mode with exposure time ranging 15–60s. All patients were given postoperative recommendation. Variable parameters were evaluated after teeth extraction for 7 days including pain, discomfort, and bleeding. Data analysis was achieved by using the Statistical Package for the Social Sciences statistics Version 21. Results: The pain scores in the laser group revealed significant difference (P = 0.001). There was found a significant difference only in the 5^th day (P < 0.05) postoperatively when comparing the pain level between the two groups. The study results also showed a significant decreased level of discomfort in the second group (laser group), while the level of discomfort in the first group (control group) was not significant. On the 1^st day up to the 5^th, 6^th, and 7^th day (P < 0.05), postoperatively, there were significant differences when comparing the discomfort level between the two groups. Bleeding score was significant between the two groups (P = 0.001). Conclusion: Using a diode laser 940nm with 0.8 W (output power) in continuous mode, as LLLT has a significant effect in reducing pain, discomfort, and bleeding levels with the formation of a stable blood clot inside the tooth socket.

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Aims and Objectives: Sodium hypochlorite (NaOCl) and QMix are solutions used for root canal irrigation. During the endodontic procedure, irrigation solutions are often leaked beyond the apical foramen and as a result cause periapical tissue complication because of their toxicity. This study was aimed at proving the cytotoxicity effect of NaOCl and QMiX on cultured human periodontal ligament fibroblast cells (HPDLFc). Materials and Methods: HPDLFc were exposed to NaOCl and QMix at various concentrations. Cell viability was assessed with Mosmann’s tetrazolium toxicity assay and the results were measured and statistically analyzed by probit analysis to determine the median lethal concentration (LC50), the concentration that is lethal to 50% of the cells and therefore considered cytotoxic. Results: NaOCl and QMix are cytotoxic to HPDLFc at 0.254 and 0.363 µL/mL, respectively. Conclusion: Both solutions are cytotoxic to HPDLFc at certain concentrations.

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Background: An impressive number of dental implants are inserted worldwide. Evolution in dental implants and simplification of surgical techniques allowed a significant increase in the number of dentists involved in implant surgery. Most of them are general dentists, are not always sufficiently formed and experienced, frequently use low-quality implants, do not adopt the proper patient selective criteria, do not adequately monitor and maintain the inserted implants, and do not report their own statistics to the dental community. Consequently, the incidence of inflammatory periimplant diseases (IPDs) has progressively increased to values significantly higher than those previously indicated by the scientific literature. Materials and Methods: Two main literature searches were undertaken in October 2018 in the PubMed Website database. Only articles written in English and published from 2008 onward were considered; “Clinical Trial,” “Meta analysis,” “Observational study,” “Review,” and “Validation study” were selected as article type filters. The following keywords were used in the searches: “Peri implantitis prevention” and “Dental implant failure prevention.”Results: Preventive measures are analyzed according to the different factors that can favor the occurrence of an infection. The factors are divided into (i) implant dependent, (ii) patient dependent, and (iii) surgeon dependent. Conclusions: Scientific and clinical data confirm that when materials are selected with care, patients are carefully evaluated for factors of risk and attitude to adhere to the necessary maintenance program, and operative protocols and maintenance programs are respected dental implants can be attractive and effective tools for oral rehabilitation. Nevertheless, dentists and patients should have greater awareness that in many cases the decision to utilize dental implants cannot be taken lightly.

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Aims and Objectives: To connect the dentists, dental nurses, and school teachers so that they can produce a discussion forum about dental and oral health. Materials and Methods: The method in implementing the empowerment program was grouped into three stages, that is, pretreatment stage through problem mapping, problem prioritization, determination of programs related to existing issues, and coordination. It was then followed by the stage of program implementation and evaluation of the activity. Results: Dentists, dental nurses, and student health unit/sport teachers were able to access online communication forum through WhatsApp without constraint. Conclusion: This online dental communication forum was an integrated system that built communication between related agencies to increase the minimum number of visits of elementary school students to dental services. With this program, the database of dental examination results from School’s Dental Health Unit indirectly will also be stored well and owned by each school.

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Aims and Objectives: Copper (Cu) and Zinc (Zn) are the important trace elements that play an important role in various functions of the human body at cellular and molecular level. The purpose of this study was to assess the alterations in serum Cu and Zn levels in oral potentially malignant disorders (OPMDs) and to correlate the variations with the severity and progression of the OPMDs. Materials and Methods: In this institution-based study, 20 of each clinically diagnosed and histopathologically proven cases of leukoplakia (Group 1), oral lichen planus (Group 2), clinically diagnosed cases of oral submucous fibrosis (OSMF) and 20 healthy age and sex matched controls were taken based on the clinical staging. Clinical examination of the selected subjects was carried out and an informed consent was obtained, following which blood samples were collected from the participants. After serum separation, Cu and Zn levels were analyzed using the colorimetric method. Data were sent for the statistical analysis using the Statistical Package for the Social Sciences (SPSS) software, version 21.0. Results: Serum copper levels were increased and zinc levels were decreased in patients with OPMDs when compared to that in the control group. However, gradual increase in the levels of serum Cu was found with the advancing stages of OSMF. No statistical significant relation was observed in the levels of serum Zn with the disease progression in OSMF. Conclusion: Serum Cu and Zn levels can have diagnostic significance in early evaluation of OPMDs. Increased serum Cu levels can be used as a marker of disease progression and severity in OSMF.

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Aims and Objectives: To determine the severity of dental caries according to the behavior of drinking traditional Tuak legen/palm wine. Materials and Methods: A descriptive study with cross-sectional design was conducted in a population of Gedongombo villagers with the habit of consuming traditional Tuak legen/palm wine for at least 1 year. The participants in this study were men aged 20–60 years comprising 50 participants. Variables observed in this study were dental caries and the habit of consuming palm wine. Caries level was measured using the decayed-missing-filled teeth (DMF-T) index. The data regarding palm wine consumption habits were obtained from self-administered questionnaire filled by the respondents. Chi-square test was carried out using the Statistical Package for the Social Sciences (SPSS) 17.0 software to analyze the data. Results: Respondents who have the habit of consuming palm wine with the frequency 2–3 times a week have higher DMF-T score (7.45) compared to respondents who consumed palm wine only once a week (5.0). We also found that respondents who consumed palm wine by slowly drinking had a higher DMF-T score (7.27) compared with respondents who consumed Tuak legen straightened up at once (5.75). Conclusion: Respondents with the habit of consuming traditional palm wine have higher DMF-T score.

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Objectives: Congenital anomalies are the biggest cause of prenatal, perinatal, or infant mortality and morbidity. A total of 15% of congenital abnormalities involve the craniofacial and oral segment. Orofacial cleft (OC) is one of the most common examples of congenital abnormalities. One example of OC is cleft lip and/or palate (CL/P). The occurrence of the incident varies depending on geographical location, ethnicity, race, environmental exposure, and socioeconomic status of the patients. The aim of the study was to investigate the variation of non-syndromic CL/P (nsCL/P) in Yayasan Surabaya CLP Center, East Java, Indonesia, as well as the number of occurrences of clefts in each gender. Materials and Methods: An analytical observational study with cross-sectional and blind total sampling method was presented. Data obtained from Yayasan Surabaya CLP Center were grouped by type and classified by the LAHSHAL classification system. The numbers were calculated and then divided into occurrence per gender and per family history. A descriptive analysis was applied and then presented in table form. Results: The number of patients with cleft lip and palate (CLP), cleft lip (CL), and cleft palate (CP) were 163, 57, and 16, respectively. The more detailed type: ...SHAL, .....AL, and ..HSH.., had the highest number of cases, which were 79, 28, and 10, respectively. Conclusion: Most types of CL/P at Yayasan Surabaya CLP Center were CLP, followed by CL and finally CP. The incidence of CLP and CL was more common in men, whereas CP was more common in women.

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Aims and Objectives: Both carious and non-carious lesions covering large dentine areas are indisputable indications of the need to use dentine bonding. Clinically, dental preparation, which is subsequently subjected to dentine bonding application often results in post-restorative pain. Various studies suggest that post-restorative pain is caused by the presence of residual monomers from the imperfect polymerization of a bonding material. The residual monomer can be a free radical that will induce oxidative stress conditions producing a toxic effect on 4-methacryloxyethyl trimellitic anhydride (4-META) monomer as the base material of dentine bonding. The aim of the study was to determine the toxic concentration of 4-META dentine bonding material using acetone as a solvent that destroys 50% of the dental pulp fibroblast cells. Materials and Methods: Human pulp fibroblast cells contained in each well were treated with 4-META-acetone solution at concentrations of 5000, 2500, 1250, 625, 312.5, 156.25, 78.12, 39.06, 19.53, and 9.76 μg/mL. Two wells were left untreated to form the control group. A cytotoxicity test was performed by means of an 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT)-assay test. The optical density of each well was measured with an enzyme-linked immunosorbent assay (ELISA) reader and the percentage of human pulp fibroblast cell destroyed was calculated using the appropriate formula. Results: The concentration of 4-META-based dentine bonding with acetone solvent capable of causing 50% human pulp fibroblast cell death (LC₅₀) was 1250 μg/mL. Conclusion: Toxic concentrations are those greater than or equal to 1250 μg/mL.

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Aims and Objectives: To measure the influence of Index of Multiple Deprivation England (IMDE) on dental caries prevalence, perceived dental need, and oral health related quality of life (OHRQoL). Materials and Methods: Secondary analysis of the 2009 Adult Dental Health Survey (ADHS) was carried out to report the influence of IMDE on the number of carious teeth, perceived need toward dental treatment OHRQoL of UK adults using Oral Health Impact Profile (OHIP-14). Results: As the range of IMDE from the least to the most deprived area is 10 to 1, IMDE score was negatively correlated with the number of carious teeth (r = −0.147, P = 0.01). Similarly, IMDE score was negatively correlated with total OHIP-14 score (higher score indicating higher impact on OHRQoL) with r = −0.135 (P = 0.01). Logistic regression showed statistically significant results of IMDE score in increasing the likelihood of respondent in having higher number of caries (odds ratio [OR] = 0.93, P = 0.000), perception of needing dental treatment (OR = 1.111, P = 0.000), and higher OHIP-14 score (OR = 0.94, P = 0.000). Conclusion: Measures of relative deprivation are important in research related to oral health inequality. Area-based deprivation index proved to be one of the tools that can visibly disclose the inequalities of burden of disease in oral health. Policymakers should consider concentrating resources toward those with low household income in highly deprived areas rather than those with similar income but in less-deprived area.

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Brugada syndrome is a ventricular arrhythmic disease causing sudden cardiac death in patients with structurally healthy heart. Common dental therapies may be risky in such patients as a simple local anesthesia may cause a fatal arrhythmia. We present a case report of a patient who had been referred to our unit with a diagnosis of acute pulpitis of 3.7 in Brugada syndrome and was assessed for cardiologic and anesthesiologic risk. He had been treated by conscious sedation and discharged after few hours. The aim of this report was to give to dental practitioners an update on this theme and to describe multidisciplinary approach adopted in Complex Operative Unit of Odontostomatology of University of Bari Aldo Moro. We described a case highlighting the importance of teamwork composed by three different specialists and the importance of promoting oral health in patients with Brugada syndrome to reduce the overall risk.

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