Sleep-disordered breathing (SDB) is a broad terminology that denotes a group of disorders. Conditions associated with SDB include obstructive sleep apnea (OSA), central sleep apnea, and upper airway resistance syndrome. Although OSA is most common in the general population, the reported prevalence shows a wide range of differences due to inconsistent study methodology. The pathophysiology of OSA has been described by active and passive theories. Polysomnography is considered as the gold standard and the most accurate tool for the diagnosis of OSA. Definitive diagnosis and determination of the severity of the OSA are instrumental before the commencement of the treatment. Patients with OSA are at increased risk of various endocrinal and metabolic disorders. OSA and temporomandibular disorders (TMD) have shown a clear relationship due to the highly prevalent rate of OSA in individuals with TMD. It may be concluded that concomitant TMD and sleep bruxism may be present in patients with OSA. Furthermore, the use of oral appliances in the treatment of OSA in mandibular advancement may cause TMD. The aim of this article was to review current knowledge on OSA and the association between TMD and OSA. This review also emphasizes that concomitant TMD in OSA is an object worthy of future study.

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Aim: To evaluate the effectiveness in plaque removal and gingival improvement between the Modified Circular and the natural toothbrushing methods in 10- to 12-year-old children. Materials and Methods: A presented quasi-experimental study had a total of 124 fifth graders who were randomized into control and intervention groups. The examination used a structured questionnaire; gingival index (GI), plaque index (PI), and video recording were performed at baseline and follow-up. One oral examiner and one interviewer were blinded for the data collection. Both groups were trained to brush their teeth twice daily for 2 minutes. The intervention group was trained to brush using the Modified Circular and the control group was asked to brush using the same way they brush every day. The collected data were analyzed using demographic statistic, t-test and chi-squared test. Results: At baseline, no significant differences were observed in the mean PI and mean GI between the intervention group (PI = 2.37, standard deviation [SD] = 0.71; GI = 0.49, SD = 0.29) and the control group (PI = 2.26, SD = 0.64; GI = 0.52, SD = 0.29). At one-month follow-up, the intervention group had significantly lower mean PI (PI = 1.74, SD = 0.96) than the control group (PI = 2.30, SD = 1.18) (P < 0.004). The intervention group had a significantly lower mean GI (GI = 0.28, SD = 0.33) than the control group (GI = 0.51, SD = 0.40) (P < 0.002). Conclusion: The Modified Circular method can effectively remove plaque in 10- to 12-year-old children better than the natural toothbrushing method.

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A presented paper is reviewed for the Special Care Dentistry (SCD) teaching of dental undergraduates from different continents and compared it to the current SCD education scene in Malaysia. Related literature were reviewed together with the current updates of SCD in Malaysia as an overview to bridge the gap for SCD teaching, planning the learning outcomes, and the curriculum guidelines. It highlights the barriers, similarities, and the different approaches applied in Malaysia. Constructing the SCD curriculum and adhering to it is a challenge. Most countries will be bound to the local expectations and needs to be able to construct their national guidelines. The literature shows the difference in approach of teaching SCD globally. Different factors such as lack of SCD expertise, lack of disabled-friendly facilities, overloaded curriculum, and lack of educational resources were highlighted in the literature as factors that can halt the SCD education. Educators need to incorporate the learning outcomes, the local needs, and/or curriculum guidelines within their institutions to design the content of their own programs. The Malaysian experience can be an example of a southeast Asian approach in SCD education.

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Aim: Indonesian health-care system evolution is attributed to billing and insurance of the health service, especially on basic dental service through capitation payment. Administrative cost estimation is important to equalize the allocation of health insurance expenditure spread over the dental clinic in Indonesia. The aim of this study was to calculate unit cost value at urban and suburban dental services at Pratama Clinic at Padang, West Sumatera, Indonesia. Materials and Methods: Two dental services at Pratama clinics at urban and suburban areas selected by random sampling. Unit cost patient day was applied by Activity-Based Costing method. Statistical analysis: The cost was calculated by using computerized Microsoft Excel analysis. Results: Suburban dental service Pratama Clinic has higher activity driver value than urban counterpart, but there is no significant difference between resource driver at urban and suburban dental service Pratama Clinic. The unit cost calculation of dental service at urban and suburban Pratama Clinic is US$5.26 and US$5.36, respectively. Conclusion: These findings outline that unit cost value at suburban is higher than urban dental service Pratama Clinic. So, these usefull to provide the basic information regarding the government to implement the equal and efficient health-care expenditure, particularly on each area in Indonesia.

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Aim: To quantify the amount of soft-tissue changes in Malaysian female patients treated with the extraction of first four premolars. Materials and Methods: This is a retrospective study involving 24 Malaysian female patients age between 18 and 24 years treated with extraction of the upper and lower first premolars and bonded by 0.22 × 0.28′′ standard edgewise technique. The average of treatment time was 22 months. Pre and posttreatment lateral cephalograms of patients were traced on a cephalometric tracing software CASSOS (Soft Enable Technology Limited, Hong Kong). Linear and angular measurements were made. Data were analyzed using paired t-test to determine the difference between two means. Results: All linear and angular measurements of hard- and soft-tissue changes showed significant differences except L1 to A-pogonion (A-pog) angle (P = 0.05), and the mean change has decreased to almost 1.0mm posttreatment. The Pearson’s correlation test showed that the lower lip contacts both the upper and lower incisors; hence, the lower lip position would be impacted not only by the lower incisor retraction but also by the upper incisor retraction. Conclusion: In Malaysian females, significant changes were found in soft-tissue profile post-orthodontic treatment with corresponding simultaneous change in the underlying hard tissue.

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The eye plays a vital role as one of the six senses in humans. From vision to expression, it has its various functions. The aim of this study was to suggest a technique using soft denture lining material to improve the retention of an ocular prosthesis in a grossly resorbed orbital cavity to minimizes the trauma of thin, atrophic tissue. An ocular prosthesis restores lost anatomical structures and corrects the cosmetic defect. A custom-made ocular prosthesis is a good alternative as soft denture lining material used during the fabrication of scleral part of ocular prosthesis improves patient comfort by acting as a shock absorber and stress distributor, and yields longer duration of wear. A good alternative of a custom-made ocular acrylic prosthesis is presented here, which had acceptable fit, retention, and esthetics. Fabrication of new ocular prosthesis with permanent soft liner is a novel way to minimize trauma to underlying supporting tissues.

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Intracanal retention determines the successful restoration after endodontic retreatment. Before inserting an intracanal retention, factors such as remaining amount of coronal tissue, root canal size and configuration, tooth position, functional requirements, and occlusion need to be analyzed. Fiber post is biocompatible, has good physical properties, and has the capacity of adhesive bonding to tooth tissue and core build up. This study aimed to determine the success of endodontic retreatment using prefabricated fiber post as an intracanal retention. A 31-year-old female patient came with a chief complaint of intense pain on right mandibular second premolar no. 45. In the first visit, radiograph of tooth no. 45 was taken, followed by caries removal and removal of screw post using ultrasonic tips with counterclockwise movement. In the second visit, endodontic retreatment was performed. Reduction of gutta-percha and cementing its prefabricated fiber post were carried out followed by composite core build-up until making temporary crowns using acrylic base resin. At the third visit, cementation for final restoration with a monolithic zirconia crown was performed. Endodontic retreatment is an alternative procedure for endodontics that fails even for teeth with post-intracanal therapy. Prefabricated fiber post as intracanal retention followed by a monolithic zirconia crown can be the best option so that the teeth can last as long as possible in the mouth.

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Aim: To show the potential role of statins on the inflammatory and lipid peroxidation biomarkers in patients with periodontal disease (PD). Materials and Methods: This case-controlled cross-sectional study involved 74 patients with PD and/or dyslipidemia divided into: Group (A): 34 patients with PD not on statin therapy (non-statin users), Group (B): 40 patients with PD on statin therapy (statin users), and Group (C): 30 healthy controls. Total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), and malondialdehyde (MDA) were measured. Also blood pressure profile and the indices of PD were evaluated in each group. Statistical analysis was conducted by using the Statistical Package for the Social Sciences (SPSS). Results: Patients with PD showed high cardiometabolic disturbances compared with control subjects. Inflammatory and lipid peroxidation biomarkers were higher in patients with PD compared with control subjects; IL-6, CRP, TNF-α, and MDA sera level were high in patients with PD compared with control subjects (P = 0.001). Statin therapy, either simvastatin or atorvastatin, led to significant reduction in TC, TG, VLDL, LDL, blood pressure profile, and cardiac risk indices with elevation in HDL compared with non-statin user (P < 0.01). Also, statin therapy in patients with PD led to significant reduction in IL-6, CRP, TNF-α, and MDA sera levels compared with non-statin user (P < 0.05). Simvastatin and atorvastatin produced improved periodontal indices compared with non-statin user (P < 0.05). Conclusion: Both simvastatin and atorvastatin are effective therapies in patients with PD through amelioration of PD-induced inflammatory disorders and periodontal indices.

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Aim: Consumption of aglycones-rich fermented soy has been positively associated with the recuperation of systemic inflammation. As oral conditions have an impact on overall health and diseases, the reestablishment of bacteria particularly by indigenous oral probiotic is believed to be able to reverse oral inflammation by antagonize oral pathogen and thus maintaining good oral health. Streptococcus salivarius can be combined with bioactive isoflavone aglycones to further improve oral healthiness. This study aimed to explore decent advantages by indigenous source of Streptococcus isolated from healthy periodontal to ferment soy while maintaining probiotic properties before delivering in product targeting oral health. Materials and Methods: Putative probiotic properties of isolated strains were explored through antibiotic susceptibility ensuring safe strain consumption. S. salivarius from Taylor’s University Culture Collection (TUCC) 1254 was selected for probiotic properties evaluation, in comparison with the type strain. Both strains were evaluated for fermentation ability in soy through growth, β-glucosidase assay, and isoflavone bioconversion. Results: The antagonistic ability of S. salivarius TUCC 1254 was better under anaerobic than microaerobic condition; the strain also showed higher colonizing ability to epithelial tissue than the tooth surface resemblance. The strain showed vast cell growth accompanied by organic acid production and higher β-glucosidase enzyme to bioconvert isoflavone glucosides to bioactive aglycones that could reduce oral inflammation than K12. Soy improved auto-aggregation ability of S. salivarius, which could promote biofilm formation and thus could achieve enhanced oral pathogen-eradicating intention. Conclusion: This study suggested that indigenous bacteria could serve as a better source of oral probiotics and coupling with fermented soy bioactive isoflavone aglycones, become a deliverable platform for improving oral health.

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Aim: This study evaluated apical seal of teeth obturated by two techniques and gutta-percha (GP) removed by two methods for post space preparation, using micro-computed tomography (micro-CT). Materials and Methods: Fifty-six single rooted teeth were decapitated at 15mm from the apex and prepared using ProTaper Universal System. Specimens were divided into two main groups of 28 each according to technique of GP Removal and post space preparation: Group A1, GP removed by a penetrating drill and Group A2, GP removed by hot plugger. Each main group was divided into two subgroups according to obturation technique: single cone (SC) and System B. Each subgroup was further divided into two minor subgroups according to storage time—immediately and one-week post-obturation. Approximately 9mm of GP was removed for post space preparation. All specimens were scanned three times by micro-CT: post-preparation, post-obturation, and after post space preparation. Total mean percentage of voids/gaps in the apical portion was calculated at 1, 3, and 5mm from the apex. Data were explored for normality using Kolmogorov–Smirnov and Shapiro–Wilk tests. Paired sample t-test was used to compare between two groups. Independent sample t-test was used to compare between two groups in non-related samples (significant P ≤ 0.05). Results: It showed that group A2 recorded significantly lower voids than group A1 at the two investigation periods. Voids associated with System B technique were lower than those with SC. Conclusion: An immediate removal of GP by hot plugger would not affect the apical seal.

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Aim: Indonesia is presumed to be a country with high incidence of cleft lip and palate (CLP). We carried out a cleft mission in Bima, Nusa Tenggara Barat, Indonesia, which is considered as a rural area. Education barrier as well as facilities and socioeconomic status of the rural area residents may contribute as challenges of verbal postoperative care information. CLP postoperative care guidebook and local wisdom may deliver a proper explanation. The aim of this study was to describe the utilization of CLP postoperative care guidebook for caregivers based on local wisdom for rural area communities. Materials and Methods: We provided CLP postoperative care guidebook after cleft and lip surgery. A total of 20 respondents were asked to complete questionnaires with 10 closed-ended questions and 1 open question in two weeks after surgery. We provided the postoperative infection questionnaire to clinicians who carried out patient follow-up care to evaluate potency of infection after surgery. Results: Most of the respondents were parents of patients with CLP (75%). Potency of postoperative infection was found in 30% patients, and it showed no correlation in all patients who were treated using this book as a guide (odds ratio = 0.76, [0.06–9.51]). All respondents (100%) used the guidebook as patient’s care guide after CLP surgery, and considered it easy to understand. Conclusion: CLP postoperative care guidebook for caregivers based on local wisdom is useful as a health education–promotion media for rural area communities, and it may help in informing early potency of postoperative infection to caregivers.

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Aim: To find out a natural peer group approach toward the knowledge of the dental and oral fields effectively. Materials and Methods: This research is a quasi-experimental research with before–after study design. This study comprising 77 students for total sampling method was conducted on grade 4–5 students (aged 10–11 years). Data collection method used is by way of pretest and posttest for measuring data of oral and dental health knowledge. Sociometric questionnaire was administered to the students in order to identify the condition of the formation and reference character of natural peer group. The third data are the primary data obtained directly from the research respondents. The researcher provided dental and oral health intervention to the peer group reference before the peer group reference was allowed to mingle with peer group members without control and supervision during the effective 2x day school. The evaluation process was confirmed the shared information from the group leader with Oral Health questionnaire. This method conducted to find out the effectiveness of Oral Health Education counseling through Natural Peer Group teaching method. The data were analyzed by the comparative method using Statistical Package for the Social Sciences software version 17.0 (SPSS, Chicago, IL). Results: There is an increase in grade averages in grade 4 (P = 0.783) members’ score, and a decrease in grade 5A (P = 0.202) and 5B (P = 0.725) members’ score. In both grade 4 and 5 leader students, all the posttest values increase, but only grade 5 has a significant difference (P = 0.047 an P = 0.006). Conclusion: Natural peer group learning is not suitable for dental health education counseling method.

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Aim: Elimination of microorganisms should be of priority in the treatment of any endodontic pathogenic process. The prevalence of microorganisms within the root canal will not cause treatment failures but the absence of microorganisms will certainly lead to success. Materials and Methods: In vivo study was conducted to compare the antibacterial effectiveness of sodium hypochlorite and Calendula officinalis against Streptococcus mutans as root canal irrigants. A total of 40 subjects (older than 18 years of age) were selected with single-rooted teeth, necrotic pulp, and chronic apical periodontitis. Access preparation was carried out, canal was negotiated and sample was taken with paper points before biomechanical preparation. After cleaning and shaping with ProTaper files, irrigation was carried out with sodium hypochlorite and C. officinalis, and was then neutralized with saline and then second sample was taken. Both samples were sent for culturing in pre-reduced medium. Mitis salivarius agar was used for S. mutans, and then calculation of the number of colony forming units per milliliter reduced transport fluid was carried out. Results: The results of the study showed good antibacterial potential for both the medicaments used. Conclusion: Sodium hypochlorite remains the gold standard for bacterial elimination in root canal therapy; however, C. officinalis also has shown promising results and may require further investigation.

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Aim: Immediate postoperative radiographs are routinely advised by surgeons for treatment of maxillofacial fractures. It is mainly for evaluation of the reduced fracture, alignment of plates, and assessment of occlusion. To scrutinize the requirement of routine postoperative radiography in patients treated by open reduction and internal fixation of fracture. Materials and Methods: The study was conducted retrospectively and radiographs of the patients who had reported to emergency department of our institute because of maxillofacial trauma from 2014 to 2016 were retrieved from the archive of dental radiology department. A total of 147 subjects were treated for 203 simple maxillofacial fractures. Information on age, gender, type of fracture, site of fracture, treatment carried out, and cause of retreatment if any were recorded. The continuous variables (age and number of fractures) were compared using the Mann–Whitney U test, whereas the Fisher’s exact test was used to compare categorical variables (gender and type of management). Results: The number of subjects that required re-treatment surgeries was evaluated. Only 13 subjects required re-treatment surgeries. Only in one subject (0.49%), the decision for re-treatment was based exclusively on postoperative radiographs. Six studies from the literature reported that postoperative occlusion can better predict the clinical outcome instead of immediate postoperative radiograph. The results of this study are in accordance with the literature review. Conclusion: Routine immediate postoperative radiograph may not be essential after management of simple maxillofacial fractures. Immediate postoperative radiographs may be indicated for subjects with possibility of complications.

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Aim: To analyze the correlation between body mass index (BMI) to the tooth eruption and the severity level of dental caries in elementary school-aged children. Materials and Methods: A descriptive cross-sectional observational study was conducted among the students of an elementary school. The population of this study comprised students aged 9–12 years. A total of 49 samples obtained in this study were selected by simple random sampling technique. In this study, PUFA (pulp, ulceration, fistula, abscess) index was performed in intraoral examination. BMI examination was conducted to measure the body mass of the respondents. The statistical analysis was carried out using SPSS software (Statistical Package for the Social Sciences), version 21. Analysis method used in this study was odds ratio with P < 0.05 (sig two-tailed) and confidence interval at 95%. Results: Approximately 48.1% children had right upper canine not fully erupted with poor BMI. A total of 63.6% children with good BMI had teeth (i.e., right upper canine) almost fully erupted. Children with teeth (i.e., left upper canine) that had erupted by 2/3 until completion were dominated by children with good BMI (72.7%). A total 86.4% children with good BMI had teeth (i.e., lower left canine) fully erupted. Whereas, children who had teeth (i.e., lower right canine) 2/3 to perfectly erupted were dominated by children with good BMI as much as 81.6%. (P > 0.05). Meanwhile, 53.6% respondents with normal BMI level had dental cares without pulp-involvement (P > 0.05). Conclusion: Tooth eruption and dental caries severity did not correlate with BMI.

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