Aim: To evaluate the effect of guava leaves extract mouthwash on antibacterial activity against streptococcus mutans, salivary pH, and patient satisfaction to taste compared with chlorhexidine mouthwash in high caries risk patients. Materials and Methods: Eighty participants were randomly allocated into two groups based on the mouthwash used: A1 (guava leaves extract) and A2 (Chlorhexidine). The participants were instructed to use the mouthwash once a day for one week and then repeatedly on a monthly basis for three months. Bacterial count, salivary pH, and patient satisfaction to taste were assessed after one week, one month, and three months. Statistical analysis of data using MedCalc software was performed for normality by using Kolmogrov-Smirnov test and Shapiro-Wilk test. Repeated-measures ANOVA and two-way ANOVA were used to assess the interaction of variables for intragroup comparison, and the significance level was set at P ≤ 0.05. Results: By taking into consideration the bacterial count, both mouthwashes showed significant antibacterial effects. However, no statistically significant difference was found between them against the streptococcus mutans during the follow-up periods: one week, one month, and three months, respectively (P = 0.3568, P = 0.0673, and P = 0.0601). Regarding the salivary pH, no statistically significant difference was found between the tested groups during the follow-up periods. Regarding the taste, no statistically significant difference between both mouthwashes was found (P = 0.4254). However, Chlorhexidine showed a statistically significant taste alteration (P < 0.0001) and prolonged taste in the mouth (P = 0.0001). Conclusion: Guava leaves extract mouthwash exhibits promising antibacterial activity without causing taste disturbances.

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Aim: To determine the difference in salivary pH before brushing the teeth, and 5, 30, and 60 minutes after eating and after brushing the teeth. Materials and Methods: This is a quasi-experimental study. The subjects were selected randomly with purposive sampling technique. Forty-five individuals were divided into three groups of 15 each, at test periods of 5, 30, and 60 min. Subjects had fulfilled the inclusion and exclusion criteria. The most common food consumed by the subjects was rice. Subjects were given instructions on how to brush their teeth, and collect and store saliva, and were instructed to use a toothpaste containing 1.12% sodium monofluorophosphate. The study was conducted in the morning, and after all the saliva sample tubes were collected, the saliva tubes were stored at 4°C. Salivary pH was measured with a pH meter (Mettler Toledo, Greifensee, Switzerland) before eating; before brushing the teeth at 5, 30, and 60 min after eating; and immediately after brushing the teeth. Data were analyzed with one-way analysis of variance (ANOVA) and General Linear Model repeated measure ANOVA (P < .05). Results: The average salivary pH when brushing the teeth at 5, 30, and 60 min after meals was 7.32 ± 0.19, 7.40 ± 0.16, and 7.42 ± 0.13, respectively. Based on the research conducted, there was no significant difference in salivary pH after brushing the teeth at 5, 30, and 60 min after meals (P < .05). There were differences in pH between the time before and after eating and also after brushing the teeth in each group of 5, 30, and 60 min intervals (P < .05). Conclusion: Brushing the teeth does not need to be delayed between 30 and 60 min after eating as the salivary pH will return to normal shortly after brushing.

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Aim: This narrative review aims to provide an insight into a resin-modified newer calcium silicate-based material called TheraCal LC, its uses, and scope in Pediatric Dentistry. Materials and Methods: Literature search was conducted through various databases such as PubMed, Hinari, Cochrane, and Google Scholar by three independent reviewers using both MeSH terms and free terms. The articles published in English relevant to Pediatric Dentistry were selected, whereas unpublished articles in other languages and studies done in permanent teeth in children above 15 years were excluded. From the search results obtained, n = 258 articles were relevant. The reference list of all the articles included were hand-searched; full text evaluation was done and duplicates were removed. Results: A total of 26 published articles encompassing animal in-vitro and clinical studies using TheraCal LC in primary and young permanent teeth were included. TheraCal LC exhibits shorter setting time, superior mechanical properties, esthetic, weakly radiopaque, and lower biocompatibility. This makes it suitable for its use as a good pulp capping material in deep dentinal carious lesions in primary and young permanent teeth as a protective liner/base. However, few animal studies showed that TheraCal LC is not suitable for pulpotomy and furcation perforation repair, and limited human studies were available. Conclusion: TheraCal LC is found to be a promising alternative as a pulp-capping material to other calcium silicate-based materials in the management of deep carious lesions for pediatric dental practice. However, more clinical studies with long-term follow-up are necessary for its use as a pulpotomy material.

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Aim: To evaluate the clinical performance of nano-hydroxyapatite reinforced glass ionomer (Carbomer) vs. conventional high viscosity glass-ionomer cement (Fuji IX) in root caries of geriatric patients. Materials and Methods: The current trial is a randomized controlled trial, with two parallel groups and a 1:1 allocation ratio. A total of 22 participants were recruited using convenience sampling and received 44 restorations randomly using either Carbomer or Fuji IX. After cavity preparation, restorative materials were applied according to manufacturers’ instructions. Restorations were evaluated using modified United States Public Health Service criteria by two blinded assessors after 1, 3, 6, and 9 months and 1 year. The χ² test was used to associate between the type of restorative material, either Carbomer or Fuji IX, and clinical performance. A P-value ≤ 0.05 was considered statistically significant. Results: After 1 year, no statistically significant difference was found between both materials for marginal staining, surface texture, marginal adaptation, secondary caries, post-operative sensitivity, color match, and retention (P = 0.4885, P = 0.1320, P = 0.3483, P = 0.9170, P = 0.7518, P = 0.1043, and P = 0.2998, respectively), whereas there was statistically significant difference between both materials for anatomical contour after 12 months (P = 0.0477). Conclusion: Both Carbomer™ and Fuji IX showed similar and successful clinical performance in the purpose of restoring root surface of permanent teeth in geriatric patients.

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Aim: To compare the effect of different preventive regimens containing fluoride toothpaste and chlorhexidine mouthwash with or without minimally invasive (MI) varnish on Cariogram parameters of high caries risk patients. Materials and Methods: A total of 66 participants were divided into three groups according to the tested regimen, A1: fluoride toothpaste with chlorhexidine mouthwash, A2: fluoride toothpaste with chlorhexidine mouthwash and MI varnish, or A3: fluoride toothpaste only (control group). All Cariogram parameters were evaluated and recorded according to Cariogram software (Cariogram, Internet Version 2.01, April 2, 2004 Copyright: D. Bratthall, Sweden) at baseline and after 3, 6, and 12 months. Clinical oral examination was carried out for recording caries experience and plaque scores. The salivary profile was generated by recording buffer capacity, salivary flow rate, and mutans streptococci count. Fluoride program was given according to each group, while the remaining parameters were kept constant. Statistical analysis was performed with significance level set at P ≤ 0.005. Results: Regarding Cariogram sectors, the green, red, and light blue sectors showed a statistically significant difference in all groups. The MI varnish group showed the best results followed by the chlorhexidine mouthwash group and finally the control group using fluoride toothpaste only. Conclusion: MI varnish with other preventive measures could be effectively applied to reduce caries risk, especially in high caries risk patients.

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Aim: To assess and compare 1-year treatment stability after correction of lower anterior crowding with nonextraction approach using passive self-ligation appliance and lower incisor extraction protocol with conventional ligation approach. Materials and Methods: This retrospective study included total 32 subjects. The inclusion criteria of the study were adult subjects with class I skeletal and dental malocclusion with mild-to-moderate mandibular anterior crowding of 4–6 mm. Subjects were divided into two groups: Group A treated with passive self-ligation nonextraction protocol (n = 15) and Group B treated with conventional ligation lower incisor extraction protocol (n = 17). The primary outcomes were the changes in arch dimension and dental crowding at three time points. Changes in intermolar width (IMW), intercanine width (ICW), little’s irregularity index, and mandibular incisor inclination at T0 (pretreatment), T1 (postdebonding), and T2 (1-year postdebonding) were evaluated. Descriptive statistics, normality tests, and intergroup comparison (independent t test) were performed. Results: Change in IMW was similar in both groups with no significant difference at T1 and T2. Change in ICW at T1 was significantly higher in Group A (2.01 mm) than Group B where ICW decreased by 0.94 mm. The relapse in ICW was significantly more in Group A. Difference in relapse of lower incisor crowding and inclination was significant between groups and it was more in Group A (P < .05). Conclusion: Orthodontic treatment with lower incisor extraction protocol with conventionally ligated approach has stable treatment outcomes than with nonextraction approach using passive self-ligation appliance Class I cases with moderate-to-severe mandibular anterior crowding.

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Aim: To assess the intensity of postoperative pain after endodontic treatment using full-sequence rotary Ni–Ti system either MPro or Hyflex in mandibular molars with irreversible pulpitis. Materials and Methods: This was a randomized, prospective, single-blind clinical trial. Fifty patients were randomly assigned into two equal groups according to rotary system used: Hyflex CM or MPro (n = 25). Both groups were mechanically prepared. Patients were asked to assess their postoperative pain using the numerical rating scale (NRS) at 3, 6, 24, 48, and 72 h after instrumentation. Data were presented as mean, standard deviation, median, and interquartile range values to be statistically analyzed with R statistical analysis software using Friedman’s test followed by Nemenyi post hoc test at different time intervals within each rotary system. Mann–Whitney U test was conducted to compare NRS values between both rotary systems. Results: The intensity of pain postoperatively was low significantly in Hyflex group in all observation periods. MPro group showed a decreasing mean from 3 h to 72 h time intervals. 3 h recorded the highest mean (3.72 ± 1.88). Statistically, there was a significant difference between all intervals except after 48 and 72 h. Hyflex group showed the same. 3 h recorded the highest mean (1.72 ± 1.34). Statistically, there was a significant difference between 3 h and the rest time intervals, but no significant difference was found between the 6, 24, 48, and 72 h. For both groups, there was no significant association between gender and pain and there was no significant correlation between age and painConclusion: Both Hyflex and Mpro systems resulted in postoperative pain with a different degree but Hyflex system represented lower postoperative pain intensity when used for mechanical instrumentation of mandibular molars with irreversible pulpitis.

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Aim: To compare the remineralizing effect of gum arabic and casein phosphopeptide–amorphous calcium phosphate–fluoride (CPP–ACP–F). Materials and Methods: Twenty extracted sound human central incisors were selected and divided into four main groups (five specimens each) according to remineralization treatment: group 1, remineralization by gum arabic; group 2, MI Paste Plus CPP–ACP–F; group 3, gum arabic and CPP–ACP–F (MI Paste Plus); and group 4, artificial saliva. Surface microhardness analysis through Vickers hardness number and morphological evaluation using environmental scanning electron microscope were assessed initially to the sound enamel, demineralized enamel, and finally after 28 days of remineralization protocol and cycles of acidic challenges. Data were collected and statistically analyzed with one-way analysis of variance (ANOVA) followed by the Tukey’s post hoc test at the significance level P ≤ .05. Results: Intergroup comparisons showed that there was no significant difference between different groups regarding microhardness at baseline, after demineralization and remineralization (P > .05). However, intragroup comparisons showed that there was a significant difference between different time intervals in the gum arabic group and the MI paste group (P > .001). Conclusion: Both gum arabic and CPP–ACP–F were able to regain and maintain surface microhardness. CPP–ACP–F is a very potent remineralizing agent due to its biomimetic remineralization strategy featuring in the treatment of early enamel lesion. Gum arabic could be a promising remineralizing agent although it had a limited initial remineralizing potential. However, the painting on of CPP–ACP–F over the gum arabic varnish could not provide the desired synergistic remineralizing action. Clinical Significance: Biomimetic remineralization of subsurface enamel lesion is the key to success in the management of early enamel lesion such as in CPP–ACP–F.

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Aim: To assess the prevalence and the association between dental pain and sociodemographic characteristics, oral health behavior, and coronavirus disease-19 (COVID-19) responses in a rural area of Indonesia during the second wave of the COVID-19 pandemic. Materials and Methods: This cross-sectional study randomly selected 296 participants aged 17 years and older in Kalisat, Jember, Indonesia. An interviewer-administered questionnaire was used to measure the variable of interest. The dental pain as an outcome variable was based on the dental pain experience from the past 2 months. A logistic regression model of 12 independent variables, including sex, age, ethnicity, education, occupation, income, insurance, toothbrush frequency, snacking, fear of COVID-19, government aids, and vaccination status, was applied to find the determinants of dental pain. Results: In the second wave of the pandemic, 25.3% of the participants reported dental pain. The increasing level of fear was significantly related to having more experience with dental pain. The most significant predictor of dental pain was having an “often” fear of COVID-19 (odds ratio, OR = 5.23; P = 0.004). The older age groups were more likely to report dental pain than the 17–25 age group, and the most significant association was 56–65 years (OR = 5.26; P = 0.015). Conclusions: The oral health programs should consider the psychological factors and pay attention to the older age groups during the COVID-19 pandemic.

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Aim: To determine practices, attitudes, and factors associated with COVID-19 vaccination among students from different health science schools. Materials and Methods: This was an analytical, observational, and prospective study. This study evaluated students from different health science schools of the Universidad Nacional Federico Villarreal, Lima, Peru, from March to July 2021. This was the period during which the national vaccination campaign began in Peru. Data collection was carried out using a validated, anonymous, and virtual questionnaire using Microsoft Forms. This measured the acceptance of the COVID-19 vaccine and consisted of 23 questions that addressed the dimensions of practices and attitudes toward vaccination. Finally, a logistic regression model was used to determine the factors associated with vaccination practices and attitudes, with a significance level of P<0.05. Results: Female subjects were more prevalent with 489 (75.5%) students, and the professional school of medicine had the most representatives, with 146 (22.5%) subjects. Most of the students belonged to cycle VIII, with 140 (21.6%). The statistical regression model showed that only sex was a factor associated with COVID-19 vaccination practices and attitudes, with odds ratio = 0.60; confidence interval = 0.42–0.93, and P =0.019. Conclusion: Undergraduate Peruvian students from all areas of health sciences showed significant practices and attitudes toward vaccination against COVID-19. However, of all the associated factors, sex was the only statistically significant factor.

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Aim: To compare the levels of receptor activator of nuclear factor β ligand (RANKL) and Cathepsin K (CSTK) in gingival crevicular fluid (GCF) between smokers and non-smokers with chronic periodontitis (CP). Materials and Methods: Eighty male patients who were systemically healthy and diagnosed with CP were recruited in this case–control study. Based on convenient sampling, they were allocated into two groups. Group A had 40 subjects who were smokers diagnosed with CP, and Group B had 40 non-smoking CP patients. Patients who had the habit of smoking 10 or more cigarettes per day for a period of 5 or more years were included in Group A, and those with no history of cigarette smoking were recruited in Group B. The baseline parameters such as probing pocket depth (PD), clinical attachment levels, bleeding index, plaque index scores, and pack years were noted prior to GCF collection. The collected GCF samples were analyzed for RANKL and CSTK levels using enzyme-linked immunosorbent assay. Results: The intergroup comparison of the clinical parameters was done using Student’s t-test. The comparison of cytokine values between Groups A and B was done using the Mann–Whitney U test. Correlation between the cytokine levels with the clinical parameters, in Groups A and B, was done using Kendall’s tau_b correlation analysis. The mean RANKL levels were not statistically significant between Group A and Group B (P = 0.073). Smokers with CP has significantly higher levels of CSTK when compared with non-smokers (P=0.037 and <0.05, respectively). The RANKL levels showed a positive correlation with PD (r=0.300, P=0.007) and pack years (r=0.467, P=0.000) in Group A. A significant positive correlation between RANKL and CSTK levels was observed in smokers with CP (r=0.246, P=0.026). Conclusion: The RANKL levels were not significantly altered by smoking. The levels of CSTK are significantly higher in smokers with periodontitis when compared with non-smokers with periodontitis. The positive correlation obtained in the smokers group may suggest that smoking may play a crucial role in modulating the cytokines levels of RANKL and CSTK.

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Aim: To evaluate the COVID-19 vaccination compliance rate and post-vaccination Adverse Effects (AEs) among the Dental Health Care Workers (DHCW). Materials and Methods: An online, cross-sectional, self-administered, structured questionnaire was distributed to 54 DHCW at the Faculty of Dentistry, SEGI University to evaluate the demographic characteristics, history of infection, type of vaccine received, post-vaccination AEs, duration, and hospitalization. In this pilot study, a convenience sampling method was adopted and descriptive statistics was employed to describe the results. Chi-square test was used to compare the post-vaccination AEs among the CoronaVac® group, Pfizer-BioNTech group and AstraZeneca group and a p-value of less than 0.05 was considered statistically significant. Results: About 85% participants had completed the vaccination and one participant tested positive for COVID-19 after the first dose. Following the first dose, participants in Pfizer-BioNTech (88.9%) and AstraZeneca group (100%), experienced higher local AEs (pain and tenderness at the site of injection) than the CoronaVac® (33.3%) group which was statistically significant (P < 0.006). Although higher systemic AEs were observed in Pfizer-BioNTech (66.7%) and AstraZeneca vaccine (100%) than the CoronaVac® (30.6%) group, this was not significant. Similarly, after the second dose, higher percentage of participants in the Pfizer-BioNTech group experienced systemic (66.7%) and local AEs (66.7%) than CoronaVac® group. However, this was not significant too. The most common systemic AEs were fatigue and myalgia. One participant reported a mild allergic reaction and the majority of these AEs resolved in 24–48 hours after vaccination, without requiring hospitalization. Conclusions: DHCW exhibited a greater compliance rate to Covid-19 vaccination. Local AEs were more frequently encountered than the systemic ones and the common AEs were pain and tenderness at the injection site, fatigue, and myalgia. Clinical Significance: Recognizing and reporting the AEs of COVID-19 vaccines are imperative to enhance the vaccine uptake among the public.

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Aim: To evaluate the effect of recasting on the elastic modulus of Ni-Cr dental alloy structures. Materials and Methods: This study was of an in vitro experimental type. The sample consisted of n=30 specimens that were divided into three groups. The study was conducted in vitro, both prospectively and longitudinally, on rectangular specimens of Ni-Cr dental alloy structures made with specific measurements by means of a casting process using the lost wax technique. Subsequently, a laboratory test to obtain the value of the elastic modulus was conducted by means of a bending test with a universal testing. The groups were as follows: Group 1: 100% reused Ni-Cr dental alloy structures; Group 2: 50% reused Ni-Cr dental alloy structures; and Group 3: 25% reused Ni-Cr dental alloy structures. The data were expressed in mega pascals (MPa). All statistical analysis was performed by using Stata software with a confidence level of 95% (Kruskal-Wallis test was used (p < 0.05)). Results: When evaluating the elastic modulus of group 1 (100% reused Ni-Cr dental alloy structures), it was found that the highest value was in the first recast. In both group 2 (50% reused Ni-Cr dental alloy structures) and group 3 (25% reused Ni-Cr dental alloy structures), the highest values occurred in the third recast. Conclusions: The number of recasts did not influence the modulus of elasticity of the Ni-Cr dental alloy structures tested in this study.

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Aim: Periodontal disease is an inflammatory disease which results is host–microbial interactions and tissue destruction as a result of microbial actions and exaggerated host immune response. Human immunodeficiency virus (HIV) causes a viral disease which leads to immunocompromised state and can cause periodontal disease initiation and unusual progression of disease course. Prevalence of oral lesions and acute periodontal lesions associated with HIV has significantly reduced with highly active antiretroviral therapy (HAART). The purpose of this study was to compare the periodontal disease progression with and without HAART in HIV-positive patients. Materials and Methods: This was a cross-sectional study, and 225 HIV-positive patients were selected by purposive sampling method. These patients were divided into three groups of 75 each: Group 1—without HAART, Group 2—HAART <5 years, and Group 3—HAART≥ 5years. Patient’s periodontal status was evaluated at baseline, 4, 8, and 12 months. Parameters such as plaque index (PI), gingival index (GI), probing pocket depth, clinical attachment level (CAL), and number of teeth lost during the period of study were assessed at each visit. Significance of differences in periodontal parameters over a period of 12 months in all three groups was determined using repeated-measures analysis of variance (ANOVA). Intergroup comparison at baseline and 4, 8, and 12 months was done by one-way ANOVA. Intragroup comparison over the duration was done by repeated-measures ANOVA. Pearson’s correlation for GI and PI was performed. Results: The result of the present study showed that plaque and gingival scores reduced significantly in both Groups 2 and 3 (P < 0.05), whereas the scores (PPD) and CAL showed no statistical difference at any of the time intervals and over the duration of 1 year in intra- and inter-group comparisons (P > 0.05). There was tooth loss in all the three groups from baseline to 12 months. Conclusion: HAART had no consistent effect on periodontal status and tooth loss; however, patients on HAART showed improvement in their plaque and gingival health status.

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