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   2021| March-April  | Volume 13 | Issue 2  
    Online since April 17, 2021

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Dentists’ restorative treatment decisions: A south african study
Razia Z Adam
March-April 2021, 13(2):156-163
Aim: To focus on clinical decision-making by dentists for defective restorations in the context of an overburdened healthcare system and a high caries rate. Materials and Methods: A cross-sectional study was conducted using mixed-methods. An online survey was administered to all members of the South African Dental Association followed by in-depth interviews of 15 purposefully selected dentists in the Western Cape. The online data included demographic data, education level, knowledge, attitudes, and practises related to dental amalgam use. The interviews consisted of two patient cases where dentist were asked to explain their treatment decisions. Quantitative data was analysed using statistical software SAS (SAS Institute Inc., Cary, NC, USA) and a Chi-square test and Spearman’s correlation was used with P < 0.05. The interviews were coded, transcribed, and analysed using the Atlas.ti ® software. Responses were analysed using the framework method. Results: A significant relationship was found between dentists with more than 21 years of experience and the repair of defective restorations (P = 0.0027*). Remaining tooth structure and the presence of pain were the most important clinical factors influencing treatment decisions. Non-clinical factors such as fear, ethical conscience, cost to patient and dental school had an influence on their decisions. Conclusion: Clinical factors and non-clinical factors influence dentists’ treatment decisions. There was a lack of translation of evidence-based information to everyday general practice dentistry in South Africa. These results have implications in changing current continuing professional education activities and motivating policy makers to incentivize preventive and minimally invasive dentistry.
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Biogenesis of microRNAs and its implication in head and neck pathologies: A Narrative Review
Niva Mahapatra, Kailash Chandra Dash, Lipsa Bhuyan, Shyam Sundar Behura, Pallavi Mishra, Abikshyeet Panda
March-April 2021, 13(2):101-107
Aim: MicroRNAs (miRNA) are 19–23 nucleotides small non-coding RNAs that regulate gene expression either by silencing or degrading the target gene. Altered miRNAs are associated with various dental and inflammatory diseases. The aim of this review is to provide an insight into the biogenesis, role of miRNA in physiology, and development of dysregulated miRNA which has an impact on hallmarks of cancer. Materials and Methods: A literature review search was made from PubMed, Scopus, and Web of Science databases using the key words biogenesis of miRNA, stem cell culture, oral cancer, circulating miRNAs, autoimmune disorders, and periodontitis. We also included systematically reviewed articles that highlighted the mechanism of silencing of gene and epigenetic modifications by miRNA. Results: Pertaining to various literatures there is definite correlation of miRNA with various pathological conditions occurring in head and neck region. Conclusion: Our review indicates that numerous miRNAs play a key role in diagnosis, prognosis, and therapeutic role in oral diseases. In this context, multitudinous studies are a prerequisite for validation of miRNA as a reliable biomarker in head and neck pathologies and its targeted therapy.
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Rolling code on histopathology laboratories during Covid pandemic: A narrative review
Aishwariya Mohanty, Pallavi Mishra, Kailash Chandra Dash, Lipsa Bhuyan, Niva Mahapatra, Abikshyeet Panda
March-April 2021, 13(2):108-114
Aim: Histopathology laboratories are assigned laboratories where contagious biopsy samples are regularly received for diagnosis and prognosis. SARS-CoV-2 is a new public health crisis that has created a global alarming. As there is a paradigm shift in the work-flow and specimen management during this COVID-19 pandemic, this review article discusses and summarizes proper sterilization protocols that need to be implemented in histopathological laboratories. This write-up highlights the biosafety level requirement along with step-by-step safety protocol from receiving a specimen till reporting of slides by pathologists. Materials and Methods: A literature search was made to review the published recommendation that is applicable for histopathology laboratories in the light of current knowledge and understanding of COVID-19. A humble effort was also made to review the interim guidelines that are updated by the World Health Organization and Center of Disease Control on day-to-day basis and are highlighted in this article. Results: Based on keywords used, 29 relevant articles were found useful and were selected for the review. Conclusion: Of all the precautions, proper hand hygiene practice, use of disinfectants, and personal protective equipment are of utmost importance. Also, several studies have shown that coronavirus was inactivated during routine formalin fixation and tissue processing processes. This article focusses on highlighting the guidelines that could help in anti-spread strategies.
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Prevalence and associated factors of self-rated oral health among a national population-based sample of adults in Ecuador: Results of the 2018 STEPS survey
Supa Pengpid, Karl Peltzer
March-April 2021, 13(2):122-128
Objective: The aims of this study were to estimate the prevalence and correlates of self-rated oral health (=SROH) among adults in a national population-based survey in Ecuador. Materials and Methods: In the national cross-sectional 2018 Ecuador STEPS survey, 4,638 persons (median age = 39 years, range 18–69 years) responded to a questionnaire, physical measures, and biomedical tests. Results: The prevalence of poor SROH was 9.7%, 10.1% among females and 9.4% among males. In multivariable logistic regression analysis, aged 5069 years [adjusted odds ratio (AOR): 3.06, 95% confidence interval (CI): 1.99, 4.72], Amerindian (AOR: 1.78, 95% CI: 1.23, 1.58), pain in the teeth/mouth (AOR: 2.03, 95% CI: 1.51, 2.73), impaired OHRQoL (OR: 3.94, 95% CI: 2.93, 5.29), dental visit more than past 12 months ago or never (AOR: 1.74, 95% CI: 1.32, 2.29), past smoking (AOR: 1.50, 95% CI: 1.08, 2.09) and history of heart attack or stroke (AOR: 1.57, 95% CI: 1.04, 2.37) were positively and having more than secondary education (AOR: 0.63, 95% CI: 0.43, 0.92) and teeth cleaning (≥twice/day) (AOR: 0.48, 95% CI: 0.37, 0.64) were negatively associated with poor SROH. Conclusions: One in ten participants reported poor SROH and several factors associated with poor SROH were found that can aid in designing programs to improve SROH in Ecuador.
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Effectiveness of electrospun Ocimum sanctum nanofibers as an adjunct to scaling and root planning in the management of chronic periodontitis: A randomized controlled clinical trial
Priyanka Mariam George, Nadathur Doraisamy Jayakumar, Gurumoorthy Kaarthikeyan
March-April 2021, 13(2):115-121
Aim: Research based on periodontal therapy is focused on the use of natural products rather than chemical agents. Ocimum sanctum has been known to possess various medicinal properties. There is only a limited literature available on the therapeutic effectiveness of O. sanctum for the treatment of periodontal disease. Local drug delivery systems allowed for the direct delivery to the diseased site thereby bypassing systemic circulation and hence attaining maximum concentration at the site that requires the drug. The aim of the study was to analyze the effect of O. sanctum on the anti-inflammatory efficiency [interleukin 1-β (IL-1β)] in patients with periodontitis. Materials and Methods: A randomized, controlled, clinical trial was conducted with a sample size of 15 patients to compare the clinical parameters and IL-1β levels in subjects who underwent nonsurgical periodontal therapy along with local application of O. sanctum fibers and those subjects who had undergone non-surgical periodontal therapy alone. Results: From the present study, a statistically significant difference could not be observed in the IL-1β levels or in the clinical parameters between the test and the control groups at the end of 1 month. There was a significant difference in clinical attachment-level gain between groups (P = 0.046). Conclusion: Ocimum sanctum nanofibers provided benefits in terms of reduction in IL-1β levels. Our study concludes that O. sanctum delivers additional benefit when used as an adjuvant in the treatment of periodontitis.
  1,198 128 -
Knowledge, attitude, and challenges in digital learning using smartphones among dental students of South India: a cross-sectional survey
Gangadharamurthy Bhuvaneshwari, Krishnasamy Nitya, Maruthamuthu Karthikeyan, Mohankumar Purushotham, ShankarRao Amberkar Vikram, Ananda Kumar Kirubakaran
March-April 2021, 13(2):181-188
Aim: Smartphones are a class of mobile phones with multipurpose facilities. They are being used for entertainment, shopping, and even educational purposes. Therefore, a study was planned to assess the knowledge, attitude, and challenges toward smartphone usage for digital learning among the dental students of South India. Materials and Methods: An observational cross-sectional web-based survey was conducted by using a structured, validated, 21-item questionnaire among dental students (final-year students, interns, and postgraduates) from seven random dental colleges in and around Chennai. The data about demographic status, the extent of smartphone utilization for knowledge, students’ attitudes toward smartphone usage, and barriers in digital learning were collected. Chi-square test was applied. Results: In the present survey, 701 students have responded, predominantly females (80%). All participants owned a smartphone, and 62% of them had surfing time as more than 4 h. Nearly 94% had used smartphones for social network surfing. Almost 99% participants viewed instructional videos and read scientific articles using their smartphone. The most common site accessed for knowledge seeking was Google Scholar (39%), followed by Wikipedia (34%) and PubMed (20%). Forty-five percent of postgraduates felt that smartphones enabled them to study independently. Small screen (56%) of smartphones and less knowledge about the available resources (42%) were the major reported barriers for digital learning through the smartphone. Conclusion: Dental students used their smartphones for educational purpose and showed a favorable attitude toward their use in dentistry. Smaller screens, nonavailability of wireless access, and less awareness about the reliability of available resources were reported as barriers.
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Salivary cortisol: a marker of anxiety in response to different dental treatment procedures: A cross sectional study
Purnima Seshadri, Pratibha Ramani
March-April 2021, 13(2):129-135
Aim: To evaluate and compare the levels of salivary cortisol prior to, during, and after different forms of dental treatment. Materials and Methods: An in-vivo cross-sectional study was designed to study saliva samples from a group of 70 subjects who reported to the Dental Outpatient Department for the estimation of salivary cortisol. The subjects were grouped into seven treatment groups and the sample size was estimated to be 10 per group (at 80% power and 5% α-error) based on the results from a previous study done by Carmen Benjamins, HenkAsscheman, and Albert H. B. Schuurs. All subjects were administered the Modified Dental Anxiety Scale. Unstimulated saliva was collected prior to, during, and at the end of the treatment procedure and assessed for salivary cortisol concentration by ELISA. Chi-square test was used to check for association between the independent variables and the mean salivary cortisol levels. ANOVA was used to estimate the variation in salivary cortisol levels across the three time periods in each of the treatment groups. Results: The mean salivary cortisol concentrations were highest in the prophylaxis group (12.16 ± 4.00) followed by extraction (9.77 ± 3.92) and the endodontics group (8.69 ± 7.81). ANOVA revealed that there was statistical significance for the mean cortisol levels across the time intervals in the examination, prophylaxis, and extraction group alone. Conclusion: The study reported maximum mean cortisol levels in the prophylaxis and extraction group. Also, maximum association between the time factor and cortisol concentrations was observed in the examination, extraction, and prophylaxis groups.
  1,008 104 -
Antibacterial activity of melatonin against prime periodontal pathogens: An in vitro study
Aruna Ganganna, Chandrashekar Byalakere Rudariah, Raghavendra Rao, Venkatesh Madhugiri Prakash
March-April 2021, 13(2):164-168
Aim: Accumulated data make it clear that by introducing large amount of antibiotics into the ecosystem, we have provided an environment conducive to antibiotic resistance and periodontal microbes are no different. Therefore, in the quest of finding a suitable drug as an alternate to antibiotic, we investigated the antibacterial activity of melatonin against predominantly Gram-negative periodontal pathogens in vitro. Melatonin with varied functions has driven its usage enormously; therefore, identifying its action against periodontal pathogens has driven this laboratory investigation. Materials and Methods: American type culture collection (ATCC) strains of Porphyromonas gingivalis, Fusobacterium nucleatum, and Aggregatibacter actinomycetemcomitans were used to determine minimum inhibitory and bactericidal concentrations (MIC and MBC) of melatonin using macro broth dilution method. MIC values were determined at 24, 48, and 72 h and sensitive MIC values were sub-cultured to determine MBC value at 24 h. Qualitative data were obtained and it was recorded as “sensitive” or “resistant” at respective concentrations. Results: When tested over a dilution range of 0.2–100 µg/mL, melatonin significantly inhibited microbial growth. At 48 h, the MIC value against A. actinomycetemcomitans, P. gingivalis, and F. nucleatum was 6.25, 0.8, and ≤0.2 µg/mL, respectively. The MBC value determined at 24 h demonstrated significant bactericidal activity against the pathogens. Conclusion: Melatonin exhibited bactericidal activity against prime periodontal pathogens even at low concentrations in comparison to previously documented evidences suggesting greater potency of the drug. Hence, renewed effort to find and develop new class of drug which can inhibit periodontal pathogens, rather than just improvements on already-existing drugs can potentially prevent the development of resistant strains in periodontal microenvironment.
  1,026 69 -
Evaluation of craniofacial morphometry of northern Saudi Arabian population, using Rickett’s analysis: A descriptive cross-sectional study
Ibrahim Eid Alroudhan, Ibadullah Kundi, Mohammad Khursheed Alam, Metab Abduldayem Albalawe, Khalid Nafea Alsharari, Abdulrahman Mohammed Alrwaili
March-April 2021, 13(2):136-143
Aims: The aims of this study are to evaluate the craniofacial morphometric measurements for Saudi Arabian adults in Jouf region using Ricketts analysis and comparing the findings with established Caucasian cephalometric norms. Materials and Methods: This is a descriptive cross-sectional analytical study. The sample consisted of 160 lateral digital cephalometric radiographs collected from the orthodontic patients of College of Dentistry, Jouf University. The inclusion criteria were good quality cephalometric film, with visible landmark. The exclusion criteria were no acquired or pathological skeletal or dental deformities, no history of corrective orthodontic therapy, and patients of non-Saudi Arabian descent. Relevant cephalometric landmarks were determined and analysis was done using the SPSS software. The level of significance was tested using independent t-test with 95 percent confidence interval. A P-value of <0.05 was considered to be significant. Results: The descriptive statistics of all lateral cephalometric radiographs for 15 measurements were carried out on the entire sample size of 160 subjects. None of the parameters measured showed any significant differences between Saudi Arabian males and females. Three out of the eight skeletal variables were larger in females compared with males. Conclusion: The differences observed between the Saudi Arabian and Caucasian values are not statistically significant, indicating that within the limitations of this study, Caucasian standardized values are adequate in treating Saudi Arabian orthodontic patients. However, there are notable differences between Saudi Arabian males and females indicating sexual dimorphism. Further investigation may be needed which is outside the scope of this study.
  888 70 -
Analysis of oral health knowledge improvement of pregnant mothers using oral health monitoring mobile application
Raden Darmawan Setijanto, Taufan Bramantoro, Aulia Ramadhani, Aditya Mukti Setyaji, Zhafira Rusyidina,   Nawira
March-April 2021, 13(2):169-174
Aims and Objectives: The aim of this study was to analyze the effectiveness and contributing factors of the oral health knowledge improvement of pregnant mother using mobile application. Materials and Methods: A presented cross-sectional analytical study had 47 respondents that were obtained using simple random sampling from pregnant mother population in the health center in Surabaya, Indonesia. Data were collected by examining periodontal health using Community Periodontal Index (CPI) questionnaires to assess the risk factors, and pre- and posttest to measure the knowledge increment. The pretest was conducted before the respondents were given counseling about this oral health monitoring mobile application. Pregnant women are given educational material about the importance of maintaining oral health, especially the health of periodontal tissue during pregnancy. Statistically, descriptive test was used to describe the respondent distribution data. Paired t test was used to compare the knowledge improvement between pretest and posttest scores. Linear regression test was used to analyze the contributing factors of knowledge improvement of the respondents. Results: There was a significant (P < 0.05) improvement in the mean score of posttest (87%) compared to pretest (56%). The contributing factors in respondents’ knowledge improvement were their number of dental visits (P = 0.04) and their experience in periodontal disease as shown in their CPI score (P = 0.010). Conclusion: Oral health monitoring mobile application can be used as dental health promotion media of pregnant women, supported with their dental checkup and periodontal disease experience.
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The use of artificial teeth for post-core techniques in a pre-clinical fixed prosthodontics undergraduate teaching program: an evaluation of student experience
James Dudley
March-April 2021, 13(2):144-150
Aim: The use of artificial teeth in pre-clinical simulation clinic teaching of post-core techniques has clear educational benefits for students and staff. This study explored the reasons for selection and direct student experiences with artificial teeth in a recently conducted pre-clinical fixed prosthodontics post-core technique teaching program. Materials and Methods: An online anonymous survey was delivered to fourth year undergraduate dental students who had completed the fixed prosthodontics pre-clinical program seeking information on the choice of artificial or natural teeth and direct experiences. Quantitative data was summarized and qualitative data was clustered into topics. Results: A 100% response rate was received. Twenty-five (36%) of 70 respondents chose to use one or more artificial teeth for the post-core exercises which was predominantly driven by difficulty in sourcing appropriate natural teeth (59%) rather than educational benefit (13%). Forty-five (64%) chose not to use artificial teeth largely due to the cost of the teeth (49%). Direct student experiences in using the artificial teeth for post-core exercises were generally positive. Conclusions: As the first known research of its kind, within the limitations of this study, artificial teeth provided an appropriate and realistic simulation compared with extracted natural teeth and were easier to source for the post-core exercises of the pre-clinical fixed prosthodontics program. More widespread use of artificial teeth was limited by cost.
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In-House aligners helping answer the distress call during the pandemic!
Anand Marya, Adith Venugopal
March-April 2021, 13(2):197-198
Fixed orthodontic treatment being a long‐term treatment has suffered during the pandemic. Clinics have undergone a prolonged and unforeseen lockdown, and patients are finding it extremely difficult to cope with their regular checkups and appointments. Advances in material sciences, simulation software, and 3D printing have enabled aligners to offer treatment solutions for complicated orthodontic problems. An orthodontist can use virtual simulations to plan out the entire treatment on a computerized three‐dimensional model, and then order aligners using these simulations. Patient compliance is one of the principal issues with clear aligner therapy and at a time when branded aligners are facing issues with regard to shipping, the entire process has become very expensive. For these reasons, it would be a good idea to consider using in‐house fabricated aligners. In‐house aligners can be easily fabricated using thermoformed plastic which is adapted to complex three-dimensional tooth surfaces that have a bearing on the deflection of the aligner on placement. They hold advantages over traditional commercially available aligners in terms of cost effectiveness and time required for fabrication and delivery.
  668 76 -
Predictability and surgical precision in the placement of multiple post-extraction implants for hybrid prostheses using reverse planning: A case report
Frank Mayta-Tovalino, Jose Rosas, Arnaldo Munive-Degregori, Neme Portal, Daniel Alvitez-Temoche, Franco Mauricio
March-April 2021, 13(2):189-196
Nowadays, it is very important to guarantee correct healing and stabilization of the soft tissues after extraction after the placement of dental implants, and this is achieved only with due planning by using a reverse protocol. This study describes a 78-year-old patient presenting with predictability and surgical precision in the placement of multiple post-extraction implants for hybrid prostheses by using reverse planning. In summary, the placement of implants in a totally edentulous area is quite challenging since in the absence of teeth, there is no parameter for correct three-dimensional placement of implants. The present case provides evidence of the clinical importance of using a surgical guide at all times to obtain optimal results in the prosthetic phase.
  650 88 -
Dental caries risk factors of childbearing-age mother in rural village: A cross-sectional study
Aulia Ramadhani, Adi Hapsoro, Roesanto Heroesoebekti, Nawira
March-April 2021, 13(2):151-155
Aim: To evaluate the risk factors of dental caries in childbearing-age mother. Materials and Methods: This was a descriptive-observational study. The samples were selected by using the total sampling method in the population of childbearing-age mothers in Urung-urung Village, Indonesia, with a total sample of 85 respondents. This study used a questionnaire for risk factor assessment, as well as intra-oral examination using the DMF-T index (decay, missed, filled teeth index) and the OHI-S (Oral Hygiene Index Simplified). Data that had been obtained were processed to determine the caries level based on the DMF-T index. From the DMF-T index data, a cross-tabulation test was carried out between the DMF-T score and education level, age, daily expenditure, use of prostheses, toothbrush habits, knowledge of oral health, and status of oral hygiene presented in table form. Data analysis was conducted by using SPSS Ver 18 Software Program (IBM, New York). Results: Overall, 65% of the respondents have a high DMF-T score (>6). The results of the cross-tabulation test with the DMF-T score showed that age (OR = 1.151), educational background (OR = 2.625), access to health services (OR = 1.140), knowledge of dental caries (OR = 1.040), and the OHI-S score (OR = 3.087) were risk factors for the severity of dental caries. However, only the OHI-S score showed a significant Odds Ratio (OR) <0.05. Conclusions: The OHI-S score variable represented the risk factor of caries severity in the childbearing-age mother population in Urung-urung Village.
  648 78 -
Comparison of stem cell markers on Gingival mesenchymal stem cells among diabetic and healthy individuals. An Ex Vivo Pilot study
Suman Basavaraju, Shashank Chandanala, Dhakshaini Mysuru Rajashekar
March-April 2021, 13(2):175-180
Aim: Diabetes mellitus (DM), being a risk factor for periodontal disease, affects various cellular functions, and it plays an important role in periodontal regeneration. However, the effect of hyperglycemia on Gingival mesenchymal stem cells (GMSCs) is unclear. We aim at investigating the effect of hyperglycemia on stem cell markers of GMSCs compared with normoglycemic conditions. Materials and Methods: An ex vivo pilot study was conducted by obtaining primary gingival tissues from subjects. Subjects from the outpatient department of periodontology were randomly selected according to the criteria. Three subjects with an HbA1c of >6.5 were selected as the test group, and three subjects with an HbA1c <6 served as controls. The tissue was enzymatically digested in 0.5 mg/mL collagenase (Sigma-Aldrich) and cultured in Knockout Dulbecco‘s Modified Eagles Medium (DMEM - KO medium, Life Technologies). MSC-like cells isolated were examined under a microscope and investigated for specific cell surface antigens CD73, CD90, CD105, CD34, CD45, HLA ABC, and HLA DR by using flow cytometry. Data were analyzed by a two-tailed non-parametric Mann–Whitney U test using SPS software. P < 0.05 was considered statistically significant. Results: The immunophenotype characterization in both test and control exhibited positive expression of CD73 (94.95%,95.93%), CD90 (98.05%, 88.53%), CD105 (73.97%, 73.88%), and HLA ABC (98.83%,98.16%) and negative expression of CD34 (0.02%,0.10%), CD45(0.57%,1.72%), and HLA DR (0.64%, 2.57%). Statistical analysis by the nonparametric Mann–Whitney U test did not reveal any statistically significant difference in the expression. Conclusion: GMSCs from the hyperglycemic environment retained their stem cell characteristics by positive expression of CD73, CD90, CD105, and HLA ABC, and negative expression of CD34, CD45, and HLA DR.
  584 49 -
Need to understand challenges at rural dental health centers among developing countries in COVID-19 context
Frank Mayta-Tovalino, Fernando Pérez-Vargas, Arnaldo Munive-Degregori, Ana Díaz-Soriano
March-April 2021, 13(2):199-200
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