Preventive and Community Dentistry

Efficacy of resin infiltrate in noncavitated proximal carious lesions: A systematic review and meta-analysis Afra Hassan Elrashid, Basmah Sulaiman Alshaiji, Sara Abdulwahab Saleh, Khadijah Ahmed Zada, Mohammad Abdul Baseer Journal of International Society of Preventive and Community Dentistry 2019 9(3):211-218 Objectives: Resin infiltration is a minimally invasive technique for treating noncavitated proximal caries. It slows/stops the carious lesion progression rate by creating a diffusion barrier inside the porous enamel lesion body. The aim was to evaluate the efficacy of resin infiltration on noncavitated proximal carious lesions in primary and permanent teeth. Materials and Methods: The records were obtained using electronic and other sources. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to ensure transparent reporting. Eligible studies were randomized controlled trials evaluating the efficacy of resin infiltration for noncavitated proximal carious lesions by comparing it with control/placebo. Each included study was assessed concerning the “risk of bias” using the Cochrane Collaboration's “risk-of-bias” assessment tool. High risk-of-bias studies were excluded from the meta-analyses due to selective reporting matters. The statistics were performed by RevMan software (The Cochrane Collaboration, The Nordic Cochrane Centre, Copenhagen, Denmark) utilizing the random effect model. The GRADE approach was implemented for assessing the quality of evidence. Results: From 106 studies identified, 17 were assessed for eligibility. After “risk-of-bias” assessment, two meta-analyses were conducted to eliminate the limitation of the significant heterogeneity between trials inspecting primary teeth (n = 2) and permanent teeth (n = 3). I2 = 0% indicates the absence of statistical heterogeneity. The risk of carious lesions' progression with resin infiltration was significantly lower in primary (risk ratio [RR]; 95% confidence interval [CI]: 0.48; 0.30–0.75, P = 0.001) and in permanent teeth (RR; 95% CI: 0.19; 0.11–0.33, P < 0.00001) compared to that of control/placebo. The GRADE approach revealed high quality of evidence. Conclusion: The available evidence conveys high confidence that proximal resin infiltration has superior efficacy in slowing/arresting the carious lesions' progression rate in comparison to conventional management modalities.

HIV-related discrimination among senior dental students in Jeddah Ehab Alshouibi, Faten Alaqil Journal of International Society of Preventive and Community Dentistry 2019 9(3):219-224 Aims and Objectives: Advances in the medical management of HIV infection have increased life expectancy and reduced the mortality rate of infected individuals. As a result, dental and medical health-care workers have a higher chance to meet HIV-positive patients in their clinics. People living with HIV and AIDS (PLWHA) are frequently experiencing discrimination. That negative attitude toward HIV remains quite common among health-care professionals. The purpose of this study was to assess students' attitudes toward PLWHA. Materials and Methods: The present study was a cross-sectional survey to assess the attitudes of senior dental students toward HIV/AIDS in Jeddah, Saudi Arabia. Data were collected using an online self-administered questionnaire. Data analysis was done using the statistical package of social sciences. Descriptive statistics including means, standard deviations, frequencies, and percentages were calculated and used to present the data. A binary logistic regression model was constructed to estimate the effect of different predictors on the level of HIV-related discrimination. Results: A total of 400 individuals took part in the study. Bivariate analysis of HIV discrimination in relation to other variables showed that those reluctant to treat HIV patients, the majority (82%) showed a negative tendency toward HIV/AIDS patients, while 75% who were willing to treat them exhibited more positive attitudes, which was statistically significant (P < 0.0001). The discrimination was high, almost 87%, among those who feared accidental exposure to HIV patients; however, 73% of those who did not experience fear, felt nondiscriminative, which was also statistically significant (P < 0.0001). Conclusions: Stigmatizing views toward PLWHA exist among senior dental students in Jeddah. The most significant predictors of discrimination included fear of accidental exposure, reluctance to provide treatment to these patients, and self-protective concerns.

Effectiveness of an oral health promotion program for the elderly in Khiri Mat district, Sukhothai province: A randomized control trial Eakpong Keyong, Songchai Thitasomakul, Sukanya Tianviwat Journal of International Society of Preventive and Community Dentistry 2019 9(3):225-231 Objectives: Oral disease is one of the most common health problems among the elderly, which impacts the quality of life. Applying the Health Belief Model (HBM) in oral health promotion is expected to improve the effectiveness of prevention and promotion that restricts oral health problems. The aim of the present study was to determine the effectiveness of an oral health promotion program on oral health behavior and oral status among the elderly in Khiri Mat, Thailand. Materials and Methods: A prospective randomized control trial was carried out among 162 elderly people for 6 months. They were interviewed to gather oral health behaviors and perception information, followed by an oral health examination. The experimental group received oral health education based on the HBM theory and tooth brushing practice in a small group of 4–5 persons, and then they were remotivated to support behavior change at 1 and 3 months. The control group received traditional oral health activity. All the elderly were followed up at 6 months. Data were analyzed using the t-test, Mann–Whitney test, Chi-square, and logistic regression. Results: The elderly in the experimental group had significantly higher oral health perception, lower plaque scores, lower gingival inflammation, and lower clinical attachment loss than those in the control group (P < 0.05). Conclusion: This oral health promotion program improved oral health perception, behavior, and oral health status of the elderly.

Oral health status among children with Down syndrome in Dubai, United Arab Emirates Batool Ghaith, Manal Al Halabi, Amar Hassan Khamis, Mawlood Kowash Journal of International Society of Preventive and Community Dentistry 2019 9(3):232-239 Objectives: The purpose of this study was to assess the oral health status in Down syndrome (DS) children in Dubai, United Arab Emirates. Materials and Methods: A total of 106 DS children (mean age = 9.3 ± 2.8) and 125 healthy children (mean age = 11.7 ± 4.4) were recruited from both special needs centers and private/public schools in Dubai. A dental examination for decayed-missing-filled teeth (DMFT) in deciduous dentition/DMFT in permanent dentition indices, simplified oral hygiene index, calculus index (CI), were carried out. In addition, occlusal, dentofacial, soft-tissue abnormalities, and erosion were assessed. Statistical analysis was conducted using SPSS for Windows, version 20.0 (SPSS Inc., Chicago, IL, USA). Results: The mean number of DMFT in DS children was significantly higher than that in healthy children. DS children in the primary dentition group had higher restorative index and Met Need Index scores than the control group. On the other hand, CI was found to be significantly higher among children with DS compared to healthy controls (P < 0.004). DS children had a significantly higher proportion of open bite and other occlusal problems. Class III molar angle malocclusion was significantly higher in DS (66%) compared to controls (11.2%). Erosion was significantly higher among DS children compared to healthy control (34% vs. 15.3%). Conclusions: DS children in Dubai had higher caries rate compared to healthy children. DS group received more restorations and dental treatment compared to the control group. More to add, DS children had significantly more calculus, erosion, and malocclusion problems.

The densitometric analysis of protein pattern in cleft lip and palate patients Regina Purnama Dewi Iskandar, Annise Proboningrat, Amaq Fadholly, Ida Bagus Narmada, Chairul Anwar Nidom, Sri Agus Sudjarwo Journal of International Society of Preventive and Community Dentistry 2019 9(3):240-244 Objectives: Cleft lip and palate (CLP) belongs to the congenital anomaly that is clinically seen as cleft in lip, alveolar bone, palate, and nasal septum. The patients suffer from esthetic and various functional defects. CLP is resulted from impaired palatogenesis during the embryonic phase. The etiology of CLP is influenced by genetic, environmental, and combination of both. According to the literature, CLP is highly associated with defect in interferon regulatory factor 6 (IRF6) and poliovirus receptor-like (PVRL1) genes. The present study aimed to investigate the total protein profile and to identify protein IRF6 and PVRL1 in plasma of CLP patients. Materials and Methods: Dot-Blot analysis was performed to identify protein target of IRF6 and PVRL1. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis was performed in gel concentration 12% using plasma of CLP patients, their parents, and control population. The gels were stained by Coomassie blue afterward. Gels were analyzed through ImageLab 5.2.1 software. Results: The intensity of major bands in CLP patients was darker than control group, but remains similar to the parents group. The target protein IRF6 and PVRL1 were positively identified through Dot-Blot. Retardation factor value was significantly different in major bands of CLP patients compared to control group. Conclusion: There pattern of protein profile in CLP patients was different compared to non-CLP.

Shaping ability of 2Shape and WaveOne Gold files using cone-beam computed tomography Shalini Singh, Nitin Mirdha, PH Shilpa, Rahul V. C. Tiwari, Muqthadir Siddiqui Mohammad Abdul, Shan Sainudeen Journal of International Society of Preventive and Community Dentistry 2019 9(3):245-249 Aim and Objective: The aim of this study is to evaluate the apical transportation, centering ability, and volume of removed dentin of WaveOne Gold (WOG) and 2Shape with the use of cone-beam computed tomography. Materials and Methods: Freshly extracted mandibular teeth with sample size of thirty were carefully chosen and instrumented using the 2Shape and WOG rotary files. Preoperative and postinstrumentation cone-beam computed tomographic scans were done to accomplish mesial and distal dentin walls' measurements and volume of removed dentin calculations, apical transportation, and centering ratio. Statistical analysis was performed and confirmed by independent t-test. Statistical significance was set at 5%. Results: When shaping ability of 2Shape and WOG was evaluated, it was reported that there was no statistically significant differences noted among the groups in relation to the total volume of removed dentin, apical transportation, and centering ratio. Conclusion: It can be concluded that 2Shape and WOG preserved the original canal anatomy well and did not eliminate excess dentin during shaping and cleaning. Rotary nickel–titanium files which work on the principle of rotary movement attained an outcome analogous to that of the rotary files working on reciprocating motion in relation to alteration in angle.

"Comparative evaluation of the effect of three polishing agents on staining characteristics of provisional restorative material:" An in vitro study Seema Sathe, Sneha Karva, Anjali Borle, Mithilesh Dhamande, Tanvi Jaiswal, Sharayu Nimonkar Journal of International Society of Preventive and Community Dentistry 2019 9(3):250-255 Aim: The present study aimed to evaluate the effect of three various polishing agents on provisional restorative material on immersion in a staining solutions. Objectives: The objective of the study is (1) To evaluate the effect of pumice on staining characteristics of provisional restorative material before and after immersion in chlorhexidine. (2) To evaluate the effect of aluminum oxide paste on staining characteristics of provisional restorative material before and after immersion in chlorhexidine. (3) To evaluate the effect of diamond paste on staining characteristics of provisional restorative material before and after immersion in chlorhexidine. (4) To compare and assess the outcome of three polishing agents on staining characteristics of provisional restorative material. Materials and Methods: Sixty samples (10 mm × 2 mm) were fabricated of bis-acryl composites (Protemp™ 4) by utilizing a metal mold. The samples were grouped into three groups (n = 20), and various polishing agents were used, including pumice, aluminum oxide paste, and diamond polishing paste. The samples that were not exposed to any polishing agent served as the control group. The samples were kept in a water bath for a day at 37°C and were stained with chlorhexidine mouthwash. The color of all specimens was measured with a spectrophotometer before and after polishing, and color changes (ΔE) were calculated. Results: By using one-way ANOVA, significant difference was found in mean color change in three polishing materials (F = 4.44, P = 0.016). By using Tukey test, statistically significant difference was found among pumice and aluminum oxide paste (P = 0.027), among pumice and diamond paste (P = 0.041) and no significant difference was found among aluminum oxide paste and diamond paste (P = 0.985). Conclusion: Pumice exhibited less staining which was statistically significant when compared with aluminum oxide paste and diamond paste. Hence, it can be considered the most efficient polishing agent.

Evaluation of styloid process and its anatomical variations: A digital panoramic study with systematic review Koduri Sridevi, N Mahesh, B Krishnaveni, A D N Deepika, V Thejasri, B H David Leninson Journal of International Society of Preventive and Community Dentistry 2019 9(3):256-262 Aims and Objectives: To evaluate the styloid process (SP) and its anatomical variations on digital panoramic radiographs from the database and also to synthesize the current evidence of literature on SP and anatomical variations along with the systematic review of the relevant studies after making the necessary exclusions. Materials and Methods: A total of 500 panoramic radiographs from the database were examined and evaluated for the length of SP using OmniVue software and for the calcification patterns which were categorized into three types as described by Langlais. The obtained values were analyzed using t-test and Chi-square tests with a significance level of 0.005 and SPSS version 20.0 software. Results and Conclusion: The mean length of the SP in females was found to be 3.7 cm on the right side and 3.8 cm on the left side. The mean length of the SP in males was found to be 3.4 cm on the right side and 3.3 cm on the left side with significant difference between the genders with the P values of 0.0002 and 0.0001, respectively. The length of the SP was significantly longer in females than in males. Type I was the most common SP and was more prevalent in females. The results of the present study along with the wide range of reported incidence of anatomical variations in the form of elongation from the literature extracted through the systematic review suggests the need to reevaluate the range of the normal length of the SP.

An in vivo study to compare anti microbial activity of triantibiotic paste, 2% chlorhexidine gel, and calcium hydroxide on microorganisms in the root canal of immature teeth Sumit Sabharwal, Shresth Kumar Bhagat, Kumar Shresth Gami, Abhishek Siddhartha, Kulwant Rai, Yuvika Ahluwalia Journal of International Society of Preventive and Community Dentistry 2019 9(3):263-268 Aims and Objectives: Intracanal medication plays an important role in disinfecting the root canal from various microorganisms. There are various intracanal medication frequently used by practitioners based on the efficacy of the same, therefore to compare antimicrobial activity of a triple antibiotic paste with chlorhexidine gel and calcium hydroxide against microorganisms in the root canal used as irrigating solution. Materials and Methods: The present study was conducted on 88 single rooted (central and lateral incisors), asymptomatic, nonvital, and necrotic teeth. Individuals included were between the ages of 12–15 years with no systemic complications. Overall, 88 teeth were divided randomly into four groups on the basis of treatment they were given, with each group having 22 teeth. Each group was assigned to one intervention group namely 2% chlorhexidine gel group, calcium hydroxide group, triantibiotic paste group, and the normal saline group. Triantibiotic paste was prepared from ciprofloxacin Hydrochloride 500 mg+ Metronidazole 400 mg+ Tetracycline 500 mg. Two samples were collected from individual tooth to assess the change in the extent of total colony forming units. Results: Mean log10 bacterial count among the triantibiotic paste was 5.222 preirrigation which was decreased to 0.653. Maximum percentage of log10 bacterial count was decreased among triantibiotic paste group of 87.20% while control group of normal saline has recorded a decrease of 54.65% in bacterial count. Among all the four groups, there was a decrease of 73.51% of bacterial count. Conclusion: From the above results, it was concluded that triantibiotic paste demonstrated the highest efficacy against bacterial pathogen when used as irrigating solution.

Awareness of specialties of dentistry among medical trainees and teaching faculty of medical college in the central West India Arun P Nagrik, Bhawana A Bhagat, Sushil B Yemle, Sainath Maidapwad Journal of International Society of Preventive and Community Dentistry 2019 9(3):269-274 Objective: The purpose of this study was, to assess and create awareness of specialties of dentistry among medical trainees and teaching faculty. Materials and Methods: Printed and validated questionnaires were given personally to a total sample of 180 patients, including 60 interns, 40 postgraduate (PG) trainees and 80 teaching staff of Government Medical College. Their responses were collected and the results were tabulated using Micro-Soft Excel 2010. Data obtained was analyzed using the GraphPad Prism 7 statistical software. To compare the responses between the study groups a Pearson's Chi-square test was used. Results: About 96.11% of the sample replied that they are not aware of the different specialties of dentistry and 89.44% of the sample refers their patients to the general dentist without knowing the specialty. About 70% of the interns marked orthodontics as a specialty dealing with fractures of the jaw, whereas 82.5% of the PGs and 95% of the faculty advised referral of the fracture mandible case to the Oral and Maxillofacial Surgeon. Percentage of correct response for interns, PGS and staff, was 53.33%, 78.75%, and 92.34%, respectively (P ≤ 0.05). Conclusion: A large number of interns are not aware of the differences among the branches in Dentistry, specifically between orthodontics, oral-maxillofacial surgery, community dentistry, and Pedodontics. Many medical doctors have misbelief that all of their dental-related issues can be solved by the general dental practitioner. It is the present need to spread the awareness among the medical trainees and doctors about different subspecialties of dentistry to ensure proper referral practices of the dental patients they come across.

Alexandros Sfakianakis
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