Salivary MMP-9 as a Biomarker for the Diagnosis of Oral Potentially Malignant Disorders and Oral Squamous Cell Carcinoma

OBJECTIVE

To compare the salivary MMP - 9 concentration among subjects with oral squamous cell carcinoma (OSCC), oral potentially malignant disorders (OPMD), tobacco users, and control groups.

MATERIALS AND METHODS

A total of 88 subjects were enrolled and divided into four study groups viz., OSCC (n=24), OPMD (n=20), tobacco habits (n=22), and healthy controls (n=22). All subjects gave unstimulated saliva samples for the evaluation MMP - 9 by ELISA kit. Demographic information like age, gender, type of tobacco, and duration of the habit were recorded.

RESULTS

Subjects with OSCC and OPMD had significantly higher mean MMP-9 levels than subjects with tobacco habits and control groups (P<0.001). Also, poorly differentiated OSCC group had significantly higher mean saliva MMP-9 than moderate and well-differentiated OSCC. The optimal cut-off point was 214.37 ng/mL with a sensitivity of 100% and specificity of 59% for OSCC versus the control group. The optimal cut-off point was as 205.87 ng/mL with a sensitivity of 100% and a specificity of 54% for OPMD versus the control group.

CONCLUSION

The data obtained from this study indicated that OSCC and OPMD had an increased level of salivary MMP-9. Salivary MMP-9 could be a useful, non-invasive adjunct technique in the diagnosis, treatment, and follow-up of OSCC and OPMD. <br />.

Comparison of Extraction Socket Healing in Non-Diabetic, Prediabetic, and Type 2 Diabetic Patients

OBJECTIVE

To compare the healing of extraction socket among non-diabetic, prediabetic, and diabetic patients.

MATERIALS AND METHODS

A single-center prospective observational study was conducted. Glycated hemoglobin and random blood glucose were recorded for all the participants before the procedure. A trained and calibrated examiner evaluated the socket size on postoperative days 0 and 7. Postoperative pain (PoP), discharge, swelling, infection, erythema, dry socket, and the number of analgesics were also recorded.

RESULTS

A total of 100 participants completed this study with a mean age of 54.7±12.11. There was no significant difference in the mean socket size among the three study groups on day 0 (P=0.101). However, there was a significant difference in the mean socket size on day 7 among the three groups. A post hoc test showed that the diabetic group had a larger socket size than the non-diabetic group (P=0.011). Complications like swelling and infection were more in the diabetic group. There was no significant difference in the mean number of analgesics among the three groups (P=0.169). The adjusted means for the socket size on postoperative day 7 was significantly higher for diabetic than the non-diabetic group.

CONCLUSION

The socket dimension was larger on postoperative day 7 in people with diabetes which suggested delayed healing without persistent complications. Dental extractions can be performed safely in optimally controlled diabetic patients with minimal complications.

Clinical applications of intraoral camera to increase patient compliance - current perspectives

Technological advancements in the field of dentistry have reformed the concept of photography as a powerful medium of expression and communication. It also offers a spectrum of perception, interpretation, and execution. One of the widespread clinical applications of computerization in dentistry today is the intraoral camera (IOC). It helps in the revelation of the hidden and overlooked defects in teeth and other parts of the cavity. Dental world constitutes of microstructures that have to be recorded in a detailed manner to perform patient education, documentation of records and treatment, illustration of lectures, publication and web connectivity of complicated cases. This review emphasizes the significant applications of IOC in dentistry and its possible impact on patient compliance for dental care.

Anti-plaque and anti-gingivitis effect of Papain, Bromelain, Miswak and Neem containing dentifrice: A randomized controlled trial

BACKGROUND

Patients undergoing fixed orthodontic therapy may have difficulty in maintaining a good oral hygiene due to the difficulty posed by the appliances in accessing such areas. This study aimed to compare anti-plaque and anti-gingivitis efficacy of dentifrice containing Papain, Bromelain, Miswak and Neem with a standard dentifrice among patient's undergoing fixed orthodontic treatment.

MATERIAL AND METHODS

Single center, single blind, parallel arm, randomized controlled clinical trial with an allocation ratio of 1:1 was conducted. Evaluation of plaque and gingivitis was done using Williams modification of Silness and Loe Plaque Index (PI) for use in orthodontic subjects and Loe and Silness's Gingival Index (GI) at baseline and one month.

RESULTS

Inter-group comparison showed there was significantly lower mean plaque index in test (0.88 ±0.05) than in control group (1.17 ±0.05) after adjusting for the baseline plaque index (p<0.001). Similarly, there was significantly lower mean gingival index in test (0.87 ±0.04) than in control group (1.14 ±0.04) after adjusting for the baseline gingival index (p<0.001).

CONCLUSIONS

The efficacy of the test dentifrice in limiting plaque and gingivitis suggests that it can be used as a home based adjunct to clinical therapy in orthodontic patients. Key words:Bromelain, gingivitis, miswak, neem, papain, plaque.

Estimation of salivary cortisol among subjects undergoing dental extraction

Background

Dental procedures can be stressful and studies have shown that salivary cortisol is elevated during such procedures. Our study aimed to evaluate saliva cortisol levels among the subjects who underwent dental extractions and to compare it with that of the controls. The secondary objective of the study was to evaluate any correlation between salivary cortisol and hemodynamic parameters.

Material and Methods

We conducted this clinical study among subjects, who were indicated for dental extraction. Saliva samples from the subjects in the study group were collected before and after (10 mins) the dental extraction. Hemodynamic parameters like heart rate, systolic (SBP) and diastolic blood pressure (DBP) and oxygen saturation (Sp O2) were measured 10 minutes prior to the dental extraction and after completion of the extraction by a single trained examiner. Salivary cortisol was estimated by solid phase enzyme-linked immunosorbent assay (ELISA).

Results

A total of 31 subjects in the study group and 24 subjects in control group have participated in this study. The mean salivary cortisol concentration was significantly higher after extraction (27.94±7.94) than before extraction (24.67±8.31) in the study group (P<0.001). No significant correlations were seen between salivary cortisol concentration and hemodynamic parameters except for diastolic blood pressure after extraction.

Conclusions

Dental extractions and local anaesthetic procedures can induce stress in subjects. Dental care providers should try to minimise the subject’s anxiety and stress to the maximum extent.

Key words:Cortisol, dental, extraction, saliva, stress.

Dental neglect and adverse birth outcomes: a validation and observational study

OBJECTIVES

The objectives of this study were to validate the Indian translation of the Dental Neglect Scale (DNS) among a sample of parturient Indian women and to investigate dental neglect as a possible risk indicator in adverse birth outcomes.

SUBJECTS AND METHODS

Three hundred and sixteen parturient women were administered the DNS and the Modified Dental Beliefs Scale (MDBS) and were also clinically examined for oral health status. Information regarding socio-economic status, weeks of gestation and birth weight was also collected. A gestation period of less than 37 weeks was considered as preterm and a birth weight of less than 2500 gm as 'low birth weight'.

RESULTS

The Indian version of the DNS was found to be reliable (Cronbach's Alpha = 0.72) and valid for assessing dental neglect among the women. Factor analysis of the DNS revealed a two-factor structure accounting for 56% variance. Dental neglect was higher among those with poorer oral health status, lower socio-economic and educational status. Multinomial logistic regression showed high dental neglect and negative dental beliefs and not poor oral health, as significant risk indicators for occurrence of adverse birth outcomes.

CONCLUSION

The finding of an association of adverse birth outcomes with dental neglect and beliefs, but not with poor oral health could be due to the influence of other more important general factors which had a direct bearing on birth outcomes. There is a need for further research to assess the role of behavioural factors like dental neglect as risk indicators for adverse birth outcomes.

Effect of polishing technique and immersion in beverages on color stability of nanoceramic composites

Background

Polishing of dental composite restorations to achieve a highly smooth and reflective surface not only enhances esthetics but also their color stability and improves resistance to staining. The objective of this study was to evaluate the effect of beverages on the color stability of nanoceramic composites polished using different techniques.

Methods

80 samples of ceram. X SphereTEC one were prepared by condensing the material into a stainless-steel split mold and divided randomly into two groups. Group I was subjected to polishing using Sof-Lex system™ disks, and Group II was kept unpolished. Each group was subdivided into four sub-groups of 10 samples each. Each subgroup samples were immersed into designated beverages (Tropicana orange juice, Coco-cola, Nescafe coffee, and distilled water) for a duration of 15mins/day for 15 days. The color of all specimens before immersion, one day, and 15 days after immersion was measured using a Spectrophotometer.

Results

Significant staining of the material was found with cola drinks and coffee compared to orange juice and distilled water. Polished material showed better resistance to staining by various beverages compared to control group.

Conclusion

Nanoceramic composites exhibited superior color stability after polishing with Sof-Lex system™. Among the beverages, coco-cola significantly altered the color of the composite.

Effectiveness of novel herbal dentifrice in control of plaque, gingivitis, and halitosis - Randomized controlled trial

Background and aim

Plaque is a common etiological factor for common oral conditions like gingivitis, periodontitis, dental caries and halitosis. We aimed to evaluate the efficacy of a novel herbal dentifrice in control of plaque, gingivitis, and halitosis in comparison to control dentifrice.

Experimental procedure

We conducted a randomized controlled, single center, double-blinded parallel arm clinical trial. Participants were randomly distributed with commercially available herbal dentifrice or control dentifrice. Assessments of plaque, gingivitis, halitosis, unstimulated saliva pH were done at baseline and at one month by a trained and calibrated periodontist. All the participants were given new toothbrushes one week before the start of the study. They were asked to brush with the designated dentifrices for 2–4 min, twice daily for one month.

Results and conclusion

A total of 79 participants were recruited for this study, out of which 75 participants completed the follow-up. Inter-group comparisons of all the variables at baseline showed no significant differences in the mean plaque index, gingival index, halitosis and pH between test and control groups respectively. Intra-group comparisons showed a significant decrease in mean plaque, gingival and halitosis at follow-up than at baseline in both test and control groups. No significant differences between test and control groups were seen in the mean plaque index (P = 0.792), gingival index (P = 0.292), halitosis (P = 0.266), pH (P = 0.742) at follow-up after adjusting the respective baseline scores. The novel herbal dentifrice could be a suitable alternative for the control of plaque, gingivitis, and halitosis.

•

Significant decrease in clinical indices at follow-up than baseline in both groups.

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Significant increase in salivary pH at follow-up than baseline in both groups.

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No significant differences were seen clinical indices between test and control.

Diagnostic Accuracy of Ultrasonography for the Assessment of Maxillofacial Fractures: A Meta-analysis

Objective

To evaluate the pooled sensitivity and specificity of ultrasonography (USG) in maxillofacial fractures.

Materials and Methods

A systematic search was performed in five databases (PubMed, Scopus, CINAHL, Web of Science, Dentistry and Oral Sciences Source) from inception to September 12, 2020. Studies that reported or from which sensitivity and specificity can be calculated and studies published in the English language were included. Conference proceedings, letter to editors, and case reports were excluded. Screening of studies, data extraction, and risk of bias assessment (QUADAS -2) were done separately by two review authors. A bivariate random-effects model was used to calculate the pooled estimates.

Results

After the removal of duplicates, 1852 studies were included for screening of title and abstracts. Only 22 studies were included in the quantitative synthesis. The sample size ranged from 6 to 87. The majority of the studies assessed orbit and nasal bones fractures. Only two studies included a comprehensive assessment of facial fractures. The overall sensitivity and specificity values were 0.94 and 0.96, respectively.

Conclusion

USG has good diagnostic accuracy for the assessment of fractures of orbit and nasal bones. Clinicians need to consider the advantages and limitations of USG before recommending advanced imaging modalities.

Effect of Green, Tulsi, and Areca Teas on the Color Stability of Two Composite Resin Materials - an in vitro Spectrophotometric Analysis

Objective

To compare the effect of Green, Tulsi, and Areca teas on the color stability of two composite materials on the 30th and 60th days.

Materials and Methods

Two light cure composite restorative materials, Brilliant EverGlow (Group 1) and Brilliant NG, (Group 2) with different resin and filler characteristics were selected. The test solutions selected were Green tea, Tulsi tea, Areca tea, and artificial saliva (control group). In total, 104-disc shaped specimens were fabricated using a custom made brass mold as per the manufacturer instructions. All specimens were put in storage for rehydration and complete polymerization at 37°C in distilled water for 24 hours. Specimens of each composite material were randomly divided into four subgroups of 13 samples. Tea solutions were freshly prepared, and specimens were immersed in the respective solutions every day for 15 minutes for 60 days. Specimens were stored in artificial saliva after the immersion regimen. The color evaluation was done before immersion, on the 30th and 60th day, using a digital reflectance spectrophotometer.

Results

At 30 days, Group 1 specimens immersed in Areca and Green teas showed significantly higher mean values than those in control and Tulsi tea. At 60 days in Group 1, specimens in Areca tea showed significantly higher mean value, followed by Green tea, Tulsi tea, and control. At 30 and 60 days in group 2, specimens in control had significantly lower mean values than other tea preparations. Group 1 showed a higher mean difference in ΔE than Group 2 specimens immersed in Green and Areca teas at 30 days (P=0.001 and 0.001) and 60 days (P=0.001 and <0.001), respectively.

Conclusion

All herbal tea preparations exhibited staining potential, which increased over time, and Areca tea showed the highest staining potential. Understanding the staining potential of newer tea preparations on recent composite materials helps the clinician to choose the right restorative materials.

Children's perception of other children with dental fluorosis - A cross-sectional study

Background

Dental appearance may influence how others perceive individuals. This study would help to understand whether young people make judgments about other young people with dental fluorosis.

Aim

We aimed to evaluate the perception of children aged 12-15 years about other children with visible dental fluorosis.

Materials and methods

A self-administered social attribute questionnaire was used to capture dental appearance-related judgments of 455 children aged 12-15 years, from 6 schools. All the children were given either a set of full-face photographs of a boy and a girl, without dental fluorosis or digitally modified anterior teeth to show visible dental fluorosis. The Total Attribute Score (TAS) was measured by totaling the participant's ratings for each characteristic, ranging from 11 (most negative score) and 44 (most positive).

Results

A total of 437 children participated, 53.8% (235) were males with a mean age of 13.99 ± 0.825. The mean TAS for photographs with fluorosis (25.9 ± 4.73) was significantly lower than without fluorosis (34.8 ± 4.83) (p < 0.001). Concerning gender, age, and SES, photos with fluorosis had significantly lower mean TAS than without fluorosis (p < 0.001, <0.001, <0.001 and < 0.001), respectively.

Conclusion

Children in our study perceived that fluorosis could have a negative impact on their appearance.

Local Dental Emergencies and Mitigation Strategies Adopted by Private Dental Practitioners of South India during COVID-19 Shelter in Place Warning - Multi-Centric Online Survey

Objective:

To evaluate the common dental emergencies reported to dental practitioners and to compare the mitigation strategies implemented during the Shelter-In-Place (SIP) warning with dental practitioners’ age and sex.

Methods:

We conducted a cross-sectional online survey among the dental practitioners of south India during the period of COVID-19 SIP warning. An initial pool of items was prepared to capture the mitigation strategies in managing local dental emergencies. A structured questionnaire was then prepared in English based on the inputs of four expert dentist panel. Age and sex of the practitioners were also recorded.

Results:

The mean age of the dental practitioners was 37.11(range: 23 - 63) years.Of 159 dental practitioners that responded to survey, 90 were male. Most dental practitioners responded that they were contacted through a phone call (n=140) and WhatsApp messaging (n=108). The common dental emergencies reported were tooth pain (100%), swelling (91.7%), a decayed tooth (81.3%), and gum pain (78.6%). A higher number of male than female dental practitioners had “scheduled the treatment immediately” (OR=3.45; P=0.002) after adjusting for age.

Conclusion:

The most common dental emergencies during COVID-19 SIP were tooth pain, swelling, decayed teeth, and gum pain. Males and older dental practitioners scheduled appointments immediately.

Relationship of salivary CD14 concentration with dental caries in young children

Background

Dental caries is a chronic disease among children and there is need for studies assessing the caries risk factors using saliva. This study aimed to evaluate the association of salivary soluble CD14 and dental caries in young children.

Material and Methods

A cross-sectional study was done among 300, 3-6 year old school children of Udupi district. A total of 40 children who were caries free, with no past systemic illness or craniofacial anomalies and 40 children with dental caries with no history of dental treatment for caries, with no past systemic illness or craniofacial anomalies were included in control and test groups respectively. Salivary CD14 was evaluated using ELISA test.

Results

The mean salivary soluble CD14 concentration was significantly higher in caries free (1.34±0.35 µg/ml) children than caries experienced (0.54±0.36 µg/ml) (p<0.001). There was significant strong negative correlation between number of decayed teeth and soluble salivary CD14 (r = -0.868, P< 0.001) among all the children. Similarly, sub-group analysis of caries experienced children also showed significant strong negative correlation between number of decayed teeth and soluble salivary CD14 (r = -0.774, P<0.001).

Conclusions

Results obtained in our study suggested that salivary CD14 can be a indicator of dental caries in young children.

Key words:Caries, CD14, Children, Saliva.

Validation of Two Point of Care Devices for Hemoglobin Estimation in Blood Donors

Hemoglobin (Hb) estimation is a critical investigation in prospective blood donors. There are numerous techniques for Hb estimation, choosing an appropriate method is essential. Point of care devices (POC) have made quantification of Hb possible even in the field or community settings. Validation against a standard measure is necessary before implementing it for routine practice. With this background, we aimed to validate two new POC devices against a standard hematology analyzer for Hb estimation. An observational study on 100 donor venous blood samples was conducted. Hemoglobin was estimated using a Sysmex Hematology Analyzer (reference method) along with POC devices (CompoLab TM and True Hb Hemometer). Three statistical techniques were applied to validate Hb by the two POC devices. CompoLab TM measures 0.4 units more than the reference method and True Hb measures 0.4 units less than the reference method. Measures of Hb obtained from both the equipment showed moderate agreement with that of reference method (CompoLab TM ICC-0.74 and True Hb ICC-0.72). There were no systematic or proportional differences in the comparison of the two POC devices with the reference method. Within the limitations of this study, both the devices can be used for Hb estimation, as there was a substantial agreement of the measurements with the reference method. Other factors such as cost, turnaround time (TAT), ease of utilization should be considered to decide on the choice of equipment to be used.

Effect of Different Herbal Tea Preparations on the Color Stability of Glass Ionomer Cements

Objective

To compare the color stability of the newer glass ionomer cements (GIC) when exposed to “Green tea” (GT), “Tulsi tea” (TT), and “Areca tea” (AT) using spectrophotometric analysis.

Materials and Methods

We selected commercially available GC Fuji IX GP EXTRA and Ketac Universal for this study. Eighty disc-shaped samples were made using a mold, which were immersed in the freshly prepared test solutions (distilled water, GT, TT, and AT) for 15 minutes per day for 60 days. The color estimation was done using a spectrophotometer.

Results

GC Fuji IX samples had a significantly higher mean difference in ΔE value than Ketac Universal when immersed in GT, AT, and control (P<0.001, 0.018, and <0.001), respectively. With GC Fuji IX, GT and AT stained more than TT and control solutions. Samples of Ketac Universal showed a significantly higher mean difference in ΔE values when immersed in AT, followed by GT, TT, and control.

Conclusion

Within the study’s limitations, we conclude that both the GICs exhibited staining over time on exposure to all the test solutions. Ketac Universal demonstrated lower staining potential than GIC Fuji IX GP Extra for GT and AT.

Effect of in-office bleaching agent on the surface roughness and microhardness of nanofilled and nanohybrid composite resins

Background: To compare the surface roughness and microhardness of Ceram.x® SphereTEC™ one and Filtek Z350 XT after in-office bleaching with Pola office. Methods: Twenty samples each of (10 mm diameter and 2 mm height) Ceram.x® SphereTEC™ one and Filtek Z350 XT were prepared. The samples were subjected to three bleaching sessions with 35% hydrogen peroxide (Pola office) with a seven-day interval between each session. Surface roughness and microhardness of the prepared samples prior to and after the bleaching regimen were measured using a profilometer and Vickers hardness tester, respectively. Results: A significant reduction (p <0.001) in the surface hardness of Filtek Z350 XT from 27.67 ± 2.10 to 17.83 ± 1.36 Vickers hardness number (VHN) was observed after the bleaching whereas no significant reduction in surface hardness was observed with Ceram.x® SphereTEC™ one. The adjusted mean (estimated marginal mean) microhardness after bleaching for Ceram.x ® SphereTEC™ one (35.79 ± 1.45) was significantly higher than Filtek Z350 XT (19.54 ± 1.45) (p < 0.001). However, in-office bleaching of these materials did not significantly alter their surface roughness. Conclusions: In office-bleaching with 35% hydrogen peroxide can reduce the microhardness of nanofilled composite. However, the surface roughness was not influenced by the bleaching procedure in both nanohybrid and nanofilled composite resin materials.

Evaluation of progressive muscle relaxation and autonomous sensory meridian response in alleviating dental anxiety in children aged 7-11 years: a randomized controlled trial

PURPOSE

To compare the effectiveness of Progressive Muscle Relaxation and Autonomous Sensory Meridian Response with Conventional Behaviour Guidance techniques on the reduction of dental anxiety in children aged 7-11 years during the administration of local anaesthesia.

METHODS AND FINDINGS

This parallel, randomised controlled trial involved 78 children requiring invasive dental treatment under local anaesthetic block, who were allocated into three groups: Progressive Muscle Relaxation, Autonomous Sensory Meridian Response, and Conventional Behaviour Guidance techniques. The primary outcome was reduction of dental anxiety, as measured by objective (pulse rate, oxygen saturation and blood pressure) and subjective (Visual Facial Anxiety Scale) parameters before, after intervention and during local anaesthesia by a blinded outcome assessor.

RESULTS

Progressive Muscle Relaxation and Autonomous Sensory Meridian Response demonstrated a significant reduction in blood pressure during local anaesthesia (p = 0.009 and 0.042, respectively). Progressive Muscle Relaxation significantly reduced mean Visual Facial Anxiety scores after intervention (p < 0.001), whilst Autonomous Sensory Meridian Response significantly reduced these scores during injection (p = 0.002).

CONCLUSION

The use of Progressive Muscle Relaxation and Autonomous Sensory Meridian Response resulted in a reduction in dental anxiety and can be used as adjuncts to basic behaviour guidance techniques.

CLINICAL TRIAL REGISTRATION

The trial was registered at Clinical Trials Registry-India (CTRI Reg no.: CTRI/2022/09/045796, Dated 23 September 2022).

Intra-Lesional Medicaments for the Management of Intra-Osseous Lesions of Maxilla and Mandible - Systematic Review

Aims and Objectives:

This study aimed to review the success or remission of intralesional medicaments in the management of intraosseous lesions in the oral cavity.

Materials and Methods:

A comprehensive search was performed in two databases (PubMed and Scopus). Research articles, case reports, case series, and clinical trials were included. Review articles, lesions not involving the bone, incomplete reporting, any other treatment other than intralesional medicaments to treat intraosseous bone lesions, publications without any treatment, and letter to editor were excluded. Data on remission (complete, partial, or no remission), details and regimen of the intervention, number of participants, and follow-up in months were recorded.

Results:

A total of 653 publications were available for title and abstract screening after the removal of duplicates. Seven articles were excluded, which were not in English. After title and abstract screening, a total of 88 publications were available for full-text screening. Fifty-five articles were included in qualitative synthesis. A total of 168 patients from 55 publications were evaluated. Minimum follow-up was 1 month and maximum was 264 months. More than two-third (n = 38) of the publications were case reports on single patient. More than two-third (n = 38) of the publications had complete remission.

Conclusion:

Intralesional medications have shown variable success rates. Extensive lesions may undergo intralesional medications followed by surgical management.