Factors influencing adherence to self-care practices among patients of type 2 diabetes mellitus from Saurashtra region of Gujarat: A conclusive research.

Background: It is commonly understood that diabetes self-care practice is critical in the management of the disease. However, the magnitude and determinants of self-care practices are not well evaluated at the community level. Methods: A community based cross-sectional study was conducted among 178 type 2 DM patients. Self-care practices were evaluated for the last seven days and each item was scored from 0 (none of the days in a week) to 7 (all 7 days were followed). Results: Adherence to medication (89.3%) and blood glucose monitoring (65.2%) were relatively higher than other domains. Factors associated with dietary adherence were secondary level education and above (OR = 22.1, 95% CI = 6.85 to 71.3), physician or endocrinologist treating doctors (OR = 3.36, 95% CI = 1.24 to 11.32), joint and three-generation family (OR = 3.32, 95% CI = 1.23 to 8.92) and upper and middle socioeconomic class (OR = 2.5, 95% CI = 1.1 to 6.2). Good glycemic control was significantly associated with dietary adherence (OR = 6.81, 95% CI = (2.71 to 17.16), medication adherence (OR = 4.59, 95% CI = 1.3 to 16.24) and regular exercise (OR = 3.65, 95% CI = 1.62 to 8.19). Conclusion: There is need to develop structured diabetes self-care education programs with involvement of private practitioners as a majority of the patients consult private practitioners for treatment. Health educators might have to place emphasis on self-care education to patients as well as caregivers belonging to low socioeconomic class and having lower education.

An in vitro Comparative Evaluation of Efficacy of Disinfecting Ability of Garlic Oil, Neem Oil, Clove Oil, and Tulsi Oil with autoclaving on Endodontic K Files tested against Enterococcus faecalis.

AIM: To comparatively evaluate the efficacy of disinfecting ability of garlic oil, neem oil, clove oil, and tulsi oil with autoclaving on endodontic K files tested against Enterococcus faecalis. MATERIALS AND METHODS: Fifty endodontic K files were exposed to the test micro-organism and checked for its disinfecting ability using three different methods. RESULT: Garlic oil, clove oil, tulsi oil and autoclave showed considerable effectiveness against E. faecalis except neem oil. CONCLUSION: Garlic oil, clove oil and tulsi oil are an effective disinfectant and can be used as an alternative to autoclaving against the test micro-organism. CLINICAL SIGNIFICANCE: Herbs and herbal extracts are a natural and harmless way of controlling infection. These products are readily available and comparable to gold standard, thus can have its applications in rural India. HOW TO CITE THIS ARTICLE: Hugar S, Patel PM, Nagmoti J, Uppin C, Mistry L, Dhariwal N. An in vitro Comparative Evaluation of Efficacy of Disinfecting Ability of Garlic Oil, Neem Oil, Clove Oil, and Tulsi Oil with autoclaving on Endodontic K Files tested against Enterococcus faecalis. Int J Clin Pediatr Dent 2017;10(3):283-288.

Comparison of the Effect of Fluoride Varnish, Chlorhexidine Varnish and Casein Phosphopeptide- Amorphous Calcium Phosphate (CPP-ACP) Varnish on Salivary Streptococcus mutans Level: A Six Month Clinical Study.

INTRODUCTION: Dental caries is the most widespread disease which has a multi factorial origin. Streptococcus mutans is considered to be the chief pathogen in its development. Different varnishes are available which can be used for the prevention of the carious process. AIM: To compare the effect of fluoride varnish, chlorhexidine varnish and fluoride varnish containing Casein Phosphopeptide - Amorphous Calcium Phosphate (CPP-ACP) on salivary Streptococcusmutans count in children with mixed dentition over a period of six months. MATERIALS AND METHODS: Seventy two children of age 6-12 years with mixed dentition were selected fulfilling inclusion and exclusion criteria and divided into three groups: Group I- Fluoride varnish group; Group II- Chlorhexidine varnish group; Group III- MI varnish (fluoride varnish containing CPP-ACP) group. After thorough oral prophylaxis and restorative treatment the varnishes were applied to the teeth once a week for four consecutive weeks in the respective groups. Salivary Streptococcus mutans count (CFU/ml of saliva) was estimated at baseline, 1 month, 3 months and 6 months after varnish application. Bonferroni post-hoc test and paired t-test for inter group and intra group comparison was used in the study. RESULTS: A statistically significant reduction in salivary S. mutans colony count was seen with all three groups at all the different time intervals. Maximum reduction was noted in chlorhexidine varnish group at all the intervals after varnish application. CONCLUSION: Prevention of dental caries plays a vital role in paediatric dental practice. The use of dental varnish has proved to be effective in reducing the dental caries. Chlorhexidine varnish was found to show maximum reduction in salivary S. mutans count for six month period, when compared to MI varnish and fluoride varnish. Thus, chlorhexidine varnish can be used as potent caries inhibiting agent and promote good oral health.

An in vitro comparison of casein phosphopeptide-amorphous calcium phosphate paste, casein phosphopeptide-amorphous calcium phosphate paste with fluoride and casein phosphopeptide-amorphous calcium phosphate varnish on the inhibition of demineralization and promotion of remineralization of enamel.

AIM: This study aims to determine and compare the extent of inhibition of demineralization and promotion of remineralization of permanent molar enamel with and without application of three remineralizing agents. MATERIALS AND METHODS: Forty extracted permanent molars were randomly divided into two groups 1 and 2, longitudinally sectioned into four and divided into subgroups A, B, C, and D. The sections were coated with nail varnish leaving a window of 3 mm × 3 mm. All sections of Group 1 were treated with their respective subgroup-specific agent: Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) paste for subgroup A, CPP-amorphous calcium phosphate fluoride (ACPF) paste for subgroup B, CPP-ACPF varnish for subgroup C and subgroup D served as a control. The sections were then subjected to demineralization for 12 days following which lesional depth was measured under the stereomicroscope. All the sections of Group 2 were subjected to demineralization for 12 days, examined for lesional depth, then treated with their respective subgroup specific agents and immersed in artificial saliva for 7 days. The sections were then examined again under the stereomicroscope to measure the lesional depth. RESULTS: CPP-ACPF varnish caused significant inhibition of demineralization. All three agents showed significant remineralization of previously demineralized lesions. However, CPP-ACPF varnish showed the greatest remineralization, followed by CPP-ACPF paste and then CPP-ACP paste. CONCLUSION: This study shows that CPP-ACPF varnish is effective in preventing demineralization as well as promoting remineralization of enamel. Thus, it can be used as an effective preventive measure for pediatric patients where compliance with the use of tooth mousse may be questionable.

Comparative Assessment of Conventional Composites and Coloured Compomers in Permanent Molars of Children with Mixed Dentition: A Pilot Study.

INTRODUCTION: Early treatment of carious lesions in children is important for the maintenance of oral health. Multicoloured restorations could be the impetus for an extremely nervous or defiant child to take dental treatment. AIM: The aim of this study was to assess and compare the clinical success of conventional composites and coloured compomer material in first permanent molars of children with mixed dentition. MATERIALS AND METHODS: A total of sixty sites, divided into two groups, with thirty subjects in each group using split mouth design were chosen amongst patients reporting to Department of Pedodontics and Preventive Dentistry. In control group conventional composites were placed, similarly coloured compomers were placed in experimental group under standard operating protocol. Patients were recalled for assessment of clinical success amongst control as well as experimental group at regular intervals of one; three and six months follow up based on Modified Ryge's Criteria. Statistical analysis was done using Chi-square test using SPSS version 20.0 (Chicago, USA). RESULTS: Both conventional composites and coloured compomers had comparable retention rates in terms of anatomical form, marginal integrity, secondary caries and marginal discolouration. CONCLUSION: The coloured compomer material showed promising results in this six month follow up study in permanent molars and had properties comparable to that of conventional composites.

In situ stable crack growth at the micron scale.

Grain boundaries typically dominate fracture toughness, strength and slow crack growth in ceramics. To improve these properties through mechanistically informed grain boundary engineering, precise measurement of the mechanical properties of individual boundaries is essential, although it is rarely achieved due to the complexity of the task. Here we present an approach to characterize fracture energy at the lengthscale of individual grain boundaries and demonstrate this capability with measurement of the surface energy of silicon carbide single crystals. We perform experiments using an in situ scanning electron microscopy-based double cantilever beam test, thus enabling viewing and measurement of stable crack growth directly. These experiments correlate well with our density functional theory calculations of the surface energy of the same silicon carbide plane. Subsequently, we measure the fracture energy for a bi-crystal of silicon carbide, diffusion bonded with a thin glassy layer.To improve mechanical properties in ceramics through grain boundary engineering, precise mechanical characterization of individual boundaries is vital yet difficult to achieve. Here authors perform experiments using an in situ scanning electron microscopy based double cantilever beam test, allowing to directly view and measure stable crack growth in silicon carbide.

Successful Management of the Masochistic Habit in a Child with Santovuori-Haltia-Hagberg Disease (Infantile Neuronal Ceriod Lipofuscinoses).

Self-injurious behaviours are usually related to paediatric patients with mental retardation. The management of such patients is quiet challenging to the paediatric dentists because of the difficulty to communicate with such patients regarding their feelings verbally. Here, we present a case report of successful management of self-injurious behaviour in a child with Infantile Neuronal Ceriod Lipofuscinoses (INCL).

Natural tooth as an interim prosthesis.

A traumatic injury to primary maxillary anterior tooth is one of the common causes for problems with the succedaneous tooth leading to it noneruption. A missing anterior tooth can be psychologically and socially damaging to the patient. Despite a wide range of treatment options available, sometimes, it is inevitable to save the natural tooth. This paper describes the immediate replacement of a right central incisor using a fiber-composite resin splint with the natural tooth crown as a pontic following surgical extraction of the dilacerated impacted permanent maxillary central incisor. The abutment teeth can be conserved with minimal or no preparation, thus keeping the technique reversible and can be completed at chair side thereby avoiding laboratory costs. It can be used as an interim measure until a definitive prosthesis can be fabricated as the growth is still incomplete.

Pathologic tooth migration-spontaneous repositioning following a non-surgical periodontal therapy: a case report.

This case report describes the spontaneous correction of a pathologic tooth migration (PTM) and reduced infra-bony pockets after a nonsurgical periodontal therapy.

The Morphometrical and Histopathological Changes which were Observed after Topical Ozone Therapy on an Exophytic Fibrous Gingival Lesion: A Case Report.

We are presenting 2 cases where ozone therapy was used in the form of ozonated oil on an exophytic fibrous gingival lesion. A 42-years female patient was selected, who presented with a mild to moderately painful, exophytic, fibrous lesion on the upper anterior gingiva. This gingival lesion was treated with 2ml of ozonated oil, thrice daily for one week. After the ozone therapy, the postoperative outcomes were measured and analyzed. Finally, the lesion was subjected to an excisional biopsy and a histopathological evaluation. After the ozone therapy, the patient revealed that there was less pain. On examination of the lesion, an improvement was observed in the clinical sign of the inflammation and also a reduction in the surface ulceration. During the final biopsy, less bleeding was observed. The morphometrical analysis showed a reduction in the size of the lesion. The histopathological analysis showed a reduction in the collagen fibres and in the inflammatory cells in the connective tissue stroma. Topical ozone therapy provides potential benefits for the treatment of exophytic gingival lesions. The observed benefits in present case report needs to be verified in future with well-controlled clinical trials.

Cytomorphometric analysis of the gingival epithelium in type 2 diabetic patients with and without smoking habit.

BACKGROUND: It has been shown that cigarette smoking as well as diabetes mellitus can produce cytomorphometric alterations in oral epithelial cells with the significant increase in the nuclear area (NA) and significant decrease in the cytoplasmic/nuclear ratio in comparison to healthy control. However, the synergistic effect of tobacco smoking and diabetes on the morphology of gingival epithelial cells is not been explored until date. AIM: This study was carried out to investigate the effects of diabetes and the synergistic effects of smoking and diabetes on the cytomorphometry of gingival epithelium. MATERIALS AND METHODS: Gingival smears were collected from 30 male subjects diagnosed with type 2 diabetes with (n = 10) or without history of smoking habit (n = 10). Healthy subjects with no history of smoking or diabetes served as the control group (n = 10). The smears were stained using Papanicolaou procedure. The cellular (CA) and nuclear areas (NA) were measured using image analysis software. One-way ANOVA and Tukey-HSD procedure (at P = 0.05) were used to analyze all the parametric variables. RESULTS: A statistically significant (P < 0.001) increase in NA and N:C ratio in smoker diabetic group was observed compared to the non-smoker diabetic group and the control group. The non-smoker diabetic group also showed significant increase. CONCLUSIONS: There were significant alterations in the cellular pattern of gingival mucosa cells in a non-smoker diabetic, but the alteration was to a greater extent in smoker diabetics demonstrating a synergistic effect of smoking and diabetes on gingival mucosa.

Microsurgical aesthetic treatment of gingival fenestration by a coronally repositioned partial thickness graft: a case report.

Gingival fenestration is a rare pathological entity, scarcely described in the literature. The present paper has reported a case of a 22-year-old male patient with a "Gingival fenestration" in the lower left central incisor. The lesion was successfully treated using a coronally positioned partial thickness graft under 4 X magnification, with excellent aesthetic results.

Clinical effect of miswak as an adjunct to tooth brushing on gingivitis.

BACKGROUND: The aim of the study was to clinically evaluate the effect of miswak as an adjunct to tooth brushing on plaque levels and gingival health in subjects diagnosed with mild to moderate chronic generalized marginal gingivitis in comparison with those of toothbrush users. MATERIALS AND METHODS: The study comprised of 30 systemically healthy subjects, aged 18-35 years diagnosed with mild to moderate gingivitis. The study was designed as a randomized, single-blind, parallel-armed study. Subjects were randomly divided into three groups. Group A (toothbrush users), group B (toothbrush and miswak users), and group C (miswak users). Subjects were advised to use toothbrush, miswak, or both, three times daily depending on their respective allocations. Gingival index according to Loe and Silness, Plaque index, according to Turesky modified Quigley-Hein plaque index, and the digital photographs of the total labial surfaces of the teeth were taken for image analysis. Recording of data were done at baseline, 2(nd), 4(th), 6(th), and 8(th) week time intervals. Obtained data were analyzed using repeated measure ANOVA and student t test (independent samples). RESULTS: Group B showed statistically significant (P<0.0001) decrease in plaque score and gingival score compared to group A and group C, respectively, from 2(nd) to 8(th) week, whereas no statistical significant difference was found in plaque score, when group A was compared with group C (P>0.05) from 2(nd) to 4(th) week. Further at the 6(th) and 8(th) week, there was significant difference (P<0.05) in plaque score between group A and group C. The difference in gingival score was not significant (P<0.05), when group A was compared with group C on all the indicated time intervals. CONCLUSION: Results showed significant improvement in plaque score and gingival health when miswak was used as an adjunct to tooth brushing.

Cytological assessment of healing palatal donor site wounds and grafted gingival wounds after application of ozonated oil: an eighteen-month randomized controlled clinical trial.

OBJECTIVE: The present study was undertaken to assess the therapeutic effects of topical ozonated oil on early healing of free gingival graft surgical sites. STUDY DESIGN: Twenty subjects were entered into this triple-blinded, randomized, placebo-controlled clinical trial, designed to evaluate the efficacy of ozonated oil on free gingival graft surgical wounds. Subjects were assigned to either the ozone group, in which ozonated oil was applied to the surgical wound, or the control group, in which non-ozonated oil was used as a control. Patients were postoperatively evaluated by cytological analysis. Cytological analysis consisted of the keratinisation and superficial cell indices measured at baseline, after 24 h, on the 3rd, 7th, 14th and 21st day and 2, 3, 8 and 18 months postoperatively. RESULTS: Cytological results showed that there was a significant (p < 0.001) improvement in epithelial healing by the 7th, 14th and 21st day and 2, 3 and 8 months postoperatively in the ozone group compared to the control group. CONCLUSION: The present study showed significant improvement in epithelial healing and gingival health after topical application of ozone-treated plant oil to gingival surgical sites.

The management of a persistent periapical lesion caused by an apicomarginal defect, associated with a root end fracture in an endodontically treated tooth: a clinical report.

This is a case report of the presentation and the management of an apicomarginal defect which was associated with a root end fracture in an endodontically treated tooth. In spite of a successful Root Canal Treatment (RCT), if the fractured root end is left intact, considering inadverdent ankylosis or resorption, it may progress to the development of a bony dehiscence.

Correlation of periodontal status and bone mineral density in postmenopausal women: a digital radiographic and quantitative ultrasound study.

BACKGROUND: Data suggest that postmenopausal women with osteoporosis are at an increased risk for periodontal attachment loss and tooth loss; however, the extent of relationship between these two diseases is still not clear. AIM: The aim of the study was to evaluate the correlation of periodontal status and bone mineral density (BMD) in postmenopausal women. MATERIALS AND METHODS: The study population included 60 postmenopausal women aged 50-60 years (mean±SD: 55.5±3.4 years). Periodontal status was examined by plaque index, bleeding index, probing depth, and clinical attachment level (CAL). Digital panoramic radiograph was taken to measure the maxillary and mandibular alveolar bone density values. Skeletal (calcaneal) BMD was measured by quantitative ultrasound technique for T-score values. The recorded data for T-score, maxillary and mandibular alveolar bone densities, and periodontal status were subjected to statistical analysis for correlation and regression procedures. RESULTS: The results showed that mandibular alveolar (r=0.907, P<0.001) and maxillary alveolar bone density (r=0.898, P<0.001) had significant positive correlation with calcaneal T-score. Probing depth (r=-0.316, P<0.05), bleeding index (r=-0.277, P<0.05), and plaque index (r=-0.285, P<0.05) showed weak but significant negative correlation with calcaneal T-score and alveolar bone density of both the jaws, whereas CAL showed weak correlation with T-score which could not reach to a statistically significance level (r=-0.221, P>0.05). CONCLUSION: Calcaneal BMD was related to alveolar bone loss and, to a lesser extent, to clinical attachment loss, implicating postmenopausal bone loss as a risk indicator for periodontal disease in postmenopausal women.

Quantitative cytomorphometric analysis of exfoliated normal gingival cells.

BACKGROUND: The use of oral exfoliative cytology as a diagnostic aid accentuates the need for establishing an accurate baseline, thereby enabling the comparison of abnormal oral tissue with established baseline. AIMS AND OBJECTIVE: To detect any changes in the nuclear area (NA), cytoplasmic area (CA), and nuclear:cytoplasmic ratio (N:C ratio) values for clinically normal gingival smears in relation to age and sex of apparently healthy subjects. MATERIALS AND METHODS: Gingival smears were collected from 80 (40 male, 40 female) apparently healthy subjects belonging to the age group of 0-20, 21-40, 41-60, and more than 60 years. Smear slides were fixed by using spray fixative. The smears were stained using Papanicolaou procedure. The cytoplasmic and NAs were measured using image analysis software. Statistical analysis of the data was done using one-way ANOVA with Tukey-HSD procedure and Student's t test. RESULTS: The result showed that there was a significant difference (P<0.001) in NA, CA, and N:C in males of different age groups. There was a significant difference (P<0.001) in NA, CA, and N:C in females of different age groups. The difference in N:C between males and females was significant (P<0.001) in all the groups. The difference in NA, CA, and N:C with age irrespective of gender was significant (P<0.05). There was a significant difference (P<0.05) between males and females with respect to NA, CA, and N:C irrespective of age. CONCLUSION: Age-and sex-related alterations were observed in gingival smears, which could be a baseline for these variables to compare identical measurements, made on pathologic smears of oral premalignant and malignant lesions.

Therapeutic effect of topical ozonated oil on the epithelial healing of palatal wound sites: a planimetrical and cytological study.

AIM: To evaluate the effect of ozonated oil on palatal wounds. METHODS: Eighteen patients were randomized and allocated to either the ozone group (n = 8) or control (n = 10) group. Free gingival graft surgery was performed, and post-harvested palatal wounds were treated with either 2 mL ozonated oil or control oil daily for 1 week. A planimetrical analysis analyzed the digital image for the wound sizes and shape factor at baseline, at 24 h, and days 5, 7, 14, 21, and 28, postoperatively. A cytological analysis used the keratinization and superficial cell indices at baseline, 24 h, and days 3, 7, 14, and 21 and the second and third months, postoperatively. RESULTS: Planimetrical results showed a significant (P ≤ 0.05) improvement in wound size on days 5, 7, 14, 21, and 28, postoperatively, in the ozone group compared to the control group. Cytological results showed a significant (P ≤ 0.001) improvement in epithelial healing on days 7, 14, and 21, and the second and third months, postoperatively, after the application of ozonated oil compared to control oil. CONCLUSION: Our results showed significant improvement in wound size and epithelial healing after topical ozonated oil application compared to control oil on palatal wounds.

Comparative performance of flat sheet and spiral wound modules in the nanofiltration of reactive dye solution.

BACKGROUND AND PURPOSE: Besides the opportunities for reuse, stringent regulations and growing public awareness demand an enhanced quality of effluent from dye industries. Treatment of an aqueous solution of dye (reactive red 198) was carried out in a nanofiltration unit using both flat sheet and spiral wound modules to obtain a comparative performance evaluation in terms of permeate flux and quality. METHODS: Hydrophilized polyamide membrane with molecular weight cutoff of 150 was used for the experiments. Effects of trans-membrane pressure (TMP), feed concentration and addition of salt on permeate flux were investigated. Percent reduction of color, chemical oxygen demand (COD), total dissolved solid (TDS), and conductivity were determined to assess performance of the membrane. RESULTS: The maximum flux decline was 16.1% of its initial value at 490 kPa TMP with 50 ppm feed concentration in spiral wound module, whereas the same in flat sheet under same conditions was 7.2%. The effect of TMP showed a quasi-linear increase in flux with increasing pressure. Increased permeate concentration led to the reduction in observed retention of dye in the membrane. The average reduction in color, COD, and TDS were 96.88%, 97.38%, and 89.24%, respectively. The decline in permeate flux was more in case of spiral wound module compared to flat sheet. However, spiral wound module performed better in terms of color removal, COD reduction, and TDS removal. CONCLUSION: Substantial removal of color was achieved in the nanofiltration experiments with a marked reduction in COD and TDS. The process allowed the production of permeate stream with great reutilization possibilities.