The Oral Health Condition of Patients on Hemodialysis at a Tertiary Healthcare Facility in Eastern Nepal.

Objectives: This study was done to compare the oral health of chronic kidney disease (CKD) patients on hemodialysis to healthy individuals and to assess the effect of the duration of dialysis on oral health. Materials and Methods: A comparative cross-sectional study was conducted among purposively selected 54 cases undergoing dialysis and 54 apparently healthy controls. Caries experience and periodontal status were recorded under similar examination conditions and compared between cases and controls. The correlation between oral health and the duration of dialysis was assessed. A p value of <0.05 was considered significant. Results: The mean age of the participants was 47.09 ± 12.23 years. Median caries experience among cases and controls was two (0-26) and three (0-15), respectively (p=0.013). Periodontitis among the two groups was found to be significantly different with a greater number of cases showing increased severity (p < 0.001). The severe form of periodontitis was associated with a greater mean duration of dialysis. Conclusion: Significant differences exist between the periodontal health of patients undergoing dialysis compared to healthy controls. Longitudinal studies are required to check the causal effect of CKD on periodontitis.

Oral health status and barriers to utilization of dental services among pregnant women in Sunsari, Nepal: A cross-sectional study.

OBJECTIVES: This study was conducted to assess oral hygiene practices, oral health status and barriers to utilization of oral health care services among pregnant mothers attending two family health care clinics in Sunsari, Nepal. METHODS: A cross-sectional study was conducted among 139 women using a purposive sampling technique. The data collection was done using a pretested standard semi-structured questionnaire. Face-to-face interviews of the participants were done by a single investigator in the local language (Nepali). The examination was done using a mouth mirror and CPI probe for periodontal status, loss of attachment and dentition status, and treatment needs. RESULTS: The majority of pregnant mothers brushed their teeth once a day or less than once a day (n = 106, 76.3%) and self-reported perceived oral health status was poor/fair (n = 93, 66.9%). The prevalence of dental caries was found to be 69.8%. Bleeding on probing was present in all participants. DMFT, presence of bleeding on probing and increased periodontal pocket was significantly high among women who had self-reported their oral health problems in comparison to those who had not reported any problem. The most common barriers reported by the participants were a lack of knowledge of dental checkups and a lack of perceived need for dental care during pregnancy. CONCLUSIONS: There was a high prevalence of dental caries and periodontal disease. Lack of knowledge and perceived need for dental care were the major barriers found in this study. Hence, this directs towards the utmost need for improvement in awareness level as well as oral hygiene practices.

Dental Caries in Permanent First Molar and Its Association with Carious Primary Second Molar among 6-11-Year-Old School Children in Sunsari, Nepal.

The permanent first molar (PFM) plays an essential role in maintaining the dental and overall health of an individual. It is the most susceptible tooth to dental caries due to its early eruption and location near the primary second molar in the oral cavity. We assessed the clinical status of the PFM and its association with carious primary second molars among 6-11-year-old children in Sunsari, Nepal, from January 2019 to December 2021. We recorded DMFT/DMFS and dft/dfs indices of the first permanent molar and secondary primary molar. Chi-square, logistic regression, and Spearman rank correlation (r s) were used to explore the association between carious molar lesions. Of the 655 children, only 612 had all first permanent molars. The prevalence of caries was higher in the second primary molar (70.9%) than in the PFM (38.6%). In both molars, the occlusal surface was the most commonly affected surface by dental caries. A significant association (p < 0.01) was found between the decayed primary second molar and the decayed PFM. A moderate but statistically significant correlation (p < 0.01) was found between the occurrence of dental caries in both the molars.

Acceptance and hesitancy of COVID-19 vaccine among Nepalese population: A cross-sectional study.

INTRODUCTION: COVID-19 is an emerging infectious disease with a high transmission rate and substantial deaths. Various vaccines have been developed to combat it. This study is aimed to assess COVID-19 vaccine acceptance and hesitancy among the Nepalese population through a web-based survey. MATERIALS AND METHODS: This is a web-based cross-sectional descriptive study of Nepalese people 18 years and above from different regions of Nepal who use social media (Facebook, Twitter, Reddit) as well as instant messaging applications (Messenger, Viber, WhatsApp). The duration of the study was 3 months from 1st June 2021 to 31st August 2021. The sampling technique used was self-selected non-probability sampling. A validated questionnaire had been taken to record the data. RESULTS: A total of 307 participants were included in the study. About three-fourths of participants 231 (75.2%) had not been vaccinated while 76 (24.8%) had been vaccinated with COVID -19 vaccine. Out of 231 non-vaccinated participants, most of participants 213 (92.2%) had shown acceptance of the COVID-19 vaccine. More than two-thirds of participants believed that the vaccine would protect them, their family members, and the community from having COVID-19 in the future. Very few participants 18 (7.2%) were hesitant to receive the vaccine against COVID-19. About two-thirds of participants were being afraid of adverse effects of the COVID-19 vaccine while more than half of participants hesitated due to lack of enough information regarding COVID-19 vaccine. CONCLUSION: This study can aid in the planning of vaccination campaigns and the direction of future public health efforts aimed at increasing COVID-19 vaccine uptake.

Musculoskeletal complaints and associated factors among dental practitioners of Nepal: a nationwide survey.

Musculoskeletal disorders (MSDs) constitute a significant occupational hazard among dental practitioners. An online-based e-survey was conducted among 252 registered dentists of Nepal using the Nordic musculoskeletal questionnaire (NMQ) to assess musculoskeletal complaints and work-related characteristics. Musculoskeletal complaints in lower regions were found to be highly prevalent among dental practitioners with prevalence of 76, 27 and 28.2% in the last 12 months, 1 month and 7 days, respectively, followed by musculoskeletal complaints in the neck, wrist/hand and shoulder. Musculoskeletal complaint during the last 12 months was significantly associated with age, years in dental practice after graduation and leave from duty in the past 12 months. Similarly, educational qualification, medical comorbidities and leave from duty were associated with complaints in the last 1 month. Musculoskeletal complaint during the last 7 days was associated with gender, working hours in a day, practice of four-handed dentistry and patients examined in a day.

Depression among Online Respondent Oral Healthcare Workers during COVID-19 Pandemic: A Descriptive Cross-sectional Study.

Introduction: COVID-19 outbreak brought unprecedented pressure on dental and oral health care workers leading to increased depression. This study aimed to find the prevalence of depression among online respondent oral healthcare workers during the COVID-19 pandemic. Methods: A descriptive cross-sectional study was conducted from 24 June 2020 to 13 July 2020 among oral health care workers in a tertiary care centre. Ethical approval was taken from the Ethical Review Board (Reference number: 2710). Convenience sampling method was used. The data were collected using a questionnaire through Google Forms. Point estimate and 95% confidence interval were calculated. Results: Among 133 oral health care workers, the prevalence of depression was found to be 29 (21.80%) (14.78-28.82, 95% Confidence Interval). Conclusions: The prevalence of depression among oral health care workers was lower than similar studies done in similar settings. Keywords: COVID-19; depression; oral health.

Effectiveness of oral health education intervention among 12-15-year-old school children in Dharan, Nepal: a randomized controlled trial.

BACKGROUND: School-aged adolescents are in particular need of preventive program to ensure positive long-term oral health and hygiene. The objective of this study was to assess the effectiveness of an oral health education (OHE) intervention on oral hygiene knowledge, attitude and practices (KAP), plaque control and gingival health among 12-15 years old school children in Dharan sub-metropolitan city, Nepal. METHODS: A randomized controlled trial was conducted with parallel study groups, comprising 12-15-year-old school children, 120 in each group. OHE was given to the experimental group at baseline, third and sixth months and to the control group after completion of the study. Interview of the participants were done using a 23-item questionnaire for assessment of oral hygiene KAP. For each question, correct answer was scored as 1 and wrong answer was scored zero. An overall composite score was then created, by adding the individual scores. Oral examination was done using mouth mirror and WHO probe to record Turesky-Gilmore-Glickman modification of the Quigley-Hein plaque index, Gingival index and Dentition status and treatment needs. Analysis was done using chi-square test for categorical data and independent t test, Mann-Whitney U test, repeated measures ANOVA and post hoc Tukey's test for quantitative data. The level of significance was set at P < 0.05. RESULTS: There was 54.58% improvement in overall oral hygiene KAP in experimental group (P = 0.001) whereas no improvement was seen in control group at the end of the study. The mean plaque score was improved by 57.67% (P = 0.001) in experimental group in comparison to 4.56% in control group. Gingival index was improved by 49.90% (P = 0.001) in experimental group in comparison to 0.7% in control group. Caries experience was increased in both groups but no significant difference was seen. CONCLUSIONS: The study concluded that oral health education was effective in improving oral hygiene KAP, plaque control and gingival health. Trial registration The trial was retrospectively registered with Clinical Trial Registry India (CTRI) with identifier no. CTRI/2018/05/013985, registered on 05/21/2018. ( http://www.ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=23651&EncHid=&modid=&compid=%27,%2723651det%27 ). Institutional Review Committee, B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal provided the ethical approval (Ref. No.: 292/074/075-IRC).

Assessment of nicotine dependence among tobacco users visiting outreach programs in Dharan, Nepal: a cross-sectional study.

BACKGROUND: Nicotine is a highly addictive substance present in tobacco. This study was conducted to assess the level of nicotine dependence among smokers and smokeless tobacco users visiting dental outreach programs of B.P. Koirala Institute of Health Sciences -Dharan, Nepal. METHODS: A cross sectional study was conducted from June 2018 to April 2019. A total of 726 people were selected from participants of dental outreach programs of 6 districts using convenience sampling technique. The data collection was done using semi-structured questionnaire through face-to-face interview by a single researcher. History of tobacco use and level of nicotine dependency was measured using Nepali translated and validated form of Fagerström Test for Nicotine Dependence for smoking and smokeless tobacco. The mean age of the tobacco users was 39.55 ± 15.57. Descriptive statistics including the mean, median, percentage, standard deviations and interquartile range were computed. Chi-square test, Fisher's exact test, univariate and bivariate logistic regression were used where needed. RESULTS: Nicotine dependence (moderate and severe) was found in 80% of smokeless tobacco users and 48% of smokers. Among the smokeless tobacco users, nicotine dependency was found to be more with increase in duration of tobacco use (AOR = 50.25, 95%CI = 3.51-718.62, p = 0.004), low socioeconomic status (AOR = 6.27, 95%CI = 1.30-30.31, p = 0.02), less number of tobacco packets used per day and tried to quit tobacco use in last 1 year. Among smokers nicotine dependency was found to be significantly higher with smoking more than 10 cigarettes per day (AOR = 7.14, 95% CI = 2.00-25.40, p = 0.002). CONCLUSIONS: The study concluded that level of nicotine dependence for both smoking and smokeless tobacco was high among the people visiting dental outreach programs. It is high time to develop a policy to control tobacco use along with creating tobacco cessation centers. Currently, tobacco control program is mostly focusing on smoking. However, it is also important to incorporate smokeless tobacco control at policy level.

Pain perception and dental anxiety during periodontal probing in patients visiting community oral health programme: a cross sectional study.

BACKGROUND: Periodontal probing is one of the basic clinical oral examination procedures. It is carried out to assess the severity of gingival and periodontal disease. The experience of pain during probing may discourage patients. So, this study was conducted to estimate the pain perception and dental anxiety experienced during periodontal probing in patients visiting the community oral health programmes of B. P. Koirala Institute of Health Sciences (BPKIHS). METHODS: A cross-sectional study was conducted among 100 participants of community oral health programmes of BPKIHS. Demographic profile, WHO modified Community Periodontal Index (CPI) 2013, Pain perception via Visual Analogue Scale (VAS Scores) and Short Version of Spielberger State-Trait Anxiety Inventory (STAI) Self-evaluation Questionnaire (Y-6 item) were assessed. Mean ± SD and Spearman correlation for pain and anxiety were computed. RESULTS: Only 10% of the study participants had healthy gingiva and 12% had periodontal pockets. Pain perception and dental anxiety was present in the participants. The participants experienced very little pain (6.75 ± 10.65) during periodontal probing. The overall anxiety score was 13.37 ± 1.81. There was a very weak correlation between the VAS Scores and the anxiety scores of the participants. CONCLUSION: This study concludes that pain perception and anxiety are low during periodontal probing. There was no correlation between bleeding on probing with pain and anxiety among the people visiting community oral health programmes of BPKIHS.

Prevalence of Dental Fear among 6-15 Years Old School Children.

INTRODUCTION: Odontophobia or dental fear is a "unique phobia with special psychosomatic components that impact on the dental health of the odontophobia persons". It is well documented that dental fear has a significant impact on dental care utilization behaviors. The objective of this study was to find out the level of dental fear among school children studying in government schools of Dharan, Nepal. METHODS: A descriptive cross-sectional study was conducted from March to August 2017 among 215 school going children of Dharan of age group 6 to 15 years. Ethical approval was obtained. Children studying in six different government schools of Dharan were selected using two stage cluster sampling method. The Children's Fear Survey Schedule-Dental Subscale was used to measure dental fear among the study group. Data were entered in Microsoft Excel Sheet 2007 and analyzed in Statistical Package of Social Sciences 11.5. RESULTS: This study showed that among the total study population, 96 (44.7%) had high fear, 62 (28.8%) had moderate fear and 57 (26.5%) had low dental fear. Among males, 29 (34.5%) had high fear whereas more than half of the female respondents had high fear. CONCLUSIONS: The present study showed that most of the school going children had high fear of dental treatment. So, school health programs should be planned to make the children familiar to dentistry and proper treatment modalities should be provided to make the child comfortable to seek dental care.

Prevalence of Oral Habits of Schoolchildren in the Mixed Dentition in Dharan, Nepal.

Purpose: To determine the prevalence of oral habits in the mixed dentition of schoolchildren in Dharan, Nepal and compare this prevalence between sexes, races, and age.
Methods: A cross-sectional study was conducted among 830 schoolchildren of 10 randomly selected schools in Dharan. The presence or absence of oral habits was determined using a structured questionnaire, and an oral examination of the children was carried out under natural light. A chi-square test was used to compare the association of oral habits with age, sex and race.
Results: The most prevalent oral habit was tongue thrusting (39.6 percent), while the habit of biting objects was the least prevalent (0.8 percent). Mouth-breathing was statistically significant for sex (P = 0.010), whereas biting objects (P = 0.035) and self-inflicting habits (P = 0.005) were statistically significant for race. Lip sucking (P ≤0.001) and lip-biting habits (P = 0.001) were statistically significant for age.
Conclusion: These findings highlight the importance of periodic screenings and timely referral for the early detection of oral habits and its associated effect on the developing occlusion.

Fluoride Level in Drinking Water Sources of Eastern Nepal.

BACKGROUND: Water is essential for the survival of every living organism of this planet, we humans being no exception to this fact. In context of oral health promotion, fluoride when consumed in recommended level decreases the solubility of enamel to acidic exposure and improves the strength of dental enamel that eventually helps reduce dental caries.So, this study was conducted to estimate the fluoride concentration in drinking water of eastern development region Nepal. METHODS: Water samples (165) were randomly collected from drinking water sources of Eastern Development Region, Nepal. Three categories of water samples (municipal, natural, packaged bottle water) each from three most populated cities of every district in the region were collected. The water samples were collected in autoclaved polypropylene plastic vessels. American Public Health Association 4500 F- D method was used for fluoride estimation. RESULTS: Majority of the water samples (88.2%) had fluoride concentration below the optimum as per WHO guideline. Median fluoride concentration of municipal water supply, natural water resources and packaged bottle water was 0.09 ppm (<0.05 to 1.11 ppm), 0.13 ppm (<0.05 to 1.80 ppm) and 0.05ppm (<0.05 ppm to 0.78 ppm) respectively. Median fluoride concentration of Himalayan region, hill region and terai region was 0.17 ppm, 0.10 ppm and 0.07 ppm respectively. Overall median fluoride concentration of eastern development region Nepal was 0.08 ppm (<0.05 pmm to 1.80 ppm). CONCLUSIONS: This study illustrated that fluoride concentration of most of the drinking water resources of eastern Nepal was below the recommended optimum level as per WHO guidelines.

Translation and validation of the Nepalese version of the Geriatric Oral Health Assessment Index.

OBJECTIVE: To translate and validate the Geriatric Oral Health Assessment Index (GOHAI) (Nepali version) from original English version. BACKGROUND: Growing numbers of elderly people have problems in different aspects of oral health increasing the demand for dental care services among them GOHAI may be one of the effective means of gathering information on oral health problems of the elderly people. MATERIALS AND METHODS: A total of 168 individuals ≥60 years from seven old-age homes located in Eastern Nepal were included in the study. The Nepali version of GOHAI was translated and validated. RESULTS: A total of 168 elderly people (79 male and 89 female participants) completed GOHAI questionnaire. The mean age (±SD) of the participants was 72.49 (±10.00) years. The mean GOHAI score (±SD) was 42.29 (±6.93) and ranged from 17 to 59. Cronbach's alpha coefficient for the Nepali version of GOHAI (GOHAI-N) was 0.74, which is categorised as very good agreement. Analysis of discriminant validity showed that lower mean GOHAI score was seen in study participants with more number of missing and decayed teeth. However, those who had more than one filled surface had higher mean GOHAI score. CONCLUSION: The Nepali version of the GOHAI exhibited acceptable reliability and validity when used for older people residing in old age homes. The GOHAI-N showed good consistency and homogeneity among the items.

Effectiveness of Herbal Mouthwash among Visually Impaired Residential School Students.

INTRODUCTION: Visually impaired patients are unable to visualize the plaque on tooth surfaces resulting in inadequate plaque removal and therefore the progression of dental caries and inflammatory disease of the periodontium. The objective of the study was to assess the effectiveness of herbal mouth wash in reduction of plaque and gingivitis among visually impaired children. METHODS: Randomized controlled clinical trial was conducted with parallel groups study, comprising 6 to 20 year old visually impaired children, 20 in each group (herbal mouth wash or chlorhexidine mouthwash or placebo mouthwash). Plaque and gingival index were recorded at baseline and at the end of the study. Children were asked to use the mouth wash twice daily for two weeks. Analysis was done using Chi-square test for categorical data and Mann-Whitney U test/independent t-test and one way analysis of variance/Kruskal-wallis H test for quantitative data. The level of significance was set at P<0.05. RESULTS: Participants showed fair oral hygiene (mean plaque scores of 1.14±0.53) and moderate gingivitis (mean gingival scores of 1.12±0.45) with no significant difference between three groups (P=0.47 and 0.84, respectively). Significant reduction of plaque and gingivitis was seen at follow-up with no significant difference between herbal and chlorhexidine mouthwash. However, significant difference was found between placebo and herbal/chlorhexidine mouthwash. CONCLUSIONS: Herbal mouthwash showed significant effect on reducing plaque formation and gingivitis in visually impaired students. The effectiveness of herbal mouthwash was analogous to the gold standard chlorhexidine.

Amelogenesis Imperfecta: A Case Series from the Community.

Amelogenesis Imperfecta is a hereditary disorder affecting the formation of enamel structure. Two female children and one male (11 years, 12 years and 6 years respectively) reported with chief complaint of yellowish discoloration of teeth since their childhood. They reported that they had similar discoloration in their deciduous teeth. Clinical examination showed generalized deposits of plaque and calculus, yellowish discoloration of the teeth with chipping off of the incisal and cuspal enamel structures. OPG revealed thin lining of enamel with thick dentin layer and pulp chamber. PA view revealed unfused anterior fontanels and lateral cephalogram indicated vertebrae in growing phase. The patients were instructed to maintain proper oral hygiene and regular follow up till the growth cessation. Permanent skeletal, functional, esthetic needs is addressed after growth completion. Oral rehabilitation through multidisciplinary approach can certainly provide a good prognosis and patients were counselled and motivated to maintain good oral hygiene. Keywords: Amelogenesis Imperfecta; esthetic; yellowish discoloration.

Evaluation of Dental Caries Among Preschool Children in Kathmandu-Using Significant Caries Index.

INTRODUCTION: Dental caries among preschool children is common but there is scarcity of updated data about its prevalence among Nepalese preschool children. This study was conducted to evaluate prevalence, Significant Caries Index, Caries pattern, Restorative care index and Disparity ratio among preschool children of Kathmandu aged 3-6 years. METHODS: A cross sectional study was conducted on 17 preschools of Kathmandu following WHO criteria. Data were analysed using SPSS 20 and descriptive statistics was applied. RESULTS: Prevalence of dental caries was 803 (55.6%) with a mean deft of 3.28±3.581 and Significant Caries Index score was 7.439. Caries pattern showed the most commonly decayed teeth were mandibular second molars followed by maxillary central incisors. The least affected teeth were mandibular lateral incisors. The restorative care index was 106 (7.32%) in the total sample size and 14 (2.86%) in the SiC and disparity ratio was 2.26. CONCLUSIONS: The SiC Index indicated high dental caries prevalence; severity rates and restorative care index indicated little experience of restorative treatment in preschool children of Kathmandu identifying the need for more targeted efforts to reach preschool children early to effectively address unmet oral health needs.