Oral health-related quality of life after rehabilitation with maxillary obturators: A comparison of patients with maxillectomy defects associated with cancer and post-COVID-19 mucormycosis.

STATEMENT OF PROBLEM: Maxillectomy alters function and esthetics, negatively affecting oral health-related quality of life (OHRQoL). OHRQoL has been assessed after prosthetic rehabilitation in patients with maxillectomy associated with cancer. However, OHRQoL studies after prosthetic rehabilitation in patients with coronavirus disease 2019 (COVID-19) associated mucormycosis are lacking. PURPOSE: The purpose of this clinical study was to compare OHRQoL before and after rehabilitation with maxillary obturators in patients with maxillectomy defects associated with cancer and post COVID-19 mucormycosis. MATERIAL AND METHODS: The study was conducted at 2 centers. A total of 47 participants who underwent maxillectomy because of cancer were included from the first center, and 32 participants who underwent maxillectomy because of post COVID-19 associated mucormycosis of the maxilla were included from the second center. Participants were asked to rate their dental problems on a Likert scale using Oral Health Impact Profile-14 (OHIP-14) before and after prosthodontic rehabilitation. The difference between scores among groups for each item and overall score was compared by using the Wilcoxon Rank-Sum test (α=.05). A linear mixed-effects model was fitted to account for the repeated measures within individuals. A random intercept for each participant was included to account for the within-subject correlation. RESULTS: An overall improvement in the OHRQoL of participants was found in both groups. The mean total OHIP-14 score for the cancer group decreased from 24.2 at the prerehabilitation stage (Pre-R) to 9.5 at the postrehabilitation stage (Post-R). The magnitude of improvement was higher for the post COVID-19 associated mucormycosis group with a reduction in the mean total OHIP-14 score of 52.0 (Pre-R) to 6.5 (Post-R). The mean change in OHIP-14 scores after rehabilitation was 15 (95% CI 10-19) in the cancer group but significantly larger at 45 (95% CI 41-49) in the mucormycosis group. The P value for the mean total OHIP-14 score at Pre-R was <.001 and at Post-R was.031. The interaction term between groups and time was significant, indicating different effects between groups with time. CONCLUSIONS: Comparison of the OHRQoL after rehabilitation with prostheses among patients with cancer and post COVID-19 associated mucormycosis showed that the OHRQoL scores, although much higher among patients with mucormycosis before rehabilitation (compared with patients with cancer), were almost similar after rehabilitation.

Oral manifestations, risk factors and management strategies of COVID-19 associated mucormycosis in tertiary care hospital.

Background: Mucormycosis (black fungus) is an aggressive, life-threatening infectious disease-causing infiltration and by destroying the surrounding bone and soft tissue through vascular thrombosis and subsequent tissue infarction that may reach the brain with fatal complications. Its outbreak has been assessed around the clock during the recent pandemic as post COVID-19 sequelae. Aims: To assess the risk factors, oral signs and symptoms, investigations, treatment and rehabilitation strategies amongst COVID-19 associated mucormycosis patients in a tertiary care hospital. Methods and Material: An observational, pilot study was carried out amongst 30 active or recent COVID-19 associated mucormycosis patients reporting in the Department of Dentistry of a tertiary care hospital in Bhopal over a period of 6 months. Statistical analysis was done using Kolmogorov-Smirnov test using the Statistical Package for Social Sciences, Version 16 software. Results: Study was done on 30 patients (80% males and 20% females) and their median age was 46 years. Predominant risk factor present was diabetes mellitus (90%) and steroid therapy (60%). Prime oral manifestations were toothache (90%), mobile teeth (83%), draining sinus (53%), palatal ulceration (43%) and para-sinusal pain (37%). Conclusions: Mucormycosis can cause serious oro-facial morbidity and mortality in COVID-19 patients. The current management strategy requires early diagnosis, prompt treatment and oral rehabilitation.

Maxillary defects due to COVID-19 associated mucormycosis: Impact on quality of life after rehabilitation with an obturator.

STATEMENT OF PROBLEM: Aggressive surgical debridement including maxillectomy in patients with coronavirus disease 2019 (COVID-19) associated mucormycosis of the maxilla alters facial appearance, function, and an individual's overall quality of life (QOL). These patients require rehabilitation of defects with obturators to help them recover from esthetic and functional disabilities and regain near-normal quality of life. Because COVID-19 associated with mucormycosis is a newer entity, less is known about the quality of life of these patients after rehabilitation with obturators. Hence, the effects of COVID-19 associated with mucormycosis, treatment, and rehabilitation need to be evaluated to assess QOL. PURPOSE: The purpose of this clinical study was to assess the impact on QOL after rehabilitation with obturators for participants with COVID-19-associated mucormycosis who underwent maxillectomy. MATERIAL AND METHODS: Oral health impact profile-14 (OHIP-14) and obturator functioning scale (OFS) questionnaires were administered to 26 participants with COVID-19-associated mucormycosis of the maxilla who underwent maxillectomy and required rehabilitation with obturators. Questionnaire responses were received on numerical Likert scales of 0 to 4 for OHIP-14 and 1 to 5 for OFS. The repeated measures analysis of variance (ANOVA) with pairwise post hoc Bonferroni tests were used to evaluate and compare mean scores of OHIP-14 and OFS at different preoperative and postoperative stages (α=.05). RESULTS: A total of 26 participants who underwent maxillectomy were provided with obturators. A higher mean ±standard deviation OHIP score was observed before rehabilitation at T1 (51.0 ±9.6) followed by 1 week after fabrication of the surgical obturator at T2 (18.6 ±16.4), and 1 week after fabrication of the interim obturator at T3 (4.7 ±8.2). The lower mean scores ±standard deviation were seen 1 week after the fabrication of definitive obturators at T4 (2.9 ±7.2). Comparison of the scores at T1, T2, T3, and T4 found significant difference (P≤.001). Similarly, higher mean ±standard deviation OFS scores were seen 1 week after rehabilitation with surgical obturators at T2 (27.3 ±12.6) and at least 1 week after fabrication with definitive obturators at T4 (15.7 ±5.6). A comparison of the scores at T2, T3, and T4 found significant differences (P≤.001). CONCLUSIONS: Considerable improvement was seen in QOL with the fabrication of surgical obturators in participants who had received maxillectomy/debridement for mucormycosis. This improvement had a linear relationship with the time elapsed and the consecutive fitting of the obturators with healing.

Joining of Dissimilar Al and Mg Metal Alloys by Friction Stir Welding.

In engineering applications, such as automobile, marine, aerospace, and railway, lightweight alloys of aluminum (Al) and magnesium (Mg) ensure design fitness for fuel economy, better efficiency, and overall cost reduction. Friction stir welding (FSW) for joining dissimilar materials has been considered better than the conventional fusion welding process because of metallurgical concerns. In this study, dissimilar joints were made between the AA6061 (A), AZ31B (B), and AZ91D (C) combinations based on the varying advancing side (AS) and retreating side (RS). The dissimilar joints prepared by the FSW process were further characterized by tensile testing, impact testing, corrosion testing, fracture, and statistical and cost analysis. The results revealed a maximum tensile strength of 192.39 MPa in AZ91 and AZ31B, maximum yield strength of 134.38 MPa in a combination of AA6061 and AZ91, maximum hardness of 114 Hv in AA6061 and AZ31B, and lowest corrosion rate of 7.03 mV/A in AA6061 and AZ31B. The results of the properties were supported by photomicrographic fracture analysis by scanning electron microscopy (SEM) observations. Further, the performance of dissimilar joints was statistically analyzed and prioritized for preference by similarity to the ideal solution (TOPSIS) method.

Vibration Exposure and Transmissibility on Dentist's Anatomy: A Study of Micro Motors and Air-Turbines.

The use of dental hand pieces endanger dentists to vibration exposure as they are subjected to very high amplitude and vibration frequency. This paper has envisaged a comparative analysis of vibration amplitudes and transmissibility during idling and drilling with micro motor (MM) and air-turbine (AT) hand pieces. The study aims to identify the mean difference in vibration amplitudes during idling, explore different grasp forces while drilling with irrigant injection by the dentist, and various vibration transmission of these hand pieces. The study utilized 22 separate frequency resonances on two new and eight used MMs and two new and eight used ATs of different brands by observing the investigator at 16 different dentist clinics. The study adopted a descriptive research design with non-probability sampling techniques for selecting dentists and hand pieces. Statistical methods like Levene Test of Homogeneity, Welch ANOVA, independent t-test, and Games-Howell test were utilized with SPSS version 22 and MS-Excel. The results reveal that vibration amplitudes and vibration transmissibility when measured at position 2 are higher than in another position 1. Vibrations during idling for used MMs are more than AT hand pieces, and the used MM (MUD) and used AT (AUA) hand pieces differ due to their obsolescence and over-usage. Vibration amplitudes increase every time with the tightening of grasping of the hand piece. Vibration amplitudes for each grasping style of MM hand piece differ from all other grasping styles of AT hand pieces. Routine exposure to consistent vibrations has ill physical, mental, and psychological effects on dentists. The used hand pieces more hazardous as compared to newer ones. The study suggests that these hand pieces must be replaced periodically, sufficient to break between two operations, especially after every hand piece usage. Hence, the present research work can be further extended by creating some control groups among dentists and then studying the vibration amplitude exposure of various dental hand pieces and subsequent transmissibility to their body parts.

Role of dentist in genetic counseling: A critical appraisal of the current practices and future requirements in Indian scenario.

Genetic disorders are showing an upward trend. The social and economic impact of genetic disorders on individual, family and society is enormous. There is an urgent need to explore alternate strategies to mitigate the burden of genetic disorders. This is especially true with regard to developing countries such as India where there is a shortage of health personnel adequately trained in genetic counseling at present. Dental professionals have a unique opportunity to observe the development of preadolescent and adolescent patients during periods when important growth and development changes occur. The objective of this study was to review the existing literature on the role of dentist in genetic counseling with a critical appraisal on the current practices among dentists on genetic services in India, the need, scope, and future requirements. The literature on genetic services and genetic counseling was identified by searching the biomedical databases for primary research material by one investigator over a period of 8 weeks. The articles related to dentist's role in genetic counseling were assessed and discussed in the present review. A total of 239 resource materials were retrieved in the initial search. The literature from these sources was thoroughly scrutinized by the authors, and the literature (review articles, descriptive studies, or any form of study) focusing on role of dentist in genetic counseling was finally considered for critical appraisal in the present review. The role of genetics in health and oral health care has not received due attention of the dental practitioners who otherwise are in a crucial position in identifying the patients with genetic disorders and offer requisite counseling and referral to designated genetic centers. The short training courses for practicing dentists, faculty members, and a small change in dental curriculum to make provision for teaching genetics to undergraduate students may go a long way in filling the void created by these obstacles.

Anticoagulation Management in Patients with Valve Replacement.

Background: Prosthetic valve implantation requires postoperative prophylactic anticoagulation to preclude thrombotic events. The aim of this review is to assess the role of anticoagulation therapy in the management of valve replacement patients. Methodology: Literature from PubMed, Embase, Medline and Google Scholar were searched using the terms "valvular heart disease", "anticoagulant", "mechanical heart valve", "bioprosthesis", "bridging", "Vitamin K antagonist (VKA)", and "acenocoumarol". A committee comprising leading cardiothoracic surgeons from India was convened to review the literature and suggest key practice points. Results: Prosthetic valve implantation requires postoperative prophylactic anticoagulation to preclude thrombotic events. A paramount risk of thromboembolic events is observed during the first three months after surgery for both mechanical and bioprosthetic devices. The VKA therapy with individualized target international normalized ratio (INR) is recommended in patients after prosthetic valve replacement. Therapies for the management of prosthetic valve complications should be based on the type of complications. Special care is mandated in distinguished individuals and those with various co-morbidities. Conclusion: In patients with prosthetic valve replacement, anticoagulant therapy with VKA seems to be an effective option. The role for non-VKA oral anticoagulants in the setting of prosthetic valve replacement has yet to be established. Furthermore, whether the novel oral anticoagulants are safe and efficacious in patients after placement of a bioprosthetic valve remains unanswered.

Pictorial essay: Computed tomography findings in acute aortic syndromes.

Acute aortic emergencies are life-threatening conditions that may require urgent surgical or interventional management. Imaging plays an important role in the diagnosis and planning of the management, and timely intervention helps in reducing mortality and morbidity.

Severity of illness and extra pyramidal symptoms as predictors for oral diseases among patients with schizophrenia.

OBJECTIVE: The study explores the association between severity of illness (positive, negative, depressive and cognitive symptoms) and extra pyramidal symptoms (EPS) with dental caries, periodontal disease and prosthetic needs among patients with schizophrenia. MATERIAL AND METHODS: A total of 71 schizophrenic patients diagnosed based on ICD-10 criteria participated in the study. Clinical Global Impression - Schizophrenia (CGI-SCH) scale was used to evaluate positive, negative, depressive, cognitive symptoms and overall severity of schizophrenia. Simpson-Angus Scale (SAS) was used for assessment of EPS. Dental examinations were conducted as per WHO (1997) criterion. RESULTS: Mean DMFT and CPI scores with periodontal pockets were 5.57 ± 2.12 and 2.37 ± 0.74; significant differences being noted among those with and without EPS (p < 0.001). Positive and EPS associated with dental caries with odds ratio of 5.26 (1.05, 26.2) and 8.52 (2.31, 31.4) (p < 0.001). Depressive and EPS were associated with periodontal disease with odds ratio of 4.19 (1.53, 32.5) and 5.27 (1.29, 21.5), respectively (p < 0.001). Cognitive and EPS were associated with dental prosthetic needs with odds ratio of 4.33 (1.47, 31.2) (p < 0.001) and 7.78 (1.43, 42.2), respectively (p < 0.001). CONCLUSIONS: Patients with schizophrenia had high dental caries, periodontal disease and unmet dental prosthetic needs. Severity of the schizophrenic and EPS was associated with poor oral health. Efforts need to be focused on strengthening the evidence of its association with oral health indicators through further studies including cohort investigations.

A study of the palatal rugae pattern among male female and transgender population of Bhopal city.

CONTEXT: Transgenders are highly disadvantaged people, deprived of adequate opportunities of earning a respectable living. The forensic literature has emphasized on two genders, male and female, the existence of a third gender (Transgenders) is almost negligible in the literature, and this makes it compulsive to determine their identity through forensic approaches at the time of disasters. Previous studies have demonstrated that no two palatal rugae pattern are alike in their configuration and this unique feature has led us to undertake a study to establish individual identities using palatal rugae pattern. AIMS: The purpose of this study was to compare the palatal rugae pattern among male, female, and transgender population of the Bhopal city. SETTINGS AND DESIGN: This study was cross sectional in nature and conducted on a convenience sample of 148 subjects selected from Bhopal city, Madhya Pradesh. The study involved 49 males, 51 females, and 48 eunuchs in the age range of 17 to 35 years. MATERIALS AND METHODS: Maxillary impression using alginate impression material was made and the cast was prepared using die stone on palatal area and dental stone as a base. The palatal rugae pattern was assessed on the basis of number, length, shape, direction, and unification. STATISTICAL ANALYSIS USED: One way ANOVA was used for comparing the mean values between different genders. The multiple pairwise comparisons were done with the Bonferroni post hoc correction. The statistical significance was fixed at 0.05. RESULTS: The statistically significant difference with regard to some parameters like number of rugae, fragmentary rugae, wavy rugae, curve rugae, forwardly directed, and backwardly directed rugae between transgender and other gender groups were present. CONCLUSION: The difference in the parameters of the palatal rugae pattern among the transgender population and the other gender group is attributed to be the genetic makeup and sexual dimorphism.

Assessment of oral mucosal lesions among eunuchs residing in Bhopal city, Madhya Pradesh, India: a cross-sectional study.

AIM: The present cross-sectional study following the STROBE guidelines was conducted to assess the prevalence of oral mucosal lesions among males, females, and eunuchs residing in Bhopal city, Madhya Pradesh India. MATERIALS AND METHODS: Based on convenient non-probability snowball sampling technique, all the self-identified eunuchs residing in the city of Bhopal who were present at the time of examination and who fulfilled the selection criteria were examined. A cross section of the general population (males and females) residing in the same locality where these eunuchs live was also examined. The World Health Organization (WHO) oral health assessment proforma (1997) was used to collect the information on oral mucosal lesions. All the obtained data were analyzed by using a Statistical Package for Social Sciences version 20. RESULTS: Overall prevalence of oral mucosal lesions was 127 (19.9%) among the study subjects. Fifty-nine (28.5%) eunuchs, 56 (25.7%) males, and 12 (5.6%) females were observed to have some oral mucosal lesions. Oral submucous fibrosis (6.4%), leukoplakia (5.5%), and traumatic ulceration (4.2%) were the major oral mucosal conditions observed. CONCLUSION: The information presented in this study adds to our understanding of the common oral mucosal lesions occurring in the eunuch population. Efforts to increase patient awareness of the oral effects of tobacco use and to eliminate the habit are needed to improve the oral and general health of eunuchs.

Oral health-related knowledge, attitude and practices among eunuchs (hijras) residing in Bhopal City, Madhya Pradesh, India: A cross-sectional questionnaire survey.

BACKGROUND: The current cross-sectional questionnaire survey was conducted to assess the oral health-related knowledge, attitude and practices among eunuchs (hijras) residing in Bhopal city, Madhya Pradesh, India. MATERIALS AND METHODS: Based on a convenient non-probability snow ball sampling technique, all the self-identified eunuchs residing in the city of Bhopal who were present at the time of study and who fulfilled the selection criteria were approached. A cross section of the general population was also surveyed. An interviewer-based, predesigned, structured, close-ended 18-item questionnaire that had been designed based on the primary objective of the study was used. All the obtained data were analyzed using software, Statistical Package for Social Science version 20. RESULTS: According to 188 (86.2%) males, 187 (87.4%) females and 168 (81.2%) eunuchs, good oral health can improve the general health. Most of the study participants including 211 (98.6%) females, 210 (96.3%) males and 205 (99%) eunuchs use either tooth paste or tooth powder to clean their teeth. While, a majority of eunuchs, i.e., 113 (54.6%), were having habit of chewing smokeless tobacco containing products such as betel nut, betel quid, gutkha, etc., The difference in use of tobacco products was statistically significant. CONCLUSION: The information presented in this study adds to our understanding of the common oral hygiene practices which are performed among eunuch population. Efforts to increase the awareness of oral effects of tobacco use and to eliminate the habit are needed to improve oral and general health of this population.

Comparison of anti-plaque efficacy between a low and high cost dentifrice: A short term randomized double-blind trial.

OBJECTIVE: The aim of this study was to compare the anti-plaque efficacy of a low and high cost commercially available tooth paste among 13-20 years old adolescents in a Residential Home, Bhopal, India. MATERIALS AND METHODS: The study was randomized double-blind parallel clinical trial conducted in a Residential Home, Bhopal, India. A total of 65 patients with established dental plaque and gingivitis were randomly assigned to either low cost or high cost dentifrice group for 4 weeks. The plaque and gingival scores at baseline and post-intervention were assessed and compared. Statistical analysis was performed using paired t-test and the independent sample t-test. The statistical significance was fixed at 0.05. RESULTS: Results indicated a significant reduction in plaque and gingival scores in both groups post-intervention compared with the baseline. Difference between the groups was not significant. No adverse events were reported and both the dentifrices were well-tolerated. CONCLUSION: Low cost dentifrice is equally effective to the high cost dentifrice in reducing plaque and gingival inflammation.

Cost-efficiency of indigenously fabricated mobile-portable dental unit in delivery of primary healthcare in rural India.

AIM: Innovation in primary oral healthcare delivery is a potential yet relatively unexplored area in Dental literature. AIM of the present study was to assess the economic gains that can be made by designing and operating an indigenously fabricated portable dental unit in rural areas. MATERIALS AND METHODS: Cost-efficiency was determined by comparing total revenue (number of patients treated) with total costs (direct - capital cost of fabrication; and indirect - dental materials, disposables, transport, miscellaneous) over a period of seven years (2005 to 2012). Operational efficiency of portable dental units was also compared with dental vans on various categories of performance indicators. Data analysis was based on institutional records of Rajasthan Dental College (RDC), Jaipur, India. RESULTS: RESULTS show that a total of 52,900 patients who attended 223 camps during this period were provided various primary oral healthcare services using four such portable dental units that were developed @ Rs. 24,000 ($ 417) per unit. Based on a cost-efficiency of Rs 35.53 ($ 0.65) per person, which is among the lowest reported from any part of the world, the authors conclude that indigenously fabricated portable dental units provide a cost-efficient service. The other aspects most relevant to portable equipment were ease of transportation and feasibility in domiciliary care provision. CONCLUSION: The Limitations of productivity due to time spent in setting up the unit and need for additional space/equipment was their main drawbacks vis-à-vis dental vans.

The effect of 30% ethanolic extract of Indian propolis on replica of human dentin compared against commercially available desensitizing agent: A methodological SEM study in vitro.

OBJECTIVE: This study evaluated the ability of 30% ethanolic extract of Indian propolis on dentinal tubule occlusion comparatively against CPP-ACP containing desensitizing agent GC tooth mousse. METHODOLOGY: The specimens were prepared from 30 freshly extracted sound human third molars stored in 10% formalin (pH 7.0) at a room temperature. From each specimen, a sectioned sample (5 mm length × 5 mm width × 3.5 mm depth) was obtained including the cervical area. Samples were smoothened and wet-polished with 1000- and 1200-grit aluminum oxide abrasive paper and diamond pastes, in order to stimulate the clinical aspect of hypersensitive dentin cervical surfaces. All the specimens were randomly assigned to three groups (n = 10), according to dentin surface treatments. Negative control: Untreated specimens (n = 4) and pretreated with 6% citric acid (n = 6); Test Group: 30% ethanolic extract of Indian propolis (n = 10); Positive Group: GC Tooth Mousse (n =10). All the specimens were prepared for SEM analysis. RESULTS: GC tooth mousse promoted tubule occlusion by crystal-like deposits in the lumen of the tubules. While propolis created a thin, smooth layer over dentin surface. CONCLUSION: According to the SEM analysis, both desensitizing agent were able to occlude the dentinal tubules.

Role of Ayurveda in management of oral health.

Oral diseases continue to be a major health problem world-wide. Oral health is integral to general well-being and relates to the quality-of-life that extends beyond the functions of the craniofacial complex. The standard Western medicine has had only limited success in the prevention of periodontal disease and in the treatment of a variety of oral diseases. Hence, the search for alternative products continues and natural phytochemicals isolated from plants used in traditional medicine are considered to be good alternatives to synthetic chemicals. The botanicals in the Ayurvedic material medica have been proven to be safe and effective, through several hundred to several thousand years of use. The exploration of botanicals used in traditional medicine may lead to the development of novel preventive or therapeutic strategies for oral health. The present scientific evidence based review is focused on the possible role of Ayurveda in the management of various orofacial disorders.

Effect of Two Desensitizing Agents in Reducing Dentin Hypersensitivity: An in-vivo Comparative Clinical Trial.

OBJECTIVE: A randomized, double blind, split mouth, controlled clinical trial was conducted to evaluate the effect of two desensitizing agents on reduction of Dentin Hypersensitivity (DH). MATERIAL AND METHODOLOGY: A sample of 73 teeth from 13 patients, among which at least 3 teeth had dentin hypersensitivity, was randomly allocated into 3 treatment groups: Group A: treated with 30% ethenolic extract of Indian Propolis, Group B: treated with GC tooth mousse, and Group C: treated with sterile water. A Verbal Rating Scale (VRS) was used to record the degree of hypersensitivity, based on patient's response to tactile and air blast stimuli. The baseline scores were obtained. Each intervention group received applications of their respective agents consecutively on 1(st), 7(th), 14(th) and 21(st) days. After each application, the scores were recorded. RESULTS: Both the 30% Indian Propolis and GC tooth mousse showed significant reductions in dentin hypersensitivity. CONCLUSION: GC tooth mousse was found to be significantly better in reducing the dentinal hypersensitivity as compared to Propolis and sterile water (p< 0.01).

A clinical efficacy of 30% ethenolic extract of Indian propolis and Recaldent™ in management of dentinal hypersensitivity: A comparative randomized clinical trial.

OBJECTIVE: The aim of this study is to evaluate the efficacy of 30% ethenolic extract of Indian propolis compared with Recaldent(™) (casein phosphopeptide-amorphous calcium phosphate) in reduction of dentinals hypersensitivity, a randomized, double-blind, split mouth, controlled clinical trial was conducted among the patients residing in Central Jail. MATERIALS AND METHODS: A sample of 73 teeth from 13 patients having at least three teeth with dentinal hypersensitivity (DH) were randomly allocated into three treatment groups: Group A: 30% ethenolic extract of Indian propolis, Group B: Recaldent(™), Group C: Sterile water. Verbal rating scale was used to record the degree of hypersensitivity based on patient's response to tactile and air blast stimuli. The baseline scores were obtained. Each intervention group received applications of their respective agents consecutively on 1(st), 7(th), 14(th), and 21(st) day. After each application the scores were recorded. RESULTS: Both the 30% Indian propolis and Recaldent(™) showed significant reduction in DH. CONCLUSION: Recaldent(™) was found to be significantly better in reducing the DH compared to propolis and sterile water (P < 0.01).

Effect of fluoride exposure on the intelligence of school children in Madhya Pradesh, India.

OBJECTIVE: To assess the relationship between exposure to different drinking water fluoride levels and children's intelligence in Madhya Pradesh state, India. MATERIALS AND METHODS: This cross-sectional study was conducted among 12-year-old school children of Madhya Pradesh state, India. The children were selected from low (< 1.5 parts per million) and high (≥1.5 parts per million) fluoride areas. A questionnaire was used to collect information on the children's personal characteristics, residential history, medical history, educational level of the head of the family, and socioeconomic status of the family. Levels of lead, arsenic, and iodine in the urine and the levels of fluoride in the water and urine were analyzed. The children's intelligence was measured using Raven's Standard Progressive Matrices. Data analysis was done using the chi-square, one way analysis of variance, simple linear regression, and multiple linear regression tests. P value <0.05 was considered statistically significant. RESULTS: Differences in participant's sociodemographic characteristics, urinary iodine, urinary lead, and urinary arsenic levels were statistically not significant (P>0.05). However, a statistically significant difference was observed in the urinary fluoride levels (P 0.000). Reduction in intelligence was observed with an increased water fluoride level (P 0.000). The urinary fluoride level was a significant predictor for intelligence (P 0.000). CONCLUSION: Children in endemic areas of fluorosis are at risk for impaired development of intelligence.