Trends in childhood vaccination in Pakistan and associated factors; 2006-2018.

INTRODUCTION: Pakistan still has ongoing transmission of wild type polio virus. This study aims to determine changes in full vaccination with recommended Expanded Program on Immunization vaccines, including polio, by several socio-economic and demographic factors. METHODS: We used three waves of Pakistan's Demographic and Health Survey, a population-based cross-sectional study from 2006-07 (N = 1471), 2012-13 (N = 1706), and 2017-18 (N = 1549), analyzed by residence, wealth, and sociodemographic factors. Analysis was limited to children aged 12-23 months in Punjab, Sindh, Northwest Frontier Province/Khyber Pakhtunkhwa and Balochistan. Full vaccination was measured as receipt of one Bacillus Calmette-Guérin dose, one measles dose, 3 polio doses, and 3 Diphtheria-Tetanus-Pertussis doses. Odds ratios (ORs) and 95 % confidence intervals (CIs) from logistic regression were used to determine associations between undervaccination and demographic variables. RESULTS: Full vaccination coverage was 50.6 % in 2006-07, 54.7 % in 2012-13, and 68.3 % in 2017-18. In 2006-07, the odds of undervaccination were significantly higher in Sindh (OR: 1.74, 95 % CI: 1.30, 2.31) than Punjab, and disparities across province changed over time (P < 0.0001); notably, undervaccination was significantly higher in Sindh, KPK, and Balochistan than Punjab in 2017. Compared to the middle wealth quintile, the poorest had significantly higher odds of undervaccination in 2006-07 (OR: 2.58, 95 % CI: 1.76, 3.78), and this did not significantly change over time (P = 0.2168). The proportion of those with a polio birth dose increased across waves from 56.3 % in 2006-07 to 83.7 % in 2017-18; receiving three or more polio vaccine doses remained unchanged. CONCLUSION: This study showed that the proportion of fully vaccinated children in Pakistan increased across three waves. Full vaccination and administration of polio vaccine birth doses have increased recently in Pakistan. The association between undervaccination with province differed significantly across the waves, with vaccination disparities between provinces increasing. Those in the poorest wealth quintile had the greatest odds of undervaccination.

Interaction of zirconium oxide nanoparticle infiltrated resin adhesive with dentin conditioned by phosphoric acid and Er, Cr: YSGG laser.

The aim was to prepare experimental adhesive (EA) with ZrO2 nanoparticles (ZEA) and without it; and its interaction with dentin conditioned with photodynamic therapy (PDT), etch and rinse, and Er, Cr: YSGG laser (ECL). Methods consisted of the scanning electron microscope (SEM), energy dispersive X-ray (EDX), shear bond strength (SBS) failure mode, and rheological property analysis. The methods were employed to assess bond integrity; the shape of ZrO2 NPs and interfacial dentin and adhesive interaction. Ninety premolar teeth were collected and pre-bonding, conditioning of dentin was performed utilizing phosphoric acid (H3PO4), photodynamic therapy (PDT), and ER-CR-YSGG laser (ECL). The teeth were set to form bonded specimens using two adhesives EA and ZEA. The microscopic imagery of ZrO2 revealed irregular-shaped, non-edged particles. EDX analysis revealed Zr to be 75.7% whereas, O2 by weight was 25.3%. The highest SBS was demonstrated in dentin conditioned with etch and rinse and ZEA (19.05 ± 0.13 MPa). Whereas, the lowest SBS was observed in dentin surface treated with PDT and EA (12.25 ± 0.14 MPa). Most of the reported failure modes were adhesive. Rheological analysis revealed that with increasing frequencies the viscosities of adhesives were reduced. The presence of 10% ZrO by weight in adhesive improves SBS of restoration and this improvement in bond values is statistically significant compared to EA. Bond values may be influenced by surface treatment of dentin.

Assessment of Caries-Affected Dentin Adhesive Interface Treated with Contemporary Conditioning Techniques.

Objective: The aim of this study was to assess shear bond strength (SBS) and failure analysis of adhesion of composite resin (CR) to caries-affected dentin (CAD) pretreated with the Er,Cr:YSGG (ECY) laser, photodynamic therapy (PDT), and etch and rinse (ER) used for cavity disinfection. Materials and methods: Methods used in this study included scanning electron microscopy (SEM), SBS analysis, failure analysis, and digital microscopy. The methods were adopted to assess bond integrity, CAD interface, smear layer, and hybridization. Thirty human third molars assessed clinically and having scores of 4 and 5 based on International Caries Detection and Assessment System (ICDAS) criteria were inspected. Infected dentin was removed. Dentin that was hard and stained pink was categorized as CAD. Ten samples were used in each group for pretreatment of CAD. Ten samples of healthy dentin [sound dentin (SD)] were collected separately and taken as controls. Samples were divided into the following groups: group 1: SD+ER; group 2: CAD+ER; group 3: CAD+ECY; and group 4: CAD+PDT after the pretreatment bonding agent was applied and the restorative procedure was performed using CR. Results: CAD conditioned with PDT before bonding to CR demonstrated the lowest SBS values (11.22 ± 0.77 MPa), whereas the highest SBS values were observed in the SD surface treated with ER (18.25 ± 1.22 MPa). In CAD and SD pretreated with ER, majority of failure modes were cohesive failure and admixed failure, whereas in CAD pretreated with PDT and the ECY laser, the adhesive failure mode was pertinent. Conclusions: The use of the ECY laser and PDT on CAD for cavity disinfection does not have potential for application in clinical settings as it decreases bond integrity of CR. Moreover, the ER pretreatment method for CAD and SD remains the gold standard.

Dietary Factors Influencing the Caries Status of Adults in Karachi, Pakistan: Initial Findings.

Objective: The objective was to identify the relationship between the dietary factors related to increases in the number of dental caries among an adult population group. Methods: A cross-sectional study was conducted involving adult patients and their accompanying person, aged 18 years and above (n = 1730) visiting the dental outpatient department (OPD) of a public sector tertiary healthcare institute in Karachi, Pakistan. A 39-item Food Frequency Questionnaire (FFQ) was administered to the patients, followed by a dental caries assessment using Radke's WHO criteria. Caries assessment data were transformed into the DMFT Index (D = decayed, M = missing, F = filled teeth). Factor analysis (FA) was performed using Stata v. 11.0, followed by assessing the internal consistency of the FFQ. Multilogistic analysis was performed to explore the association between dental caries (cut-off = 5) and other independent variables, considering a p-value < 0.05 as significant. Results: The mean age of participants in the group was 32.65 ± 10.49 years. The number of female participants (934; 54%) was higher than male participants (796; 46%). Of the total, 951 (52%) participants were married. The internal consistency value for the FFQ, as measured by Cronbach's alpha, was 0.80. In addition to age and gender, out of four dietary patterns, only "cereals" were found to be significantly (p < 0.05) associated with increased DMFT. Conclusion: This study established that the high intake of cereals is a contributory factor to the high prevalence of dental caries among adults.

Analysis of occupational stress, burnout, and job satisfaction among dental practitioners.

BACKGROUND: Dental practitioners can be prone to stress because of the long working hours, high patient expectations, and work environment. OBJECTIVE: To investigate dimensions of occupational stress among dental practitioners leading to burnout and to model its causality with job satisfaction. METHODS: An analytical cross-sectional study was conducted for five months. A sample of 302 practicing dental practitioners was selected using the consecutive sample technique. This sample included dental practitioners working in clinical and non-clinical departments of public and private sector universities as well as those doing private general practice. A self-administered structured questionnaire based on the Work Stress Questionnaire was sent using Survey Monkey. Descriptive statistics were calculated. Spearman correlation was applied between stress scores and job satisfaction. A Chi-square test was applied to look into the association between stress levels and different categories. Univariate and multivariate analysis was performed. RESULT: The prevalence of overall occupational stress was high among dental practitioners (83.4%). Occupational stress was greatest in females (55.8%), dental practitioners in the private sector (55.7%), and general dental practitioners (GDPs) (47%). The overall prevalence of job satisfaction among dental professionals was 30%. Occupational stress was significantly associated with burnout and job dissatisfaction in dentistry. Stress levels and working hours were statistically and positively associated, whereas the association between stress levels and job satisfaction was inversely and significantly associated. CONCLUSION: The prevalence of occupational stress among dental practitioners was high and the level of job satisfaction was moderate. The model between these variables was well-fitted.

Influence of methylene blue, Riboflavin, and indocyanine green on the bond strength of caries affected dentin when bonded to resin-modified glass ionomer cement.

AIM: The present study aimed to assess the influence of methylene blue (MBP), Riboflavin, and indocyanine green (ICG) on the bond strength of caries affected dentin (CAD) when bonded to resin-modified glass ionomer cement (RMGIC). MATERIALS AND METHODS: Human third molars with caries lesions were isolated and collected scrutinized based on ICDAS criteria. The teeth were cleaned using a periodontal scaler and disinfected. All samples were positioned in polyvinyl up to the cementoenamel junction. The samples were randomly distributed into five groups based on the pretreatment regime. Samples in group 1, were pretreated with MBP; group 2, polyacrylic acid (PAA) group 3, ICG, group 4, Riboflavin photosensitizer, and group 5, 37% phosphoric acid (PA). All samples were bonded with RMGIC. 10 samples were subjected to the universal testing machine for shear bond strength (SBS) testing. Five samples from each group were placed in fuchsine dye for the microleakage assessment. Comparison of means and standard deviations (SD) of SBS and microleakage in investigated groups was performed using analysis of variance (ANOVA) and Tukey's post hoc test at a significance level (p = 0.05) RESULTS: The highest micro shear bond values were observed in group 2 (CAD conditioned with PAA) (14.26±1.67 MPa). Whereas, the lowest bond values were found in group 1 (treated with MBP) (8.82±1.08 MPa). CAD conditioned with different photosensitizers i.e., MBP, ICG, and Riboflavin before bonding to RMGIC displayed comparable bond values (8.82±1.08 MPa), (9.47±0.21 MPa), and (11.23±0.47 MPa) respectively (p>0.05). Samples conditioned with 37% PA showed significantly higher microleakage scores compared to other surface-treated groups (p<0.05). CONCLUSION: Caries-affected dentin conditioned with polyacrylic acid demonstrated low microleakage and high bond strength.

Peri-implant parameters and bone metabolic markers among water-pipe users treated with photodynamic therapy.

AIM: The study aimed to evaluate the efficacy of Mechanical debridement (MD) with and without adjunct antimicrobial photodynamic therapy (aPDT) in the treatment of peri­implantitis among waterpipe smokers (WPS) and non-smokers with peri­implantitis MATERIAL AND METHODS: Participants were stratified into two groups. Group 1: Subjects who smoked water pipes for the last 2 years with peri­implant disease were treated with aPDT adjunct to MD and group 2: Participants who did not use water pipes in the last 2 years but have periimplantitis (controls) were treated with MD only. Participants were scrutinized with peri­implantitis (PI) in one dental implant at least based on the inclusion and exclusion criteria. Using structured questionnaire information was gathered from participants. All participants underwent mechanical debridement (MD). Participants of WPS underwent antimicrobial photodynamic therapy (aPDT). Peri implant inflammatory parameters (PI, BI, PD, and CBL) were assessed in all participant at baseline, 3 months and 6 months follow-up. Periimplant sulcular fluid was collected for assessment of bone metabolic biomarkers RANK-L and OPG. For immunological and clinical peri­implant parameters analysis of variance (ANOVA) and Kruskal-Wallis test were used. For multiple comparisons, Bonferroni post hoc test was deployed. RESULTS: Clinical periodontal parameters at baseline were significantly different in the control group PI (49.8 ± 10.5), BI(46.8 ± 7.7), and PD (5.0 ± 1.8) compared to WPS PI (56.1 ± 12.0), BI (40.9 ± 8.3), and PD (5.6 ± 1.5) (p < 0.05). At 3 months follow-up after PDT, PI (19.1 ± 7.7) and PD (3.9 ± 1.4) were significantly lower in the control group compared to WPS group PI (23.5 ± 8.4) and PD (4.5 ± 1.2) (p < 0.05). Whereas, BI of control (16.3 ± 6.8) and WPS group (17.1 ± 5.3) at 3 months follow-up was comparable (p > 0.05). At six months follow up following PDT, PI (15.7 ± 5.5) and PD (3.4 ± 1.2) was significantly lower in the control group compared to participants with water piped users PI (18.6 ± 7.4) and PD (3.9 ± 1.3) (p < 0.05). No significant difference was noted in BI in both groups (p > 0.05). Participants treated with PDT adjunct to MD demonstrated significantly reduced mean RANK-L levels at both 3 and 6 months (p<0.05). CONCLUSION: aPDT adjunctive to MD improved periodontal parameters i.e., plaque index, pocket depth, and crestal bone loss along with metabolic marker RANK-L in water pipe smokers compared to non piped smokers.

Use of Photosensitizer, Glutaraldehyde, alcohol and Ultrasonics in disinfection of polished and rough surfaces of self-curing polymethyl methacrylate denture base material.

AIM: To assess the effectiveness of chemical, ultrasonic and photodynamic therapy (PDT) mediated disinfection against in-vitro biofilms colonized with C. albicans, S. oralis, and S. aureus on surfaces of PMMA (polymethylmethacrylate) denture base material. MATERIALS AND METHODS: Fifty plates of PMMA were prepared with two different surface topography (rough and polished) analyzed by profilometry. Provenance culture (ATCC) of C. albicans, S. oralis, and S. aureus were inoculated on specimens and exposed to disinfection. The disinfection included Rosebengal (RB) 5 µM activated by a red LED, 2% glutaraldehyde, 70% Isopropyl alcohol, ultrasonic disinfection, and saline solution as a control. The antimicrobial efficacy was assessed by subsequently calculating viable counts after disinfection. The data were analyzed using analysis of variance (ANOVA) and Tukey's Post Hoc test. RESULTS: The unpolished surface demonstrated the highest average surface roughness As 5.32±0.36 (µm) and root mean square roughness Rr 7.22±0.81 (µm) compared to the polished surface. Intergroup comparison demonstrated polished and rough PMMA plate disinfected with rose bengal, glutaraldehyde and alcohol-based disinfection exhibited comparable reduction against C. albicans and S. oralis CFU/mL (log10) (p>0.05). Whereas, this reduction was significantly higher on the rough and polished surface of PMMA when disinfected using ultrasounds for 30 sec (p<0.05). Rose Bengal was the most effective method of disinfection against S. aureus both on polished (0.17±0.13) and rough (0.44±0.22) denture plates (p<0.05). CONCLUSION: The ultrasonic disinfection was most effective in reducing viable microbial counts. RB mediated PDT exhibited a more substantial reduction of the colonies of S.aureus.

Evaluating the Influence of COVID-19 Among Dental Practitioners After Lockdown.

Clinical activities at dental premises after the COVID-19 lockdown period or post-COVID-19 are likely to be a challenge for all practicing dentists. To assess the impact of the COVID-19 pandemic on dentists and change in dental practice following lockdown, a total of 1150 participants were approached through online survey forms registered on www.surveys.google. A link containing details of the questionnaire and a consent form was sent to dentists through emails and social media forums. The questionnaire included 3 domains comprising of seventeen questions. The first section focused on demographics. The second section inquired about the change in dental practice, that is, clinical hours, use of PPE, type of treatment, and patient flow. The third section investigated the impact of COVID-19 on dentistry. Means, standard deviation, and percentages were calculated using descriptive statistics. Chi-square was used to find an association between different variables. The response rate was 87%. Demographic factors revealed participants aged from 20.45 to 40.55 years. The data showed around 89.6% (896) of dentists have altered their clinical working hours post lockdown and, approximately, 59.7% (597) of dentists provided only emergency treatments. 88.1% (881) of the dentists wore PPE during dental procedures. Overall, a huge negative impact of the COVID-19 pandemic was observed among practicing dentists in terms of the dental supply chain, cost, and availability of dental equipment, treatment cost, and bill payments.COVID-19 pandemic compromised dental care. Though dentists were taking precautionary measures and have changed their practice according to the guidelines provided by the ADA and World Health Organization, they were still experiencing monetary loss due to decrease patient influx post lockdown.

Comparison of adhesive bond strength among fiber reinforced post and core with different cementation techniques: In vitro study.

AIM: To investigate push-out bond strength (PBS) of fiber post to radicular dentin after using different cementation techniques. MATERIAL AND METHODS: Sixty single-rooted premolars were disinfected and cleaned by mechanical instrumentation. S1, S2, and SX were used for canal shaping and finishing of the canal was carried out using F1 and F2. This was followed by constant irrigation and smear layer removal using 17%EDTA. The canal was dried filled with gutta-percha and canal space was prepared using a peso reamer. Based on cementation techniques, samples were randomly allocated into six groups. Group 1: One-step Monoblock MC; Group 2: One-step, Monoblock MC-NA (no adhesive) GFP; Group 3: One-step, RX-MC-Monoblock; Group 4: Two-step, RX-MC; Group 5: Two-step, RX-FZ; and Group 6: Two-step RX-FZ-custom post. All specimens were mounted in polyvinyl pipes using acrylic resin up to cement enamel junction. All specimens were mounted in a universal testing machine subjected to push-out forces at a speed of 0.5 mm/min. Five samples from each group were sputter-coated with 6 nm gold thickness for 300 s at 250 mA. The coated specimens were assessed under the scanning electron microscope (SEM). Analysis of variance (ANOVA) and Tukey Kramer multiple comparisons tests were performed to compare means among groups maintaining the level of significance at (p < 0.001). RESULTS: The highest PBS was displayed in RX-MC-Monoblock (199.020 ± 21.432 MPa). Whereas, lowest PBS was found in Monoblock MC-NA (no adhesive)-GFP (76.440 ± 9.468 MPa). Among one-step groups, RX-MC Monoblock exhibited the highest PBS (199.020 ± 21.432 MPa) comparable to one-step Monoblock MC (134.28 ± 19.37 MPa) (p > 0.05). Similarly, among two-steps groups, two-step RX-MC demonstrated significantly higher PBS values than two-step RX-FZ (143.340 ± 23.68 MPa) and RX-FZ-custom post (86.90 ± 7.41 MPa) (p < 0.05). CONCLUSION: One-step RX-MC-Monoblock technique using self-adhesive cement and core foundation composite resin material multicore flow when cured simultaneously exhibited the highest bond integrity of post retention compared to other cementation technique.

Efficacy of porphyrin derivative, Chlorhexidine and PDT in the surface disinfection and roughness of Cobalt chromium alloy removable partial dentures.

AIM: The present study aimed to evaluate the effect of different cleansers and photodynamic therapy (PDT) on disinfection of Co/Cr removable partial denture colonized with C. albicans, S.aureus and S.mutans. MATERIAL AND METHODS: Twenty-five Co/Cr removable partial dentures were constructed. and inoculated by American Type Culture Collection (ATCC) of Candida albicans, S.aureus, and S.mutans in an in-vitro setup. Co/Cr removable partial dentures were randomly allocated into five groups and framework was immersed in 15 mL of contaminated culture medium broth. Based on the cleansing method, disinfected dentures in group 1 were cleansed with porphyrin derivative; group 2 was exposed to 0.12% chlorhexidine digluconate; samples in group 3 and group 4 were subjected to sodium perborate enzyme and citric acid respectively. Through a surface analyzer, the surface roughness of Co/Cr and methacrylate resin was measured in 3 different zones in micrometers before and after disinfection. Two-way ANOVA and Tukey's test was used to analyze the data. Levene test was used to assess the normal distribution of data. Significance level p< 0.05 RESULTS: The results of metal roughness displayed that Co/Cr used as an alloy did not exhibit significant difference when exposed to different chemical disinfectants and photosensitizer (p > 0.05). Similarly, surface roughness (Ra) of heat polymerized acrylic resin using cleansers and PDT demonstrated no significant difference. Intergroup comparison showed that, hematoporphyrin derivative displayed comparable cleansing property against S. aureus, C.albicans, and S. mutans compared to to 0.12% CHX digluconate (p>0.05). The intragroup comparison showed hematoporphyrin derivative and CHX were equally effective against all bacteria (p>0.05). CONCLUSION: CHX digluconate and hematoporphyrin derivative demonstrated high antimicrobial activity against S.aureus, S.mutans, and C.albicans with minimum Ra of an acrylic denture and Co/Cr metallic framework.

Influence of ER-CR-YSGG Laser and Photodynamic Therapy on the Dentin Bond Integrity of Nano-Hydroxyapatite Containing Resin Dentin Adhesive: SEM-EDX, Micro-Raman, Micro-Tensile, and FTIR Evaluation.

The study aimed to analyze the effect of the addition of nano-hydroxyapatite (nano-HA) particles on the mechanical properties of experimental adhesive (EA). Furthermore, dentin interaction of EA (without nano-HA) and EA with nano-HA (hereon referred to as HA-10%) were also investigated and equated. Methods consisting of scanning electron microscopy (SEM)-energy-dispersive X-ray spectroscopy (EDX), micro-Raman spectroscopy, micro-tensile bond strength (µTBS) test, and Fourier transform infrared (FTIR) spectroscopy were employed to study nano-HA particles shape, dentin bond strength, degree of conversion (DC), and adhesive-dentin interaction. Ninety teeth (N = 90) were collected, and pre-bonding, conditioning of dentin was performed utilizing phosphoric acid (H3PO4) etching, photodynamic therapy (PDT), and ER-CR-YSGG (ECY) laser. The teeth were set to form bonded specimens using two adhesives. Nano-HA particles were spherical-shaped, and EDX confirmed the presence of oxygen, calcium, and phosphorus. Micro-Raman spectroscopy revealed distinct phosphate and carbonate peaks for nano-HA. The µTBS test demonstrated highest values for HA-10% group on the H3PO4 conditioned dentin. The greatest DC was observed for the EA group. The addition of nano-HA-10 wt.% particles in dentin adhesive resulted in improved bond strength. The incorporation also demonstrated acceptable DC (although lower than EA group), suitable dentin interaction, and resin tag formation.

Association of Self-Perceived Psychological Stress with the Periodontal Health of Socially Deprived Women in Shelter Homes.

The present study aimed to assess the effect of self-perceived psychological stress on the periodontal health of socially deprived women. The study included three hundred and eighty-five socially deprived women residing in shelter homes. The presence of stress and its severity was assessed by using Sheldon Cohen's 10-item perceived stress scale (PSS), and periodontal health status was assessed utilizing the community periodontal index. Statistical analyses were performed using an independent sample t-test, a one-way ANOVA, the Pearson chi-Square test, and binary logistic regression. Results: A total of 385 samples were included, the majority of whom (n = 297; 72.5%) belonged to the age group of 15-30 years. There were 34 (8.8%) participants who were educated up to graduate level. A total of 47.8% of the women were found with healthy periodontal status, and 52.5% of the samples were diagnosed with major psychological stress. Half of the samples (201-52.2%) had a periodontal problem. The mean PSS was found statistically significant concerning age group, education, and psychological stress level. In the univariate logistic regression analysis, a significant association of periodontal status was observed with the age group 31-45 years [(OR = 1.76; 95% C.I (1.11-2.78)] and with a major psychological stress level [(OR = 2.60; 95% C.I (1.72-3.93)]. Psychosocial stress among socially deprived women was found to be a risk factor for periodontal disease.

Disinfection of acrylic denture resin polymer with Rose Bengal, Methylene blue and Porphyrin derivative in photodynamic therapy.

AIM: The study aimed to assess the effect of in-vitro chlorhexidine and antimicrobial photodynamic therapy (aPDT) disinfection protocols against acrylic resin specimens colonized with S. mutans, S. aureus, E. coli, and C. albicans. MATERIAL AND METHODS: Reference strains of S. mutans, S. aureus, E. coli, and C. albicans were tested. Sixteen blocks of acrylic specimens were prepared by heat-cure acrylic resin and contaminated by in-vitro biofilm growth. Specimens in group 1, group 2 and group 3 were treated with Rose Bengal (RB), methylene blue (MB) 500 mg/L and porphyrin derivative (PD) 5 ml respectively, for the sensitization of biofilms. All photosensitizers (PS) were activated by LED at different wavelength. CHX was prepared in sterile distilled water and applied for 60 s. Each contaminated specimen was sprayed on all its surfaces with the aforementioned photosensitizers and control CHX. One-way analysis of variance (ANOVA) model was used to test the effect of the treatments and Tukey multiple comparison tests to compare means OF CFU/mL (log10) for exposed E. coli, C. albicans, S aureus, and S. mutans RESULTS: Specimens treated with 0.12% CHX (control) demonstrated a significant reduction in CFU/mL (log10) for exposed E. coli; 2.04±0.07 CFU/mL, C. albicans; 2.09±0.85 CFU/mL, S aureus; 3.04±0.11 CFU/mL, and S. mutans; 2.54±0.91 CFU/mL. The intragroup comparison revealed E.coli did not exhibit a decrease in reduction CFU/mL (log10) when acrylic resin irradiated with RB 5 µm. Whereas, CFU/mL (log10) values of S.aureus; 3.62±0.68 and S.mutans; 3.41±0.13 plummeted (p<0.05). Intergroup comparison showed E.coli values to display comparable reduction when disinfected with MB 500 mg/L and 0.12% CHX; 3.16±0.34 and 2.04±0.07 CFU/mL (log10) (p<0.05). CONCLUSION: Photosensitizers (RB, MB, PD) are selective in reducing bacterial count on acrylic resin blocks. CHX was found to be effective against all bacteria E.coli, C.albicans, S.aureus, and S.mutans at a concentration of 0.12%.

Association of Dental Caries and Anthropometric Measures among Primary School Children.

Aim: This study aimed to investigate an association between dental caries status and anthropometric measures in primary school children. Methods and Materials: An analytical cross-sectional study (n = 376) was conducted among primary school children (age range = 6-9 years) registered in private schools. Non-clinical data was gathered from parents of participating children through a self-administered structured questionnaire as well as from the children through an interviewer-administered questionnaire. Clinical data included the examination of dental caries using dmft/DMFT index and anthropometric measures including calculated z-scores of height-for-age (HAZ), weight-for-age (WAZ), BMI-for-age (BAZ), and physical examination. Inferential statistics included Kruskal Wallis and linear regression for univariate and multivariate analysis respectively. Results: The proportion of dental caries in primary and secondary dentition was 67.6% and 8.2% respectively. A significant association was observed between dental caries status and HAZ, WAZ, and BAZ (p < 0.001). An inverse relation was found between low, medium, and high dental caries categories and anthropometric measures. Conclusions: In the primary dentition, dental caries were significantly and inversely related to weight-for-age, height-for-age, and BMI-for-age. Hence, it can be concluded that among the low-income population dental caries is associated with lower anthropometric outcomes in children and therefore caries management should be considered an approach impacting overall health and quality of life.

Dentin Bond Integrity of Hydroxyapatite Containing Resin Adhesive Enhanced with Graphene Oxide Nano-Particles-An SEM, EDX, Micro-Raman, and Microtensile Bond Strength Study.

The aim was to synthesize and characterize an adhesive incorporating HA and GO nanoparticles. Techniques including scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDX), micro-tensile bond strength (µTBS), and micro-Raman spectroscopy were employed to investigate bond durability, presence of nanoparticles inside adhesive, and dentin interaction. Control experimental adhesive (CEA) was synthesized with 5 wt% HA. GO particles were fabricated and added to CEA at 0.5 wt% (HA-GO-0.5%) and 2 wt% GO (HA-GO-2%). Teeth were prepared to produce bonded specimens using the three adhesive bonding agents for assessment of µTBS, with and without thermocycling (TC). The adhesives were applied twice on the dentin with a micro-brush followed by air thinning and photo-polymerization. The HA and GO nanoparticles demonstrated uniform dispersion inside adhesive. Resin tags with varying depths were observed on SEM micrographs. The EDX mapping revealed the presence of carbon (C), calcium (Ca), and phosphorus (P) in the two GO adhesives. For both TC and NTC samples, HA-GO-2% had higher µTBS and durability, followed by HA-GO-0.5%. The representative micro-Raman spectra demonstrated D and G bands for nano-GO particles containing adhesives. HA-GO-2% group demonstrated uniform diffusion in adhesive, higher µTBS, adequate durability, and comparable resin tag development to controls.

Repair strength and surface topography of lithium disilicate and hybrid resin ceramics with LLLT and photodynamic therapy in comparison to hydrofluoric acid.

AIM: The aim was to compare the repair bond strength and surface topography of lithium disilicate ceramics (LDC) and hybrid resin ceramics (HRC) using different surface conditioning treatments [low level laser therapy (LLLT), photodynamic therapy (PDT), hydrofluoric acid (HF) with silane and air abrasion (AA) and silane]. MATERIAL AND METHOD: Sixty specimens each of LDC and HRC were used. Discs were prepared for each group (6 × 2 mm), conditioned using different regimes. Specimens in group 1 and 5 were laser irradiated using Er,Cr:YSGG (ECYL), group 2 and 6 were conditioned using methylene blue photosensitizer (PDT), group 3 and 7 surface was treated with hydrofluoric acid and silane (HFA-S), group 4 and 8 conditioned with Al2O3 air abrasion and silane (AA-S). A Porcelain Repair Kit was used according to manufacturer recommendation in all samples. Peak universal bond adhesive was rubbed on ceramic surface and then bonded with composite resin. For shear bond strength testing the specimens were placed in a universal testing machine. A stereomicroscope at 40x magnification was used to analyse failure pattern. Five specimens in each group after surface treatment were evaluated for surface changes and topography using scanning electron microscopy. The mean repair bond strength was calculated using ANOVA and Tukey's post hoc test at a significance level of (p < 0.05). RESULT: The highest repair bond strength was observed in group 3 (LDC) (20.57 ± 3.58 MPa) (HFA-S), whereas, the lowest score was displayed in Group 2 (LDC) using methylene blue photosensitizer (MBPS) (12.18 ± 1.08 MPa). Similarly, in HRC the highest repair SBS was presented in group 8 (AA-S) (20.52 ± 2.51 MPa) and the lowest SBS values were exhibited by PDT treated group 6 (13.22 ± 0.62 MPa). CONCLUSION: A combination of mechanical and chemical surface treatments should be used in order to achieve adequate repair bond strength between resin composites and ceramic interface of LDC and HRC.

Influence of disinfection of caries effected dentin with different concentration of silver diamine fluoride, curcumin and Er, Cr:YSGG on adhesive bond strength to resin composite.

AIM: The aim of the study was to determine the effect of various disinfectants (CP, MB, 3.8 % SDF, 38 % SDF and ECL) on caries affected dentine (CAD) and its bond strength to composite restoration MATERIAL AND METHODS: Fifty carious mandibular teeth were collected based on the criteria of ICDAS (International Caries Detection and Assessment system). Specimens up to cement enamel junction were fixed in poly vinyl pipes. All caries molars were grinded using silicon grinding carbon disk and randomly assigned into five groups based on disinfecting regimes (n = 10). Group 1, Caries affected dentin (CAD) treated with MBP [100 mg/L]; Group 2, CAD treated with Curcumin photosensitizer (CP) [500 mg/L]; Group 3, CAD treated with 3.8 % SDF Group 4, CAD treated with 38 % SDF and group 5 sterile with Er,Cr:YSGG (ECL).Self-etch adhesive bond was smeared over the surface of all specimens followed by application of composite incrementally and light cured. Samples were debonded in a universal testing machine and shear bond strength (SBS) was noted in MegaPascal (MPa). The debonded surfaces were evaluated under stereomicroscope to determine the failure mode. For inter group comparison analysis of variance (ANOVA). Tukey HSD was applied for multiple group comparison. The significance level was kept at p < 0.05 RESULTS: The maximum bond strength was observed in group 2 CAD disinfected with CP (17.57 ± 0.85 MPa). Whereas, minimum bond strength values were presented by group 3 CAD disinfected with 38 % SDF (11.14 ± 0.29 MPa). CAD treated with MBP (14.21 ± 0.22 MPa) was comparable to group 5 (p > 0.05). Similarly, group 2 was found to be comparable to group 4 CAD disinfected with 3.8 % SDF (16.22±0.53 MPa) (p > 0.05). CONCLUSION: 3.8 % SDF and PDT with CP have shown potential to be adopted for dentin disinfection treatment without adversely affecting bond strength of CAD to composite resin.

Antimicrobial efficacy of silver diamine fluoride in comparison to photodynamic therapy and chlorhexidine on canal disinfection and bond strength to radicular dentin.

AIM: To assess the antimicrobial efficacy of Silver diamine fluoride (SDF), Sodium hypochlorite (NaOCl), Chlorhexidine (CHX) and Photodynamic therapy (PDT) in radicular dentin and subsequent bond strength of Fiber reinforced composite post (FRCP) to radicular dentin. MATERIAL AND METHODS: Forty extracted premolars were disinfected and decoronated up-to cement-o-enamel junction (CEJ). Canals were instrumented using crown-down technique, dried and filled with gutta percha. Post space was prepared with the help of peso reamers and inoculated with E. faecalis. Samples were randomly allocated into four groups based on chemical irrigation (n = 10). Group 1, canal disinfected with (PDT, MB), group 2 (5.25 % NaOCl +17 % EDTA), group 3 (3.8 % SDF) and group 4 (CHX). Specimens were tested with confocal laser scanning microscopy analysis (CLSM) to confirm the presence of E. faecalis. Fibre post were luted in root canal and sectioned at three levels (apical, middle and coronal). Push-out test was performed and failure analysis of debonded surfaces was evaluated using stereomicroscope. Live and dead cells after exposure were calculated in percentage. One-way analysis of variance (ANOVA) assessed the means and standard deviations of extrusion bond strength (EBS). Tukey multiple comparison tests was used to compare means of bond strength (p = 0.05). RESULTS: The maximum antimicrobial efficacy against E. faecalis was observed in group 2 which included canal disinfected with 5.25 % NaOCl and 17 % EDTA (64.41 ±â€¯1.22). Similarly, CHX showed lowest effectiveness as canal irrigant against E.faecalis (58.29 ±â€¯2.41). Intragroup comparison revealed highest bond strength for group 2 at all three level. Similarly, the lowest EBS was found in CHX group. Inter-group comparison confirmed comparable EBS at all root levels (apical, middle and coronal) for group 2 and group 3 (p > 0.05). CONCLUSION: Radicular dentin treated with 5.25 % NaOCl and 17 % EDTA displayed highest antimicrobial and bond strength scores. SDF and PDT can potentially be used in canal irrigation.

Management of caries affected dentin (CAD) with resin modified glass ionomer cement (RMGIC) in the presence of different caries disinfectants and photosensitizers.

AIM: To evaluate Shear bond strength (SBS) of resin modified glass ionomer cement (RMGIC) on caries affected dentin after using different cavity disinfectants i.e., chlorhexidine gluconate (CHX), Er,Cr:YSGG laser (ECYL) and photodynamic therapy (PDT). MATERIAL AND METHODS: Total 50 freshly extracted mandibular molars were obtained through non-traumatic extraction. All the samples were rooted vertically within self-cure acrylic resin blocks up to cervical level so that only coronal portion remain visible. Silicon carbide grinding discs 1200 and 600 grits was used to prepare the teeth. However affected dentin remains untouched. All samples were randomly distributed in to five groups (n = 10). Group 1: 2 % CHX, Group 2: 2 % solution of methylene blue (MB) and Diode laser, Group 3: Indocyanine green (ICGP) solution and Diode laser, Group 4: curcumin (CP) and LED curing unit, Group 5: ECYL. The specimens were then stored at a temperature of 37 °C for 24 h and 100 % humidity before specimens were placed in to universal testing machine for the SBS measurements. Failure mode examination was performed by a stereomicroscope. ANOVA test analyze inter group comparison. Tukey HSD test was used to analyze multiple group comparison. The level of significance was set at p < 0.05 value. RESULTS: Among all the groups, group 1 (control, CHX treated) demonstrated highest SBS value (18.31 ±â€¯1.06 MPa). Whereas lowest SBS was displayed by group 2 (PDT, MB) (12.31 ±â€¯0.57 MPa). Dentin disinfected with group 4 (PDT, CP) (16.86 ±â€¯0.97 MPa) and group 5 (ECYL) (17.39 ±â€¯2.26) showed comparable result to that of CHX (p > 0.05). CONCLUSIONS: Bond strength of RMGIC bonded to CHX disinfected caries affected dentin was highest among study groups. Use of MB showed lowest shear bond strength outcomes. Moreover, application of ECYL and curcumin with LED showed bond strengths comparable to CHX control.