Probiotics in Caries Prevention.

Past few decades have seen a significant increase in the prevalence of dental caries at a global scale. To reduce the pervasiveness of cariogenic microflora, various efforts have been undertaken. However, completely eradicating caries-associated microorganisms has been futile.1 Endogenous bacteria, such as Lactobacillus species, Streptococcus mutans, and Streptococcus sobrinus persisting in biofilms ferment carbohydrate and produce weak organic acids as by-products. This, in turn, results in a drop in the local pH well below the critical level, resulting in demineralization of tooth.2.

Effect of Probiotic Streptococcus salivarius K12 and M18 Lozenges on the Cariogram Parameters of Patients With High Caries Risk: A Randomised Control Trial.

PURPOSE: To evaluate the effect of Probiotic Streptococcus Salivarius K12 and M18 Lozenges on the Cariogram (Cariogram Mobile application Version 1.3 developed by Wong Jung Ming, Faculty of Dentistry, National University of Singapore) parameters of patients with high caries risk. MATERIALS AND METHODS: Fourty-two subjects were randomly allocated to Group 1 and 2 who received BLIS K12TM and BLIS M18TM probiotics (Blis Probiotics, Dunedin, New Zealand) respectively along with oral hygiene instructions and Group 3 (control) received only oral hygiene instructions with 1:1:1 allocation ratio. Subjects were instructed to follow the instructions and use the probiotics for a period of three months. Their caries risk was assessed using Cariogram software at baseline and 30 days after the use of probiotics. Change in the chance to avoid new cavities was recorded and statistically analysed using appropriate statistical tests. RESULTS: About 38 subjects completed the trial with a drop-out count of eight. Multiple imputations were carried out for the missing data using an expectation-maximization algorithm. The mean percentage of actual chance to avoid new cavities was found to be 47.14 ± 6.837; 41.36 ± 16.04 and 32.50 ± 14.54 among the subjects in Group 1, Group 2, and Group 3 respectively. The mean percentage difference between the three groups was found to be statistically significant (p-value = 0.047). Dunn's pair-wise comparison showed a significant mean percentage difference between Group 1 (BLIS K12) and Group 3 (control) (p=0.020). CONCLUSION: It can be concluded that the use of BLIS K12TM and BLIS M18TM probiotics for three months resulted in a considerable decrease in the caries risk. Further long-term clinical trials are needed to evaluate the difference in caries risk following the use of BLIS K12TMand BLIS M18TM among different age and risk groups.

Estimating Genotypic Diversity of Streptococcus mutans Isolated From Caries-Active and Caries-Free Individuals Among Indian Population.

Purpose To identify the genetic characterization of S mutans strains isolated from the caries-free and caries-active population using arbitrarily primed -polymerase chain reaction (AP-PCR). Materials and methods Thirty-five subjects with a decayed missing and filled teeth (DMFT) score of 0 were allocated to the caries-free group and 35 subjects with a DMFT score greater than four were allocated to the caries-active group and salivary samples were collected. The samples were processed and the colony forming units (CFU) of S mutans were determined for all the samples. About three colonies resembling S mutans from each subject were subjected to deoxyribonucleic acid (DNA) isolation, a purification process was performed, and DNA was analyzed by AP-PCR. Results Among the 210 isolates from 35 caries-active and 35 caries-free subjects that were analyzed by AP-PCR, 41.9% had a single genotype, 25.8% had two genotypes, 19.4% had three genotypes, 9.7% had four genotypes and 3.2% had more than four genotypes among the caries-free group. Among the caries-active group, 54.3% had a single genotype, 25.7% had two genotypes, 14.3% had three genotypes and 5.7% had four genotypes. Conclusion The study concluded that different genotypic pattern was present in caries-free and caries-active subjects which indicate the occurrence of genetic polymorphism among the S mutans strains. There was no particular genotype of S mutans that was uniquely present in subjects in caries-active and caries-free individuals.

Evaluation of Fluoride Release in Chitosan-Modified Glass Ionomer Cements.

OBJECTIVE: This study assessed the influence of chitosan nanoparticles on the fluoride-releasing ability of 4 glass ionomer cement (GIC) through an in vitro analysis. METHODS: Four types of GIC (type II light cure universal restorative, type II universal restorative, GC Fuji VII, and type IX) were modified with nanochitosan particles; 10% chitosan was added to the glass ionomer liquid. Six specimens for each of the 4 groups were created, using expendable Teflon moulds. Discs of each type of GIC (n = 6) were immersed in deionised water at various time intervals. Electrodes selective for fluoride ions were employed to analyse the amount of released fluoride at 1, 7, 14, 21, and 28 days. RESULTS: Chitosan-modified GICs showed greater fluoride release than conventional GICs at all time points. All samples showed an initial high release of fluoride that tapered off with time. The total amount of fluoride released increased from the 1st day to the 28th day on adding chitosan to all the 4 types of GIC. Amongst those, type IX high-strength posterior extra with chitosan released a considerably higher quantity of fluoride at all time intervals. CONCLUSIONS: In all the experimental groups, adding chitosan to the glass ionomer liquid had an accelerating effect on its fluoride-releasing property.

Knowledge, attitude, and practice of Chennai school teachers on traumatic dental injuries management - A cross-sectional study.

Aim: To assess the knowledge, attitude, and practice of traumatic dental injury (TDI) management among school teachers of Chennai. Materials and Methods: Forty-seven schools were selected from various parts of Chennai for the cross-sectional survey by simple random sampling. Four hundred school teachers who participated were from 26 regular schools and 21 special schools. Questionnaire with 32 close-ended questions assessing knowledge, attitude, and practice of TDI management was devised, face validated by experts, and pilot tested. Link to the online survey questions was provided after obtaining the informed consent. Responses were analyzed using Microsoft Excel. Results: Twenty-two percent reported to have undergone first aid training and among them, 4% were trained on TDIs management. 27% had a false sense of knowledge and practice of TDIs management. 12% were confident in replanting an avulsed tooth by themselves. Ten percent were aware of using milk as a storage media. 86% were willing to learn about TDIs management. Conclusions: Within the limitations of the present study, it can be concluded that despite the lack of knowledge and practice regarding TDI management, school teachers of Chennai had a good attitude towards TDI education. Emergency management training is by itself a necessity in schools and it should be inclusive of TDI management.

Probiotic Streptococcus strains in caries prevention: A systematic review.

OBJECTIVE: The aim of this article is to review the published literature with the purpose of knowing the importance of using various probiotic Streptococcus strains as a preventive and therapeutic method for dental caries management. MATERIALS AND METHODS: Research question was formulated based on the PICO strategy. A comprehensive electronic literature search was conducted across PubMed/Medline, Scopus, and EBSCOhost databases independently by two reviewers. All papers published from 1989 to December 2017 that focused on the use of probiotic Streptococcus strains for caries prevention were included in this review. Inclusion and exclusion criteria were applied to the selected articles, and a customized data extraction sheet was formulated. The selected articles were subjected to quality assessment, and the risk of bias in selected studies was evaluated. RESULTS: A total of five articles were included. The overall risk of bias of the selected clinical trials was found to be high risk, and the overall level of evidence of the selected in vitro studies was moderate. CONCLUSION: The two included clinical studies on the use of probiotic Streptococcus strains for caries prevention had high risk of bias. Although in-vitro studies showed promising results, clinical studies have not demonstrated clear clinical outcomes. Thus, there is a vast scope for future research in this field. CLINICAL RELEVANCE: Application of oral probiotics will help reinstate a balanced microbiota and thereby improving oral health. This systematic review focused on evaluating the role played by probiotic Streptococcus strains in the carious lesion incidence.

Effectiveness of casein phosphopeptide-amorphous calcium phosphate and xylitol chewing gums on salivary pH, buffer capacity, and Streptococcus mutans levels: An interventional study.

AIM: The aim of the study is to compare the anticariogenic effectiveness of Casein phosphopeptide- Amorphous Calcium phosphate (CPP-ACP) and xylitol chewing gums based on salivary pH, buffer capacity, and Streptococcus mutans levels. MATERIALS AND METHODS: A group of twenty individuals in the age group of 18-25 years were randomly divided into two Groups A and B. Test arm A received xylitol gums and test arm B received CPP-ACP gums and they were instructed to use the gums thrice daily for 2 weeks. Unstimulated salivary samples were collected before they began the use of the gums for baseline values, 24 h after beginning the usage of chewing gums and at the end of 14 days. The samples were analyzed for pH, buffer capacity, and S. mutans levels. RESULTS: A statistically significant reduction of salivary S. mutans levels, improvement in salivary pH, and buffer capacity were displayed in both groups 24 h and 14 days after the intervention when compared with baseline. Group B showed more statistically significant improvement in pH than group A after 24 h (P = 0.028) and at the end of 2 weeks (P = 0.041). CONCLUSION: CPP-ACP has better ability than xylitol in improving the pH of saliva. Both CPP-ACP and xylitol gums individually have remarkable ability in bringing down S. mutans levels while simultaneously improving the pH and buffer of saliva.

Comparative Evaluation of Antimicrobial Efficacy of Silver Nanoparticles and 2% Chlorhexidine Gluconate When Used Alone and in Combination Assessed Using Agar Diffusion Method: An In vitro Study.

CONTEXT: Silver nanoparticle (AgNP) is a potent antimicrobial that is widely used in several fields of medicine. Chlorhexidine (CHX) gluconate is a well-known agent used in dentistry to eliminate oral microbial flora. AIMS: The aim of this study is to evaluate the efficacy of AgNPs, 2% CHX gluconate, and the combination of two solutions against endodontic pathogens such as Enterococcus faecalis, Klebsiella pneumoniae, and Candida albicans. These organisms are frequently found in the root canal space and their persistence may lead to endodontic failure. The synergistic effect of the two solutions has been evaluated in this study. The antibiotic gentamycin was taken as the control group. SETTINGS AND DESIGN: Agar well diffusion method was used and minimum inhibitory concentration of AgNP was found to be 15 µg/mL. AgNPs were synthesized from the aqueous plant extract of Cassia roxburghii. The combination of CHX-AgNP solution was stirred together by a glass rod. The values were tabulated and subjected to statistical analysis using the SPSS software version 20. One-way ANOVA test was used to compare within the groups and between groups. The level of significance was set at 5%. RESULTS: CHX-AgNP combined solution exhibited the highest efficacy in comparison to these solutions used alone. They showed the highest efficacy against C. albicans among the three organisms tested. CONCLUSION: The present study demonstrates the antimicrobial efficacy of a novel mixture of CHX-AgNP solution, and it may be developed as a promising antimicrobial agent against endodontic flora.

Prevalence of impacted permanent mandibular second molars in South Indian population: A cross-sectional study.

AIMS: The aim of this study is to retrospectively determine the prevalence of impacted second molars and associated dental and radiographic findings in South Indian population. SETTINGS AND DESIGN: Cross-sectional design. MATERIALS AND METHODS: Dental records of 4976 patients depending on the selection criteria from various dental clinics in South India were retrospectively analyzed in this study. All selected radiographs and records were examined by the two authors. The angle of impacted second molars was also recorded on panoramic radiographs. Data were tabulated and analyzed. RESULTS: The prevalence of impacted second mandibular molars was found to be 0.16%. In seven cases, the impaction was unilateral with three on the left and four on the right, and in one case, it was bilateral. The prevalence was found to be more in females than males. The angle of impaction was found to range from 19° to 80°. CONCLUSIONS: Although the prevalence of impacted second molars is low, it is crucial to diagnose early for optimal treatment.

Research experiences, attitudes, and barriers to publishing among the dental postgraduate teachers: a cross-sectional study.

INTRODUCTION: Research is important in medical and dental sciences to improve healthcare. Faculties play an important role in research productivity and student motivation in research. AIM: The aim of this paper was to assess the attitude and experiences of dental post-graduate teachers toward article writing and reading and to discuss the barriers faced by them. MATERIALS AND METHODS: A total of 150 dental post-graduate teachers from various Dental Colleges in South India participated as the study group. A questionnaire relating to publishing practices was distributed, and the results were analyzed. RESULT: Majority of the study group (82%) were involved in the publication with many (48.4%) doing so for career progression. Journal prestige was the main reason for selection of journals. Lack of time was the main reason for those not involved in the publication. CONCLUSION: This study revealed the positive attitude of teachers toward scientific reading and writing. They only require motivation and time.

Endodontic management of mandibular first molar with middle distal canal: a case report.

The knowledge of variations in root canal morphology is critical for a successful endodontic treatment. This article presents the endodontic management of a unique case of mandibular molar with middle distal canal which is quite uncommon.

Anesthetic efficacy of four percent articaine for pulpal anesthesia by using inferior alveolar nerve block and buccal infiltration techniques in patients with irreversible pulpitis: a prospective randomized double-blind clinical trial.

INTRODUCTION: The study was designed as a randomized double-blind trial to evaluate the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine in inferior alveolar nerve block (IANB) and infiltration anesthetic techniques to anesthetize mandibular molars with irreversible pulpitis. METHODS: The study was composed of 2 test arms and 1 control arm. Subjects in the test arms received either a standard IANB or a buccal infiltration (B Infil) of 4% articaine with 1:100,000 epinephrine, whereas the subjects in the control arm received a standard IANB of 2% lidocaine with 1:100,000 epinephrine. Subject's self-reported pain response was recorded on Heft Parker Visual Analogue Scale after local anesthetic administration during access preparation and pulp extirpation. RESULTS: For statistical analysis Pearson χ(2), Student's paired t test, 1-way analysis of variance, and Friedman tests showed no significant difference in success rates among the 3 arms of the trial. CONCLUSIONS: Although B Infil and IANB of 4% articaine were equally effective, B Infil can be considered a viable alterative in IANB for pulpal anesthesia in mandibular molars with irreversible pulpitis.

Contributions of Indian conservative dentists and endodontists to the Medline database during 1996-2009: A bibliometric analysis.

BACKGROUND: Analysis of publication trends will guide the policy framers, administrators, and dentists to frame future policies and design programs for the development of scientific and technological policies in the field of dentistry. AIMS AND OBJECTIVES: This study was undertaken to assess the trends in Indian Conservative dentists and endodontists' Publication in PubMed-Medline database during 1996-2009. MATERIALS AND METHODS: Using the time limitation of publication date limit of 1(st) January 1996 to 31(st) December 2009, all articles where authors' affiliation had the words Dental AND India were selected. From this collection of articles, the following were noted down: year of publication, number of authors, name of the journal, reach of the journal, status of the journal, specialty of the first, state of origin, and type of research. From this database, the performance of department of conservative dentistry and endodontics was analyzed. RESULTS: The number of articles published by conservative dentists and endodontists was 124. Among them, 63 got published in international journals and 61 in Indian journals. A majority of 33 journals were published in Indian Journal of Dental Research followed by 25 in the Journal of Conservative Dentistry. Out of these articles, 66 were on the basis of original research done by the authors. Nearly 45.2% of the published articles were from the institutes in Tamil Nadu, followed by Karnataka (30.6%), and Maharashtra (8.1%). Although the overall distribution of the publication trends seems to be constant from 1996 to 2006, there seems to be boom in the publication trend since 2007.

Mandibular first premolar with two roots and three canals.

This case report presents a relatively uncommon clinical case of a mandibular premolar with two roots and three canals. The possibility of additional root canals should be considered even in teeth with a low frequency of abnormal root canal anatomy. Sound knowledge of root canal anatomy, appropriate assessment of the pulp chamber floor, critical interpretation of radiographs and high-magnification examinations are highly desirable to achieve the best possible outcome in complicated root canal therapy.

Evaluation of the antibacterial and physical properties of glass ionomer cements containing chlorhexidine and cetrimide: an in-vitro study.

BACKGROUND: Incorporation of antibacterial agents frequently results in changes in the physical properties of restorative materials. MATERIALS AND METHODS: This in-vitro study investigated the antibacterial and physical properties of Glass ionomer cement (GIC) with chlorhexidine and cetrimide, to determine the optimal concentration, for incorporation of these agents to obtain antibacterial GICs for use with the Atraumatic restorative treatment approach. This was assessed using the agar diffusion test. Chlorhexidine diacetate and cetrimide were added to Glass ionomer cement type-IX (GIC-FUJI IX) at 1 and 2% W/W ratio. The experimental GIC specimens were placed on agar plates inoculated with Lactobacillus casei, and the area of inhibition was calculated after 48 hours. RESULTS: All the experimental GICs exhibited inhibition of bacteria, but the sizes were dependent on the concentration of the antibacterial agent. Incorporation of chlorhexidine diacetate and cetrimide, at 2%, significantly decreased the compressive strength, and the setting time was extended a little by the addition of any concentration of chlorhexidine and cetrimide. CONCLUSIONS: The present study demonstrated that experimental GICs containing chlorhexidine diacetate and cetrimide were effective in inhibiting bacteria associated with caries, and incorporation of 1% cetrimide was optimal to give the appropriate antibacterial and physical properties.

Effect of 10% sodium ascorbate on the calcium: Phosphorus ratio of enamel bleached with 35% hydrogen peroxide: an in vitro quantitative energy-dispersive X-ray analysis.

OBJECTIVES: The study assessed quantitatively the calcium and phosphorous loss from the enamel surface following bleaching with 35% hydrogen peroxide and reversal with 10% sodium ascorbate using energy-dispersive X-ray analysis (EDAX). MATERIALS AND METHODS: Eight non-carious, freshly extracted human permanent maxillary central incisors without any visible defects were used. Each specimen was bleached with 35% hydrogen peroxide activated by light and reversed with sodium ascorbate antioxidant gel. The calcium and phosphorous content in weight percent of sound, bleached and reversed enamel was acquired using EDAX. The Ca/P ratio was calculated from the obtained data. One-way ANOVA followed by Post Hoc Tukey test was used for comparing the Ca/P ratio of sound, bleached and reversed enamel. RESULTS: All the samples subjected to bleaching using 35% hydrogen peroxide showed a statistically significant decrease in the Ca/P ratio as compared with samples in which no bleaching procedure was performed (P-value < 0.01). The striking finding was that there was a significant increase in the Ca/P ratio on application of sodium ascorbate antioxidant gel when compared with the bleached enamel (P-value < 0.01). CONCLUSION: The authors concluded that 35% hydrogen peroxide causes a significant decrease in the Ca/P ratio. This decrease in the Ca/P ratio can be restored by the application of 10% sodium ascorbate antioxidant gel.

Maxillary first molar with aberrant canal configuration: a report of 3 cases.

The prognosis for endodontic treatment in teeth exhibiting morphological aberrations is unfavorable if the clinician fails to recognize extra root canals. This report demonstrates 3 clinical cases of maxillary first molars that presented 2 canals in the palatal root merging at the apical third (Vertucci's type II canal morphology), a pattern that is rare and seldom encountered.