Covid-19 Outbreak - Immediate and long-term impacts on the dental profession.

The health professions and systems have been challenged evoking heightened reactions around the globe as response to Covid-19. While most heavily impacted, the role of the dental professionals in preventing the transmission and responding to its long-term impacts on dentistry is critically important. This report, while outlining the immediate impact that the Covid-19 outbreak currently has on dental healthcare professionals, it also looks at some heavier impacts that this outbreak might have on the profession of dentistry. As such this manuscript offers some suggestions and recommendations based on personal feeling.

Mechanical properties of an experimental resin based composite containing silver nanoparticles and bioactive glass.

OBJECTIVE: To compare the elastic modulus, flexural strength, and hardness of an experimental resin based composite (RBC) with and without containing silver nanoparticles (AgNPs) and bioactive glass (BAG) with a commercially available RBC. METHODS: This study was conducted, during the period August 2016-May 2018, at the Department of Dental Materials, Peshawar Dental College, Peshawar (Pakistan) and Department of Chemistry, University of Montreal, Canada. Test specimens made in the commercial RBC acted as Group-1 (G1). An experimental RBC containing 70 wt % filler content was synthesized. It was first used as such to prepare test specimens to act as the experimental control group (G2). This RBC was then modified by adding various amounts of BAG (5%, 10% and 15%) and a fixed amount of 0.009% AgNPs to use the so modified RBCs for preparing the test specimens to belong to three groups (G3, G4 & G5). The AgNPs had been synthesized in situ by reduction of salt during photo-polymerization. Flexural strength (FS), elastic modulus (EM) and Vickers hardness were determined using universal testing machine and hardness tester respectively. Data were analyzed using one-way ANOVA and Tukey post-hoc test. RESULTS: Except for G3 restorations showing significantly lower mean FS value, the FS for those in the other groups were not significantly different (p>0.05). Elastic modulus of the experimental RBC restorations was though higher than those of the others but the difference was statistically insignificant (p>0.05). Reduced Vickers hardness values were documented for the restorations in the G4 and G5 compared to those in the G3 but again the difference was insignificant (p>0.05). Flexural strength and hardness values of the test specimens in the experimental RBCs were significantly lower than those made in the commercial hybrid RBC (p<0.05). CONCLUSION: BAG and AgNPs addition to the experimental RBC in the mentioned concentration adversely affected the tested mechanical properties.

The effect of some missing teeth on a subjects' oral health related quality of life.

OBJECTIVES: To determine the impact of missing teeth on the level of Oral Health Related Quality of Life (OHRQoL)in subjects reporting at a teaching dental hospital. METHOD: Using a structured Performa incorporating the 12-item General Oral Health Assessment Index (GOHAI) Questionnaire, and a consecutive (non-probability) sampling technique, data relating to 182 subjects fulfilling the study inclusion and exclusion criteria were collected using the method of interview and examination. Subjects responses to each of the 12 items of the GOHAI questionnaire were recorded to determine the impact of missing teeth on OHRQoL. Each of the GOHAI item had a maximum score of 5 thus giving a total of 60 as the maximum score. A high score of GOHAI indicated better ORHRQoL. The ORHRQol of subject was taken as good when the GOHAI score ranged 57-60, average when 51-56 and poor when ≤50. RESULTS: Subjects had a mean age of 35.6 ± 5.8 (S. Dev) with males as 50.5% compared to females (49.5%). The mean GOHAI score for all the subjects was 48.4 ± 8.2 as compared to the mean GOHAI score of 48.4 ± 8.2 for males and 47.6 ± 8.3 for females. The ORHRQoL was good in only 27%. A high proportion of subjects (53%) had poor OHRQoL. The number and the frontal location of the missing teeth adversely impacted OHRQoL. Missing maxillary anterior teeth had the most negative effect on OHRQoL. Missing mandibular first molar was the most common missing tooth either alone or in combination with other missing teeth among the subjects studied. The most important GOHAI items contributing to the adverse impact on the OHRQoL of the majority of subjects with some missing teeth were;often worried/concerned about dental problems and never having been pleased or happy with the look of their teeth and gum. CONCLUSION: The adverse effect of missing teeth on OHRQoL was substantial necessitating the importance of preventing the condition of missing teeth or restoring when missing and maintaining the oral health of subjects.

Common Post-fitting Complications in Tooth-supported Fixed-Fixed Design Metal-Ceramic Fixed Dental Prostheses.

OBJECTIVES: To report the frequency of common complications and their levels in metal-ceramic fixed dental prostheses (MC-FDPs). METHODS: A Descriptive Cross-sectional study was conducted at the Prosthodontics Department, Khyber College of Dentistry Peshawar from January 2011 to October 2012. Using a structured proforma, data from 139 subjects fulfilling the inclusion and exclusion criteria for the study and reporting complications in their MC- FDPs were collected using the method of interview, clinical & radiographic examination. RESULTS: Of 139 subjects (Mean age = 34+ 6.4 Years), 81 (58.3%) were males and 58 (41.7%) were females with a male to female ratio of 1.4:1. De-cementation was the most common complication (41.7%). Least common complication was secondary caries (6.5%). Level-1 complications were more prevalent (77.7%) than level-2 complications (22.3%). In 91.4% cases, complications occurred before the FDP completed their fifth-years' service life with 25.2% of these occurring within the first years' service life. CONCLUSION: Irrespective of the type of complications, level-1 complications were more common with de-cementation being the most common complication. One-quarter of all the complications occurred within the first-year service life of the FDPs highlighting concern over the quality of the provided MC-FDPs. .

Complex Fermatean fuzzy extended TOPSIS method and its applications in decision making.

The fuzzy set has its own limitations due to the membership function only. The fuzzy set does not describe the negative aspects of an object. The Fermatean fuzzy set covers the negative aspects of an object. The complex Fermatean fuzzy set is the most effective tool for handling ambiguous and uncertain information. The aim of this research work is to develop new techniques for complex decision-making based on complex Fermatean fuzzy numbers. First, we construct different aggregation operators for complex Fermatean fuzzy numbers, using Einstein t-norms. We define a series of aggregation operators named complex Fermatean fuzzy Einstein weighted average aggregation (CFFEWAA), complex Fermatean fuzzy Einstein ordered weighted average aggregation (CFFEOWAA), and complex Fermatean fuzzy Einstein hybrid average aggregation (CFFEHAA). The fundamental properties of the proposed aggregation operators are discussed here. The proposed aggregation operators are applied to the decision-making technique with the help of the score functions. We also construct different algorithms based on different aggregation operators. The extended TOPSIS method is described for the decision-making problem. We apply the proposed extended TOPSIS method to MAGDM problem "selection of an English language instructor". We also compare the proposed models with the existing models.

Polymyositis: The Comet Tail After COVID-19.

Infectious agents have been implicated in the pathogenesis of autoimmune disorders for decades. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is no exception. This became evident as the pandemic evolved. Once considered a respiratory pathogen only, SARS-CoV-2 is now linked to a variety of autoimmune rheumatic disorders such as rheumatoid arthritis, systemic lupus erythematosus, reactive arthritis, spondyloarthropathies, vasculitis, and inflammatory myopathy. Although the exact cause for muscle injury in the setting of coronavirus disease 2019 (COVID-19) is not established, autoimmune inflammatory damage is the most accepted mechanism. Moreover, SARS-CoV-2 can cause direct muscle damage and indirectly through a cytokine storm. Inflammatory polymyositis in relation to COVID-19 has seldom been reported in developing countries. Here, we report a unique case of inflammatory polymyositis in a 52-year-old lady. The patient presented with muscle weakness, generalized body aches, and fatigue occurring four months after recovering from mild COVID-19. She had muscle weakness of Medical Research Council (MRC) grade 3/5 involving the shoulders and pelvic girdle with elevated muscle enzymes. Electromyography revealed an active irritable myopathic process consistent with inflammatory polymyositis. She underwent magnetic resonance imaging-guided muscle biopsy from the right thigh which revealed findings consistent with inflammatory myopathy. She was offered prednisolone and azathioprine. After four weeks of treatment, she had a remarkable improvement in her muscle strength to MRC grade 5/5.

Effect of some curing methods on acrylic maxillary denture base fit.

The aim of this study was to investigate the fit of acrylic maxillary denture bases processed by the methods of microwave, quick-wet-heat, slow-wet-heat, and self curing. Forty stone-casts were obtained using a mould of an undercut-free acrylic resin master cast of an edentulous maxilla. Standard acrylic replicas patterns sealed on casts and randomized to four groups (10 in each) were used to make denture bases using different processing methods for each of the four groups. The resultant discrepancy of fit between the denture base and the casts were measured using a silicone wafer. Varying fit discrepancies both within and between denture base groups was observed. The proportional fit-loss in the palatal region was significantly greater than the sulcular areas for all materials tested (p < 0.05). The fit-loss observed was greater in microwave-cured bases than for other materials examined. Careful selection of appropriate denture base materials and processing technique is important when providing complete dentures for edentulous patients.

COVID-19 Outbreak and Dentistry: Guidelines and Recommendations for the Provision of Dental Healthcare Services.

After lockdown beginning from the third week of March 2020, face-to-face dentistry is gradually resuming with dental healthcare personnel feeling encouraged to safely provide treatment to the patients amid stringent infection control strategies. Having alerted to the associated infection threat, dentists will be better responding to the challenges of infection control in their clinics. Infection control strategies will follow the rapidly evolving guidelines of the local and international regulatory bodies that are relevant to this pandemic. Despite this, a concern exists as both the dental team members and the patients do not want to be the vectors for this deadly infection; and hence, the need for guidance. This article aims to inform dental healthcare professionals of the guidelines and recommendations to follow when receiving and treating patients in reopened practices. It appears that the novel coronavirus disease 2019 (COVID-19) outbreak has significantly and adversely impacted dentistry. The impacts seem to have long-term effect on the pattern of dental care; and a need for significant changes in the way dentists will provide dental care from now onwards. A wider use of tele-dentistry consultation platforms will obviously reduce the need for patients 2019; visits to dentists and dental hospitals. Key Words: COVID-19, Dentistry, Guidelines, Standards, Healthcare services.

Lumbosacral Transitional Vertebrae In Patients Visiting Tertiary Care Hospital Of Khyber Pakhtukhwa: A Radiological Study.

BACKGROUND: Lumbosacral transitional vertebra is a common anatomical variant of the spine that possibly is related to low back pain. The objective is to determine the frequency of Lumbosacral Transitional Vertebrae on lumbosacral radiographs in patients with low back pain visiting Neurosurgery OPD of Khyber Teaching Hospital Peshawar Khyber Pakhtunkhwa (KP). METHODS: This cross-sectional study was conducted on radiographs of lumbosacral spine in patients visiting for low back pain to the Neurosurgery OPD of Khyber Teaching Hospital Peshawar. A total of 300 anteroposterior (AP) and lateral lumbosacral plain radiographs were studied for the variation in lumbosacral spinal segment. The transition was classified according to the scheme used by Castellvi. RESULTS: Among a total of 300 patients, normal anatomy of lumbosacral segments was observed in 215 patients (72%). About 85 cases (28%) showed Lumbosacral Transitional Vertebrae. The relationship of vertebral variation with age and gender was not observed. With regard to morphology, 29 (34.1%) patients had Castellvi type I, 26 cases (30.5%) were observed with Castellvi type II and 12 patients (14.1%) had type III while 18 cases (21.2%) had type IV transitional morphology. CONCLUSIONS: Lumbosacral Transitional Vertebrae are commonly found in patient with low back pain. Identification of Lumbosacral Transitional Vertebrae is clinically important to prevent an intervention at an incorrect vertebral level.

Appropriateness of knowledge and practices of dentists relating to using clasps in removable partial dentures.

OBJECTIVES: To investigate the knowledge and appropriateness of practices relating to RPD clasps of dentists working in NWFP. STUDY DESIGN & SETTING: A questionnaire-based-survey conducted at the Department of Prosthodontics, Khyber College of Dentistry Peshawar. SUBJECTS & METHODS: Participant's qualifications, experience in dental practice and the proportions of practice time they devoted to RPD services were recorded. Their knowledge and practices appropriateness relating to RPD clasps were documented as responses to statements pertaining to use, design and type of clasps and problems, causes and management methods for replacing RPD clasps. RESULTS: One hundred out 153 dentists completed questionnaires. Participants were house officers (23%), dental practitioners only BDS qualified (63%), and specialists (14%). Their mean practice experience was 8.4 years with < 30% time given to RPD services. Delegation of RPD design to technicians was routine. Seventy-four percent dentists preferred wrought-wire-clasps. Circumferential and projection clasps were used by 52% and 40% respectively. Sixty-nine percent were not surveying jaw-cast with 62% not knowing correct cast-tilt for identifying undercuts for clasps. Correct amount of undercut was not known for cast-cobalt-chromium and steel-wire clasps on molars to 68% and 52% dentists respectively. Seventy-six percent and 66% were unfamiliar with using Adams and RPI design clasps respectively. Some more than half of dentists were experiencing clasp fit and clasp seating problems or their RPD eliciting the complaint of pain in abutments. Many did not know methods for adjustment or replacement of RPD clasps. CONCLUSION: Appropriateness of knowledge and practices of local dentists were considered poor. Need for enhancement of RPD clasp understanding is highlighted.

Prosthetic posterior teeth with cusps may improve patient satisfaction with complete dentures.

DATA SOURCES: The Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials, Medline, OLDMedline, Embase, Zetoc (Zetoc provides access to the British Library's electronic table of contents of approx. 20,000 current journals and 16,000 conference proceedings published per year. The database covers 1993 to date and is updated daily. It includes an e-mail alert service to enable you to keep up-to-date with relevant new articles and papers), System for Information on Grey Literature in Europe (SIGLE) (SIGLE is a bibliographic database covering European non-conventional (or 'grey') literature in the fields of pure and applied science and technology, economics, social sciences and humanities), and the Science Citation Index were used to source studies. Reference lists of identified, relevant trials and review articles were scanned. Unpublished data were sought through personal contact with experts in the field. There was no language restriction. STUDY SELECTION: Randomised controlled trials (RCT) or quasi-RCT were selected that recruited edentulous adults and compared complete dentures with different occlusal schemes, with regard to patient satisfaction and masticatory function. DATA EXTRACTION AND SYNTHESIS: The quality assessment of included trials was undertaken independently and in duplicate by two reviewers. Data were also extracted by two reviewers independently. Disagreements were discussed and a third reviewer consulted as necessary. Authors were contacted for clarification or missing information. Data were excluded until further clarification if agreement could not be reached. RESULTS: Thirteen trials were thought to be potentially relevant. Ten of these studies were subsequently excluded following further analysis. Two trials require further information from the author before being considered eligible for inclusion. Only one crossover trial (n=30), which compared lingualised teeth and zero-degree teeth, fully met the review's inclusion criteria. Twenty patients preferred the lingualised denture, five the zero-degree denture and five patients had no preference. There was a statistically significant difference in favour of the lingualised denture with an odds ratio of 10.00 (95% confidence interval, 2.04-48.96). CONCLUSIONS: There is weak evidence that it may be advantageous for dentists who provide a complete denture service to prescribe prosthetic posterior teeth with cusps, rather than cuspless teeth, to improve patient satisfaction. This conclusion may only be made tentatively until further, well-conducted trials are undertaken that compare different occlusal schemes for complete dentures.