Analysis of Fluoride Content of Different Types of Salts Used in the Indian Diet: An In Vitro Study.

Introduction Salt is an essential component of the Indian diet. Edible salt contains fluoride, and its concentration varies depending on the source and manufacturing process. This study aimed to assess the fluoride concentration of commonly available varieties of edible salts in India. Methodology This in vitro study was conducted with four different types of edible salts viz. iodized salt, rock salt, pink salt, and black salt. Two brands of each salt available in the market were procured. Fluoride estimation was conducted using the sodium 2-(parasulphophenylazo-)- 1,8-dihydroxy-3,6-naphthalene disulphonate (SPADNS) method using Fluoride High-Range Checker® HC (Hanna Equipments India Pvt. Ltd., Mumbai, India) with HI739-26 reagent. The reaction between fluoride and the reagent forms a colorless complex in the sample. The concentration is then determined from the color produced, measured in parts per million (ppm). Results Iodized salt showed the least fluoride content (12.5 ± 7.5 ppm), while it was highest for black salt (77.5 ± 19.9 ppm). There was a statistically significant difference between the study groups (p=0.009). Rock salt also showed high amounts of fluoride (40.8 ± 52.4 ppm). Conclusion Fluoride content in different types of edible salt varied, though well within the prescribed limits. This calls for nutritional labelling of fluoride to help the consumer make informed choices.

Impact of free school lunch program on nutritional status and academic outcomes among school children in India: A systematic review.

INTRODUCTION: Mid-day meal programmes (MDM) were introduced in India to improve school attendance, nutritional status and educational outcomes of school children. Numerous primary studies have examined the impact of the MDM programmes on both nutritional and educational outcomes in various settings across the country. However, synthesising the findings from these studies has been challenging. To address this gap, we conducted a systematic review to assess the effects of MDM programmes on the nutritional and academic outcomes of school children in India. METHODS: A comprehensive literature search was conducted, and relevant studies published between 1997 and 2022 were included. Two reviewers independently conducted study selection, data extraction and risk of bias assessment. The results were synthesised descriptively. RESULTS: The systematic review included 31 studies. Among them, 16 studies focused on academic outcomes, while 18 studies reported children's nutritional status. Studies on MDM Scheme (MDMS) in children show mixed results on nutritional outcomes. While some studies show marginal improvements in height and weight measurements, others show no significant improvement. Regular MDMS access improves enrollment, attendance and retention rates for children, with lower dropout rates and higher academic achievement. However, its impact on academic performance remains unclear. CONCLUSION: The MDM programme in India was effective in improving the academic achievement and a few nutritional outcomes of school children, underscoring the importance of sustaining MDM programmes in India. PROTOCOL REGISTRATION NUMBER: The review was prospectively registered in PROSPERO (CRD42023391776). Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023391776.

Challenges during implant-assisted prosthetic rehabilitation in fibula reconstructed jaws and its management: a scoping review protocol.

Introduction: Oral cancer is the sixth most prevalent cancer type worldwide. Patients are placed in a crippling predicament due to the functional and psychosocial difficulties brought on by the illness and its treatments. Both surgeons and maxillofacial prosthodontists may encounter challenges with reconstruction and therapy following cancer treatment. Over 20 years, the fibula has remained the mainstay of reconstructions for head and neck cancer. Maxillary and mandibular jaws with fibula reconstructions can use fixed or removable prosthetic rehabilitation solutions. The proposed scoping review aims to ascertain the volume and nature of evidence concerning the difficulties and corrective measures in the prosthetic rehabilitation of fibula-reconstructed head and neck cancer cases. The findings will aid in improving the prosthetic treatment care for the affected population. Materials and Methods: The Joanna Briggs Institute (JBI) scoping review protocol will be followed in developing and reporting the scoping review methodology. Methods to identify the relevant literature will involve the systematic search of databases like PubMed, Scopus, Google Scholar, Cochrane Library, and gray literature sources for pertinent articles on the subject. Only papers published in English literature will be considered for the review, and the data collection period is limited to the past 20 years. The screening process will utilize defined inclusion/exclusion criteria for Title/Abstract and Full-text screening by two independent reviewers in covidence, and a third reviewer will resolve any conflicts. The data extracted will include specific details about the participants, concept, population, study methods, challenges encountered during prosthetic rehabilitation, and their management. Inductive thematic analysis and descriptive statistics will be applied where appropriate. The narrative synthesis of the evidence will be accomplished through data extraction in a tabular format, and the results will be presented as a narrative summary.

Mechanical properties of tissue adhesives used for retaining extraoral silicone prostheses in maxillofacial defects: A systematic review.

STATEMENT OF PROBLEM: Different tissue adhesives are available for retaining extraoral silicone prostheses in maxillofacial defects. Comparative assessment of their mechanical properties will help the clinician select the right product for a specific clinical situation, but a systematic review is lacking. PURPOSE: The purpose of this systematic review was to analyze the existing data in the literature regarding 5 mechanical properties of tissue adhesives for extraoral silicone prostheses: peel strength, tensile strength, shear strength, torsional strength, and tack. MATERIAL AND METHODS: A manual and electronic search was performed in appropriate databases to identify relevant publications with specific inclusion and exclusion criteria. The retrieved studies were screened for eligibility using the title, abstract, and published full texts. To evaluate the risk of bias, a methodological quality assessment was performed using the Joanna Briggs Institute Critical Appraisal Checklists for Randomized Controlled Trials. A custom data extraction template was used, and the results pooled using descriptive methods. RESULTS: After screening, 15 articles, 5 in vitro studies, and 10 clinical studies were eligible for data extraction. In vitro studies assessed tack and peel bond strength. In contrast, clinical studies assessed peel strength, tensile strength, shear strength, and torsional strength through direct comparisons and in diverse settings. CONCLUSIONS: The assessed studies showed considerable methodological heterogeneity. When silicone-based tissue adhesives (Secure2 Medical Adhesive; Factor II, Hollister Colostomy Adhesive; Hollister Inc, Dow Corning 355 Medical adhesives; Dow Corning Europe Inc) were compared with water-based adhesives (Pros-Aide Adhesive; ADM Tronics Inc, PSA 1; Cosmedica Ltd, Daro adhesive; Factor II, Epithane-3; Daro Products), the silicone-based adhesives showed a higher peel bond strength (PBS), while double-sided medical adhesive tapes showed lower PBS. A few studies evaluated variations in the PBS as being affected by the addition of stone wool fibers, immersion in water, application of skin protective dressings and adhesive removers, application of multiple layers of adhesive, and usage of urethane liner.

Utilization of dental health services and its associated factors among adult population in Ernakulam district, Kerala, India: A mixed-method analysis.

Background: There exists a high burden of oral diseases. Yet, the utilization of oral health care remains low. Understanding how, when, and why/why not individuals utilize dental healthcare resources is essential for planning health services and developing policies as it reflects the population's oral health needs, helps allocate resources efficiently, and formulate policies that are tailored to address their needs. Objectives: To assess the utilization of dental health services and its associated factors along with barriers and facilitators among adults residing in Ernakulam district, Kerala, using the Anderson healthcare model for healthcare utilization. Methods: A mixed-method study was conducted among adults aged 18 years and above in urban and rural wards of Ernakulam district using the cluster sampling method. Univariate and multivariate analysis were used for the quantitative part, and thematic analysis was used for the qualitative aspect. The total sample size was 544. Results: The dental healthcare utilization was 15.4 ± 2.9 % among the study participants. Age and education were associated with dental healthcare utilization. The level of education, pain, and self-consciousness of oral diseases were independent predictors. Barriers identified were negative attitudes, financial restraints, and difficulty in access, while facilitators were trust in service providers, availability of services, and a positive attitude. Conclusion: Utilization was poor despite the perceived need for oral health care. This was affected by several personal and system-level facilitators and barriers.

Removable prosthetic management for tooth agenesis in the pediatric population: A systematic review of case reports and case series.

STATEMENT OF PROBLEM: Dental agenesis is a condition in which the absence of teeth causes debilitating problems, primarily in speech, mastication, and esthetics. The optimal removable prosthetic management for the condition is unclear. PURPOSE: The purpose of this systematic review was to evaluate the spectrum of removable prosthetic techniques with regard to the type of edentulism and to provide clinical guidance for practicing dentists. MATERIAL AND METHODS: An electronic and manual search was conducted in the PubMed, Scopus, and Google Scholar databases. Publications of case reports and series written in English without data restrictions that reported on removable prosthodontic management of patients with oligodontia, hypodontia, or anodontia were included. RESULTS: A total of 59 articles comprising 83 case reports were analyzed. In patients with anodontia, the most common treatment option was an acrylic resin complete denture. Hypodontia and oligodontia were commonly managed by using either a partial denture or overdenture. Irreversible hydrocolloid or alginate was the most accepted material for the preliminary impressions and elastomeric materials for definitive impressions. The tooth arrangements were modified to simulate natural dentition and improve esthetics. Modifications of conventional acrylic resin dentures have been proposed for improved denture adaptation. Good retention is essential to the long-term success of prosthetic treatment and may be achieved with a denture reline or with retention clasps. The active growth of the patients means constant maintenance, including denture renewals or repairs, emphasizing the need for long-term follow-up care. CONCLUSIONS: Prosthodontic rehabilitation at an early age has been shown to significantly impact the overall quality of life for a child with tooth agenesis.

Effectiveness of an oral health curriculum in reducing dental caries increment and improving oral hygiene behaviour among schoolchildren of Ernakulam district in Kerala, India: study protocol for a cluster randomised trial.

INTRODUCTION: Children's learning abilities suffer when their oral health is compromised. Inadequate oral health can harm children's quality of life, academic performance, and future success and achievements. Oral health problems may result in appetite loss, depression, increased inattentiveness, and distractibility from play and schoolwork, all of which can lower self-esteem and contribute to academic failure. An oral health curriculum, in addition to the standard school curriculum, may instil preventive oral hygiene behaviour in school students, enabling them to retain good oral health for the rest of their lives. Because most children attend school, the school setting is the most effective for promoting behavioural change in children. A 'health-promoting school' actively promotes health by enhancing its ability to serve as a healthy place to live, learn and work, bringing health and education together. Making every school a health-promoting school is one of the joint objectives of the WHO and UNICEF. The primary objective of this proposed study is to assess the effectiveness of an oral health curriculum intervention in reducing dental caries incidence and improving oral hygiene behaviour among high school children in grades 8-10 of the Ernakulam district in Kerala, India. If found to be effective in changing children's behaviour in a positive way, an oral health curriculum may eventually be incorporated into the school health curriculum in the future. Classroom interventions can serve as a cost-effective tool to increase children's oral health awareness. METHODS AND ANALYSIS: This protocol presents a cluster randomised trial design. It is a parallel-group comparative trial with two arms having a 1:1 distribution-groups A and B with oral health curriculum intervention from a dental professional and a schoolteacher, respectively. High schools (grades 8-10) will be selected as clusters for the trial. The minimum cluster size is 20 students per school. The total sample size is 2000 high school children. Data will be collected at three time points, including baseline, after 1 year (mid-term) and 2 years (final), respectively. The outcome measures are Decayed, Missing and Filled Teeth Index; Oral Hygiene Index-Simplified; and knowledge, attitude and behaviour. Data collection will be done by clinical oral examination and questionnaire involving oral health-related knowledge, attitude and behaviour items. ETHICS AND DISSEMINATION: Ethical approval was obtained from the Institutional Ethics Committee of Amrita Institute of Medical Sciences and Research Centre (dated 19 July 2022, no: IEC-AIMS-2022-ASD-179). TRIAL REGISTRATION NUMBER: Clinical Trial Registry of India (CTRI/2022/09/045410).

Exploring the perceived sociocultural factors in the initiation of smokeless tobacco among adolescents: a qualitative systematic review protocol.

OBJECTIVE: The objective of the review is to identify and explore the perceived sociocultural factors leading to smokeless tobacco initiation among the adolescent population. INTRODUCTION: Smokeless tobacco use is associated with oral cancer and premalignant lesions. The initiation of smokeless tobacco often occurs in adolescence, with multiple sociocultural factors facilitating the commencement of this habit. An in-depth understanding of the factors influencing smokeless tobacco uptake can assist policymakers and tobacco-control units in establishing global policies and implementing control strategies to prevent adolescents' taking up smokeless tobacco. INCLUSION CRITERIA: This review will consider qualitative studies conducted within the last 20 years on adolescent smokeless tobacco users, focusing on sociocultural factors influencing smokeless tobacco initiation. Studies involving cigarette smoking, other alternative forms of smoking, and any form of tobacco cessation intervention will be excluded. METHODS: A systematic search will be conducted in MEDLINE, Scopus, CINAHL, Embase, PsycINFO, and the Cochrane CENTRAL databases, using a 3-step search process. ProQuest Dissertations and Theses, OAIster, and Google will be searched for unpublished studies. Only studies published from January 2002 until the present and in English will be considered. Study screening, extraction, and critical appraisal will be performed by 2 independent reviewers using the standardized JBI qualitative appraisal and data extraction tools. Data synthesis will involve aggregation of the review findings to generate a set of statements based on similarity of meaning. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42021240588.

Attitude and perceptions regarding online teaching in dental undergraduate program during COVID-19 pandemic: A mixed method study.

BACKGROUND: Transformation of education to virtual mode during COVID-19 pandemic was a major challenge for a clinical specialty like dentistry. MATERIALS AND METHODS: A sequential explanatory mixed method was adopted with quantitative dominant design. A self-reported questionnaire on attitude and perceptions toward online learning were distributed among dental undergraduate students. The qualitative arm explored perceptions of online teaching among various stakeholders and thematic content analysis was performed. RESULTS: A total of 141 responses were obtained, about 21% of them felt online classes to be highly useful and 78% felt it was moderately useful. About 80% of the students were satisfied with the online education. About 40% of participants felt internet connectivity was a frequent issue. The qualitative data analysis revealed five emergent themes of lecture content and delivery, instructional control, resource management, interaction, and evaluation exploring the perceptions of various stakeholders toward online learning and provided several insights. CONCLUSION: Though online education cannot be compared to traditional education in a clinical specialty like dentistry, it does have its advantages and a portion of student learning can be conducted through this mode.

Prevalence of early childhood caries in India: A systematic review and meta-analysis.

This review was designed to assess the pooled prevalence of early childhood caries (ECC) in India. An electronic data search was done in PubMed/MEDLINE and Scopus databases in October 2020. Epidemiological surveys assessing the prevalence of ECC were included, and data on gender, geographic region, sampling strategy, feeding habits, and dmft values were extracted. The risk of bias was assessed, and a meta-analysis was performed for pooled prevalence and mean dmft values. The selection of articles, data extraction, and validity assessment were done independently by the two reviewers (ID and RV). A third reviewer (CJ) resolved any conflict between these two reviewers. A total of seventy-one studies were included for quantitative analysis. The pooled prevalence of ECC estimated from 71 studies with 69,330 participants is 46.9% (confidence interval [CI] 46.5-47.2). Males had a higher prevalence of ECC (47%, CI: 46.4-47.6,40 studies, 26,840 participants) than females (43.8%, CI: 43.2-44.2,40 studies, 24,389 participants). Region-wise analysis showed the highest number of studies (44) in southern India, with a sample size of 35,988 with a pooled prevalence of 44.6% (CI: 44-45.1). The pooled mean dmft (random effect) is 2.23 (1.97-2.48), with males having a higher proportion of 2.26 compared to 2.23 in females. The pooled prevalence of ECC was 46.9%, and the pooled mean was 2.23. The results from this study state that one in every two children in India is suffering from ECC, reflecting its public health relevance.

Effectiveness of 38% Silver Diamine Fluoride Application along with Atraumatic Restorative Treatment for Arresting Caries in Permanent Teeth When Compared to Atraumatic Restorative Treatment in Adults-Study Protocol for a Randomized Controlled Trial.

INTRODUCTION: Dental caries in the adult population that require preventive and therapeutic treatment are generally neglected in rural communities. The determination of the effectiveness of the application of 38% silver diamine fluoride (SDF) in arresting caries lesions when combined with atraumatic restorative treatment (ART) is very important, as it serves as a preventive and restorative procedure to regain the function of the permanent dentition. The assessment of optimal SDF application with ART, in comparison with ART alone, in managing cavitated carious lesions in a pragmatic setting, is the need of the hour to recommend optimal dental care, especially in rural settings which have minimal access to comprehensive dental care. METHODS AND ANALYSIS: The clinical trial will enrol 220 adults (18-65 years) with cavitated carious lesions attending the Amrita School of Dentistry in the Ernakulam district, India. This study is a randomized, controlled trial with a 1:1 allocation ratio in two parallel groups. Study arm 1 will receive 38% SDF application and ART, and study arm 2 will receive ART only. A digital radiograph will be taken immediately after restoration (baseline) as well as at the end of the 6th month for evaluation of caries arrest. The assessment of the survival of the restoration will be done on the 7th day, 30th day, and at the end of the 6th month. The final analysis would include both the tooth and person levels. ETHICS AND DISSEMINATION: This trial adheres to the principles of the Declaration of Helsinki and the guidelines of the Indian Council of Medical Research (ICMR). This study protocol has been approved by the Institutional Review Board. This trial has been registered prospectively with the Clinical Trial Registry of India (Registration No: CTRI/2021/12/038816).

Effectiveness of tea tree oil versus chlorhexidine in the treatment of periodontal diseases: a systematic review.

Background Plaque biofilm that adheres to tooth surfaces and gingiva is the main aetiology of periodontitis. Chlorhexidine (CHX) is considered as a gold standard anti-plaque and anti-gingivitis agent but it has side effects such as permanent staining of teeth and dysgeusia. Tea tree oil (TTO) is an essential oil extracted from the leaves of Melaleuca alternifolia. Many studies have reported that TTO exerts strong antibacterial, antifungal, antiviral and anti-inflammatory activities.Primary study objective The review aims to answer the question of whether TTO (intervention) is a viable alternative to CHX (comparator) for the management of gingival and periodontal disease (outcomes) in adolescents and adults (population).Methods/design The following search terms were used in PubMed, Scopus, Proquest, Web of Science, EBSCO (dentistry and open access), Cochrane database, Clinical.gov.org and ctri.nic.in to search for relevant articles: patients with periodontal disease; OR periodontitis; OR gingivitis; OR gingival inflammation; AND essential oil; OR tea tree oil; OR Melaleuca alternifolia; AND chlorhexidine; AND reduction in gingival index; OR reduction in plaque index; OR reduction in bleeding from gums. The initial check for the title and abstract screening followed by removal of duplicates in Mendeley Reference Manager (version 1.19.4) based on the inclusion and exclusion criteria were performed.Primary outcome measures Parameters such as plaque index (PI), plaque surface score, gingival index (GI), bleeding index or bleeding as measured by % of sites with bleeding on probing (BOP) or bleeding scores, papillary bleeding index (PBI), were the primary outcomes considered.Results TTO is found to be superior to CHX in reducing signs of gingival inflammation; however, CHX is superior to TTO in inhibiting plaque formation, probably due to its increased substantivity.Conclusion TTO may be used as an alternative to CHX for reduction of gingival inflammation in conjunction with efficient plaque control measures.

The effect of curcumin as an adjunct in the treatment of chronic periodontitis: A systematic review and meta-analysis.

BACKGROUND: A large number of trials has been conducted using curcumin as the main ingredient in mouth rinses, topical oral gel, subgingival irrigant, locally delivered gel and locally delivered chips to reduce gingival inflammation and probing pocket depth. However, the results of these trials vary and are debatable. OBJECTIVE: To evaluate the effectiveness of oral curcumin products as compared to the routinely used ones in reducing gingival inflammation and probing pocket depth in adults. METHODS: Electronic databases such as Pubmed/Medline and Cochrane Library and hand searching was done for randomised controlled trials (RCTs), which yielded 148 results, of which 27 RCTs compared curcumin products with routinely used ones. Meta-analysis was conducted to check for plaque reduction, gingival inflammation and pocket depth. RESULTS: 963 participants in the 27 RCT studies were considered for a systematic review. We found that for a long-term evaluation of probing pocket depth in nine studies each with 400 participants, there was a statistically significant difference in the reduction when curcumin topical gel was used as compared with the control [SMD -0.87, 95% CI: -1.31 to -0.43]. However, in the evaluation of short-term plaque and gingival scores, we found no statistically significant differences in the reduction when curcumin mouth rinse was used [SMD -0.76, 95% CI: -2.25 to 0.73] and [MD: -0.09, 95% CI: -0.29 to 0.10]. CONCLUSION: Curcumin topical and local delivery gel, mouth rinses and sub-gingival irrigants were found to be equally effective compared to the routinely used agents for reduction of plaque and gingival inflammation. Curcumin local delivery gel had greater reduction in probing pocket depth.

Association between Smokeless Tobacco Use and Risk of Periodontitis in Asian Countries: A Systematic Review and Meta-Analysis.

BACKGROUND: Individual studies conducted in Asian countries have reported higher risk of periodontitis among smokeless tobacco (SLT) users in comparison to non-users. Therefore, a systematic review was conducted to summarize the available evidence on this topic. METHODS: Prominent electronic databases were searched using pre-decided MeSH terms and keywords. Screening of titles and abstracts, full text reading, quality assessment and data extraction was done by two investigators independently. The Newcastle-Ottawa scale was used for risk of bias assessment of eligible studies. Meta-analysis was performed for four periodontal outcomes (periodontal pocket depth, loss of attachment, clinical attachment level and gingival recession). A sensitivity analysis was also performed. RESULTS: Of the 546 citations, 367 were screened for eligibility. Finally, 89 studies were shortlisted for full text reading, of which, 36 were found eligible for qualitative analysis. Most of the studies were conducted in India (n=22), were of cross-sectional design (n=33), utilized purposive sampling and 24 studies were included for meta-analysis (n=28) and done on hospital-based population (n=26). Only 13 (37.1%) studies achieved a score of more than 50% (5/10 stars) on quality assessment scale. SLT users had higher odds of greater periodontal pocket depth greater than 4 mm (OR=3.64), gingival recession (OR=1.71) and loss of attachment 4-5 mm (OR=2.83) and mean difference of 1.7 mm for Clinical Attachment Level compared to non-users. CONCLUSION: The studies included in this review suggests that SLT users have poorer periodontal health in comparison to non-users. But most of this evidence comes from cross-sectional studies. Longitudinal studies with rigorous methodology are required to support this elucidation. Registration: This systematic review protocol has been registered in PROSPERO (CRD42019122964).

Effectiveness of Silver Diammine Fluoride Applications for Dental Caries Cessation in Tribal Preschool Children in India: Study Protocol for a Randomized Controlled Trial.

INTRODUCTION: Silver Diammine Fluoride (SDF) is an emerging caries preventive treatment option that is inexpensive, safe, and easily accessible. The evidence is clear that the use of SDF at concentrations of 38% is effective for arresting caries in primary teeth. However, the determination of an optimal SDF application frequency for a cavitated lesion in pragmatic settings is warranted especially among high dental caries risk groups. Hence, the primary objective of this clinical trial is to compare the effectiveness of annual, bi-annual, and four times a year application of 38% SDF application in arresting active coronal dentinal carious lesions on primary teeth among tribal preschool children aged 2-6 years. Methods and Analysis: This study is designed as a randomized, controlled trial consisting of three parallel arms with an allocation ratio of 1:1:1. The trial will enroll 480 preschool tribal children with a cavitated carious lesion (2-6 years) attending a primary health care Centre in Wayanad district, India. Each arm will receive 38% SDF application on an annual (baseline), bi-annual (baseline and 6 months), and four times a year (baseline, 2nd, 4th, and 8th week), respectively. The analysis will be performed both at the tooth- and person-level. Ethics and Dissemination: This trial will be conducted following the principles of the Declaration of Helsinki and local guidelines (Indian Council of Medical Research). The protocol has been approved by Institutional Review Committee (IRB). This trial has been registered prospectively with the Clinical Trial Registry of India [Registration No: CTRI/2020/03/024265].

The Covid-19 uncertainty and ethical dilemmas in dental practice.

The Covid-19 pandemic has affected dental practice globally. Proximity with patients and predominance of aerosol-generating procedures has raised concerns regarding the safety of dentists and patients alike. The near-total, yet inevitable, suspension of dental practice has raised several ethical issues.

Prevalence of Tooth Mortality among Adults in India: A Systematic Review and Meta-Analysis.

Tooth loss remains a significant deterrent to oral health and adversely affects the dietary intake and nutritional status of individuals compromising their general health. It is a debilitating and irreversible condition and is considered as the "final marker of disease burden for oral health." The prevalence of tooth mortality and its causes has been studied for many years through point prevalence studies; however, there is a need to generate a national representative data. This study aimed to systematically review the available literature measuring the prevalence of tooth mortality in India. We searched the following databases for studies that had assessed the prevalence of tooth mortality in India: PubMed/Medline, PubMed Central, and Scopus. This yielded 36 studies, of which 16 eligible cross-sectional studies assessing the prevalence among those 18 years and above were included. Meta-analyses using the random-effects model were conducted for tooth mortality outcomes which stratified for different covariates such as age groups, gender, geographic region, population group, type of index, and reason for loss using MetaXL Version 5.3 Software, Netherlands developed by Dr Jan J Barendregt. Pooled prevalence was used to estimate the overall effect, with 95% confidence intervals (CI). A total of 13,662 adults participated in the 16 studies. We found that the overall prevalence of complete tooth mortality (loss of 32 teeth) was 10.7% (95% CI: 10.2%-11.2%, 16 studies, n = 2249) and partial tooth mortality (having one or more teeth) was 58.8% (95% CI: 57.9%-59.6%, 16 studies, n = 7526). Rural area adults showed twice 61% (60.5%, 95% CI: 58.9-62.1, 7 studies) than urban adults. Females had higher partial tooth mortality (48.2%%), whereas males higher complete tooth mortality (20.2%). There was higher methodological heterogeneity of included studies. Nearly 35% of adults have complete or partial tooth mortality. Greater tooth mortality indicates the burden of the prosthetic needs.

Oral health care system analysis: A case study from India.

OBJECTIVES: The health system of Kerala, India has won many accolades in having health indicators comparable to developed countries. But oral health has not received its due importance at the policy level. With the burden of oral diseases on the rise in the state, a critical introspection of the existing system is warranted. The objective of this review was to assess the oral health care system in Kerala to provide policy solutions. METHODS: This study adopted a mixed methodological approach that gathered information from the primary and secondary sources, which included health facility surveys, key informant interviews, review of published literature, and websites of governmental and non-governmental bodies. The WHO framework of health system building blocks was adapted for the assessment. RESULTS: A review of epidemiological studies conducted in Kerala suggests that the prevalence of oral diseases is high with the prevalence of dental caries at the age of 12 years ranging from 37-69%. The state has a dentist population ratio of 1:2200 which is well within the prescribed ratio by WHO (1:7500). Only 2% of dentists in Kerala work with government sector catering to 0.6 million of the approximately 33.4 million population. This point to the absence of oral care in first contact levels like primary health centers. Service delivery is chiefly through the private sector and payment for dental care is predominantly through out-of-pocket expenditure. CONCLUSION: Despite having the best health indicators, the oral health system of Kerala is deficient in many aspects. Reorientation of oral health services is required to combat the burden of diseases.

Effect of LASER therapy Vs conventional techniques on clinical and radiographic outcomes of deciduous molar pulpotomy: A systematic review and meta-analysis.

BACKGROUND: To systematically review the effectiveness primary molar pulpotomy based on the clinical and radiographic outcomes using lasers over the conventional therapies. MATERIAL AND METHODS: This systematic review and meta-analysis included Randomized or Quasi-randomized trials comparing LASER with conventional pulpotomy therapies (formocresol, ferric sulphate, MTA or calcium hydroxide) with atleast 6-month follow-up period was included. Risk of bias of included studies was assessed and metanalysis was done using RevMan software. RESULTS: Of the 1383 articles that were searched, only 14 studies were included for qualitative synthesis and 10 for meta- analysis. There was no statistically significant difference in clinical success rate [OR 0.99, 95%CI (0.19,5.22)] or radiographic success rate [OR 0.77, 95%CI (0.31,1.87)] of LASER therapy compared to Formocresol in primary molar pulpotomy for 6 months. No statistically significant difference were found in clinical success rate [OR 1.04, 95%CI (0.35,3.07)] and radiographic success rate [OR 0.71, 95%CI (0.37,1.35)] at 12 month follow-up also. Comparison of LASER with Ferric Sulphate also did not show a statistically significant difference. CONCLUSIONS: Meta-analysis showed no statistically significant difference in clinical and radiographic outcomes of LASER pulpotomy with conventional pulpotomy (formocresol and ferric sulphate) at 6 and 12 months follow-up. However, there was considerable risk of bias in the included studies. Key words:Pulp therapy, Laser, formocresol.