Patients' Readiness Towards Teledentistry in the Malaysian Urban Population Attending an Undergraduate Teaching University.

Introduction: COVID-19 disease has resulted in suspension of all nonurgent routine dental treatments. In view of COVID-19 situation, social distancing, movement restriction orders, and affected health care systems, there is an urgent need to resume and deliver oral health care remotely. Hence, alternative means of dental care should be available for both patients and dentists. Therefore, this study aims to assess patients' readiness for teledentistry in Malaysian urban population attending an undergraduate teaching university. Methods: A cross-sectional study was conducted among 631 adult patients visiting the Faculty of Dentistry, SEGi University, from January 2020 to May 2021 in Selangor, Malaysia. A validated, self-administered, 5-point Likert scale online questionnaire comprising five domains was administered. (1) Patients' demographics and dental history, (2) patients' access to teledentistry, (3) patients' understanding towards teledentistry, (4) patients' willingness, and (5) barriers in using teledentistry were used to collect the required information. Results: Six hundred and thirty-one (n = 631) participants responded to the questionnaire. Ninety percent of patients were able to connect to Wi-Fi services independently and 77% participants were comfortable using online communication platforms. Seventy-one percent of the participants agreed that video and telephone clinics can reduce chances of infection rather than face-to-face consultation during the pandemic. Fifty-five percent of patients felt that virtual clinics would save time and 60% thought it could reduce travelling costs. Fifty-one percent showed their willingness to use video or telephone clinics when implemented at onsite clinics. Conclusion: Our study shows the readiness of patients to accept teledentistry as an alternative method of oral care if appropriate training and education are provided. The results of this study have prompted an increase in patients' education and shown a need to train clinicians and patients to integrate this technology at SEGi University. This might facilitate unhindered dental consultation and care in all situations.

Degradation effects of dietary solvents on microhardness and inorganic elements of computer-aided design/computer-aided manufacturing dental composites.

BACKGROUND: Computer-aided design/computer-aided manufacturing (CAD/CAM) dental composites were introduced with superior mechanical properties than conventional dental composites. However, little is known on effects of dietary solvents on microhardness or inorganic elemental composition of CAD/CAM composites. OBJECTIVES: The objectives of this study were to evaluate the degradation effects of each dietary solvent on the microhardness of the different CAD/CAM dental composites and to observe the degradation effects of dietary solvent on the inorganic elements of the dental composites investigated. METHODS: Fifty specimens with dimensions 12 mm x 14 mm x 1.5 mm were prepared for direct composite (Filtek Z350 XT [FZ]), indirect composite (Shofu Ceramage [CM]), and three CAD/CAM composites (Lava Ultimate [LU], Cerasmart [CS], and Vita Enamic [VE]). The specimens were randomly divided into 5 groups (n = 10) and conditioned for 1-week at 37°C in the following: air (control), distilled water, 0.02 N citric acid, 0.02 N lactic acid and 50% ethanol-water solution. Subsequently, the specimens were subjected to microhardness test (KHN) using Knoop hardness indenter. Air (control) and representative postconditioning specimens with the lowest mean KHN value for each material were analyzed using energy dispersive X-ray spectroscopy (EDX). Statistical analysis was done using one-way ANOVA and post hoc Bonferroni test at a significance level of p = 0.05. RESULTS: Mean KHN values ranged from 39.7 ± 2.7 kg/mm2 for FZ conditioned in 50% ethanol-water solution to 79.2 ± 3.4 kg/mm2 for VE conditioned in air (control). With exception to LU, significant differences were observed between materials and dietary solvents for other dental composites investigated. EDX showed stable peaks of the inorganic elements between air (control) and representative postconditioning specimens. CONCLUSIONS: The microhardness of dental composites was significantly affected by dietary solvents, except for one CAD/CAM composite [LU]. However, no changes were observed in the inorganic elemental composition of dental composites between air (control) and 1-week postconditioning.

Calcium Silicate-Based Cements as Root Canal Medicament.

PURPOSE: This study aims to retard the setting reaction of CSC by mixing it with 2% chlorhexidine gel (CHX) which will be used as an intracanal medicament, and to evaluate the removal of the experimental medicaments from the root canal. MATERIALS AND METHODS: White Portland cement, white ProRoot MTA and Biodentine were mixed with 2% CHX. The setting time, flowability and film thickness of the CSC/CHX mixture (experimental medicaments) were assessed and measured following the standards of ISO specification. Calcium ion release was measured using ICP-OES, while pH was tested using a pH meter. Moreover, twenty single-rooted teeth were filled with the experimental medicaments for seven days, then the medicaments were removed and the samples analyzed using SEM. Calcium hydroxide paste was used as a control. RESULTS: The setting time of the experimental medicaments was inhibited until 84 days. The calcium ion release of the experimental medicaments was significantly higher compared to the control over the period of 14 days (P<0.001). The mean pH value was above 11.45 for all tested materials over a period of 14 days, with no significant difference between them (P<0.05). There was no significant difference in film thickness of the experimental medicaments compared to the control (P> 0.05). However, the flowability of the experimental medicaments was significantly higher than the control (P<0.05). SEM showed no significant differences in the removal of the intracanal medicaments between all the tested groups. CONCLUSION: The addition of 2% CHX to CSCs retarded or inhibited its setting reaction over a period of 84 days. The calcium ion release and flowability of these experimental medicaments was found to be better than calcium hydroxide. Removal of the intracanal medicaments from the root canal was successfully achieved in all groups. Therefore, these experimental medicaments have the potential to be used as an enhanced root canal medicament.

Heavy metals in human teeth dentine: A bio-indicator of metals exposure and environmental pollution.

With rapid urbanization and large-scale industrial activities, modern human populations are being increasingly subjected to chronic environmental heavy metal exposures. Elemental uptake in tooth dentine is a bioindicator, the uptake occurring during the formation and mineralization processes, stored to large extent over periods of many years. The uptake includes essential elements, most typically geogenic dietary sources, as well as non-essential elements arising through environmental insults. In this study, with the help of the Dental Faculty of the University of Malaya, a total of 50 separate human teeth were collected from dental patients of various ethnicity, age, gender, occupation, dietary habit, residency, etc. Analysis was conducted using inductively coupled plasma-mass spectrometry (ICP-MS), most samples indicating the presence of the following trace elements, placed in order of concentration, from least to greatest: As, Mn, Ba, Cu, Cr, Pb, Zn, Hg, Sb, Al, Sr, Sn. The concentrations have been observed to increase with age. Among the ethnic groups, the teeth of ethnic Chinese showed marginally greater metal concentrations than those of the Indians and Malays, the teeth dentine of females generally showing greater concentrations than that of males. Greater concentrations of Hg, Cu and Sn were found in molars while Pb, Sr, Sb and Zn were present in greater concentrations in incisors. With the elevated concentration levels of heavy metals in tooth dentine reflecting pollution from industrial emissions and urbanization, it is evident that human tooth dentine can provide chronological information on exposure, representing a reliable bio-indicator of environmental pollution.

Effect of operators' experience and cement space on the marginal fit of an in-office digitally produced monolithic ceramic crown system.

OBJECTIVES: To investigate the marginal accuracy of Cerec three-dimensional (3D) all-ceramic crowns, in terms of gap and overhang, and to analyze the "operators' experience" and "cement space" effects on the marginal fit. METHOD AND MATERIALS: Thirty virtual models were obtained from a metal master die by scanning by three different operators: operator 1 (novice), operator 2 (beginner), and operator 3 (expert) (n = 10). These were further divided into two subgroups of five each, based on the cement space settings: 10 µm and 20 µm. Monolithic ceramic crowns (n = 10) were designed and milled for each virtual model and subjected to marginal gap and overhang evaluation at six designated margin locations. The influence of operators' experience and cement space on the marginal fit of the crowns was assessed by performing Box tests and MANOVA (multiple analysis of variance) (α = .05). Kruskal Wallis test was also used to analyze the interactions between the operators' experience and the cement space. RESULTS: The overall mean ± SD marginal gaps and overhangs for the Cerec 3D crowns, were 154 ± 56 µm and 74 ± 74 µm for novice, 158 ± 53 µm and 86 ± 66 µm for beginner, and 155 ± 52 µm and 47 ± 76 µm for expert, respectively. The MANOVA and Kruskal Wallis tests found no significant differences (P > .05) between the operators, in terms of gap and overhang, for all cement settings. CONCLUSION: The operator experience did not seem to influence the marginal accuracy of Cerec 3D fabricated crowns.