The clinical association between Periodontitis and COVID-19.

OBJECTIVES: The study aimed to clinically assess the association between periodontitis and COVID-19-related outcomes. MATERIAL AND METHODS: Data pertaining to patient demographics, medical history, blood parameters, periodontal clinical examination and aMMP-8 point-of-care diagnostics (both site-level and patient-level) was recorded for eighty-two COVID-19-positive patients. COVID-19-related outcomes such as COVID-19 pneumonia, death/survival, types of hospital admission and need of assisted ventilation were also assessed. RESULTS: Males were predominantly afflicted with COVID-19, with advanced age exhibiting a greater association with the presence of periodontitis. Higher severity of periodontitis led to 7.45 odds of requiring assisted ventilation, 36.52 odds of hospital admission, 14.58 odds of being deceased and 4.42 odds of COVID-19-related pneumonia. The aMMP-8 mouthrinse kit was slightly more sensitive but less specific than aMMP-8 site-specific tests. CONCLUSIONS: Based on the findings of the present study, periodontitis seems to be related to poorer COVID-19-related outcomes. However, within the constraints of this work, a direct causality may not be established. Periodontitis, by means of skewing the systemic condition for a number of comorbidities, may eventually influence COVID-19 outcomes in an indirect manner. CLINICAL RELEVANCE: The study is the first to clinically, and by means of a validated point-of-care diagnostic methodology, assess the association between periodontal health and COVID-19-related outcomes. Assessment of the periodontal status of individuals can aid in the identification of risk groups during the pandemic along with reinforcing the need to maintain oral hygiene and seeking periodontal care.

A Cross-sectional Study to assess the Perception of Psychosocial Elements among Pediatric Patients visiting Dental Clinics.

INTRODUCTION: Children with high dental fear and perception usually encounter high prevalence of dental caries. Data showed that individuals with dental fear will probably defer dental appointments which may result in the formation of a setup of an endless loop of dental fear. Present study was aimed to assess different psycho-social parameters among pediatric patients visiting dental clinics. MATERIALS AND METHODS: In the present cross-sectional study, the data of 200 schoolchildren were collected and analyzed by means of a questionnaire. Evaluation of the oral health status was done by experienced pedodontists. All the answers were recorded and analyzed by Statistical Package for the Social Sciences (SPSS) software. RESULTS: Nearly 120 were regular attendees while remaining 80 were found to be irregular attendees. Significant difference was observed while comparing the decayed, missing, and filled teeth (DMFT) index, decayed teeth, dental fear, cognitive vulnerability, and dental prevention belief between the regular and irregular group. Significant correlation was observed between higher number of decayed teeth and increasing level of dental fear. CONCLUSION: Various psychosocial parameters, by affecting the dental visits, are associated with outcome of oral health measures. CLINICAL SIGNIFICANCE: Special attention should be paid to the pediatric patients with such kind of behavior so that their psy-chosocial attitude could be modified in favor of dental treatment.

Shock absorption ability of laminate mouth guards in two different malocclusions using fiber Bragg grating (FBG) sensor.

PURPOSE: The majority of orofacial injuries affect the upper jaw, with the maxillary incisors being most prone to injury, often accounting for as many as 80% of all cases. Children with malocclusion in the anterior segment of the maxilla are more prone to traumatic injuries than those exhibiting normal occlusion, because most often the damaging force impacts directly against the maxillary anterior teeth. Hence, because of the difference of dissipation of the impact force because of the presence or absence of malocclusion, the mouthguard's shock absorption capacity would be influenced by certain factors. In the present study, a unique in vitro experiment utilizing fiber Bragg Grating (FBG) as distributed strain sensors was carried out to evaluate the shock absorption ability of laminate customized mouthguards in two different malocclusions compared with normal occlusion. MATERIAL AND METHODS: The impact was produced using a customized pendulum device with three interchangeable impact objects on typhodont models with two different malocclusions and normal occlusion from different heights. Response of gratings was monitored using an optical spectrum analyzer. Strain induced because each impact was determined from the Bragg's wavelength shifts for each grating. For every model, 12 impact strikes were measured using three different impact objects on the two specified sites by releasing the object from two different heights. RESULTS AND CONCLUSIONS: The laminated mouthguards showed significant variation in shock absorption ability when different malocclusions were compared. Hence, modifications in the original design of the laminated mouthguards should be considered for athletic competitors with malocclusion to provide adequate protection against impact. FBG sensor has shown the unique advantage of high sensitivity to strain measurement and can be used in further studies. The height of the impact is an important variable in determining the shock absorption ability of mouthguards.

Validation of a noninvasive aMMP-8 point-of-care diagnostic methodology in COVID-19 patients with periodontal disease.

OBJECTIVES: The aim of this study was to validate an active matrix metalloproteinase (MMP-8) point-of-care diagnostic tool in COVID-19 patients with periodontal disease. SUBJECTS, MATERIALS, AND METHODS: Seventy-two COVID-19-positive and 30 COVID-19-negative subjects were enrolled in the study. Demographic data were recorded, periodontal examination carried out, and chairside tests run for evaluating the expression of active MMP-8 (aMMP-8) in the site with maximum periodontal breakdown via gingival crevicular fluid sampling as well as via a mouth rinse-based kit for general disease activity. In COVID-19-positive patients, the kits were run again once the patients turned COVID-19 negative. RESULTS: The overall (n = 102) sensitivity/specificity of the mouthrinse-based kits to detect periodontal disease was 79.41%/36.76% and that of site-specific kits was 64.71%/55.88% while adjusting for age, gender, and smoking status increased the sensitivity and specificity (82.35%/76.47% and 73.53%/88.24, respectively). Receiver operating characteristic (ROC) analysis for the adjusted model revealed very good area under the ROC curve 0.746-0.869 (p < .001) and 0.740-0.872 (p < .001) (the aMMP-8 mouth rinse and site-specific kits, respectively). No statistically significant difference was observed in the distribution of results of aMMP-8 mouth rinse test (p = .302) and aMMP-8 site-specific test (p = .189) once the subjects recovered from COVID-19. CONCLUSIONS: The findings of the present study support the aMMP-8 point-of-care testing (PoCT) kits as screening tools for periodontitis in COVID-19 patients. The overall screening accuracy can be further increased by utilizing adjunctively risk factors of periodontitis. The reported noninvasive, user-friendly, and objective PoCT diagnostic methodology may provide a way of stratifying risk groups, deciding upon referrals, and in the institution of diligent oral hygiene regimens.

Fiber Bragg grating sensor for measurement of impact absorption capability of mouthguards.

BACKGROUND: There is no standard technique to monitor impact absorption capability of mouthguards. Earlier investigations have established that strain transferred to the teeth through mouthguard is a good indication of their efficiency. In the present study, a unique experimental scheme utilizing fiber Bragg gratings (FBGs) as distributed strain sensors is proposed and investigated to estimate impact absorption capability of custom-made mouthguard. The proposed methodology is useful due to advantages such as, very small size and flexibility for ease of bonding, self-referencing, and multiplexing capability of using FBG sensors. MATERIAL AND METHODS: Finite-element analysis was performed to simulate the stress distribution due to impact on the mouthguard. The FBGs were fabricated by exposing the core of photosensitive fiber to intense Ultra-Violet light through a 'phase mask'. One FBG sensor was bonded on the jaw model and another on the mouthguard surface at similar positions, so that both gratings are simultaneously affected by impact. Two different sets of the sensors were used, one for the anterior region and another for posterior region. The impact was produced using customized pendulum device with interchangeable impact objects i.e. cricket ball, hockey ball, and steel ball. Response of gratings was monitored using optical spectrum analyzer and strain induced due to each impact was determined from the Bragg wavelength shifts for each grating. RESULTS AND CONCLUSIONS: Strain induced due to impact was calculated from the Bragg wavelength shifts. Difference in the strain values for the two gratings is interpreted as impact energy absorbed by the mouthguard. The Bragg wavelength shifts (induced strain) for FBG bonded on the jaw model was much lower than the shift for FBG bonded on the mouthguard, indicating that most of the impact energy is absorbed by the mouthguard.

Buccal swabs as non-invasive specimens for detection of severe acute respiratory syndrome coronavirus-2.

INTRODUCTION: The current gold standard for detection of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) RNA involves subjecting nasopharyngeal or oropharyngeal swabs to reverse transcription quantitative PCR (RT-qPCR). However, both sample types need to be collected by trained professionals. Using self-collected buccal swabs as an alternative could simplify and accelerate diagnosis of coronavirus disease 2019 (COVID-19). OBJECTIVE: To assess self-collected buccal swab samples as an alternative method for SARS-CoV-2 detection in patients with COVID-19. METHODS: Buccal swab samples were self-collected by 73 patients with COVID-19. Total RNA was extracted using Qiagen kits. RNA encoding the SARS-CoV-2 Env protein and human RNase P as an internal control was amplified using the TRUPCR® SARS-CoV-2 RT-qPCR kit version 2.1 and a Bio-Rad CFX96 Real-Time Detection System. RESULT: The sensitivity of RT-qPCR from buccal swabs was 58.9% (43/73; 95% confidence interval [CI] 46.77%-70.27%) and that of RT-qPCR from saliva was 62.90% (39/62; 95% CI 49.69%-74.84%) taking positive SARS-CoV-2 RT-qPCR from nasopharyngeal swabs as the gold standard. CONCLUSION: Self-collected buccal swabs are promising alternatives to nasopharyngeal or oropharyngeal swabs for SARS CoV-2 detection.

Cyanoacrylate therapy for the treatment of gastric varices: a new method.

OBJECTIVE: Cyanoacrylate (CYA) injection is recommended for bleeding gastric varices (GV) but with significant adverse effects. Transesophageal endoscopic ultrasound-guided therapy of large GV with a combined coil and CYA injection has shown promising results. However, it is expensive and requires technical expertise. In this study, we aimed to compare the safety and efficacy of a new method with UCYA [undiluated CYA (UCYA) followed by lipiodol-diluated CYA (DCYA)] in the management of large bleeding GV. METHODS: Fifteen consecutive patients with bleeding from large GV (>1 cm) were prospectively treated with DCYA and another 15 patients treated with UCYA retrospectively. All patients in the DCYA group underwent thoracic computed tomography scan to identify glue embolism. RESULTS: Baseline characteristics were similar between the two groups. Rates of GV obliteration and rebleeding were 100% vs 93.3% (P = 0.309) and 6.7% vs 33.3% (P = 0.06) in the DCYA and UCYA groups, respectively. One patient in the UCYA group had needle fixation which led to fatal bleeding after forceful needle extraction. In DCYA group none had glue embolism. CONCLUSIONS: Both UCYA and DCYA are effective in treating bleeding from large GV. DCYA has lower rebleeding rates and tends to have fewer adverse events than UCYA injection, although the differences are not statistically significant. Large-sample-sized prospective randomized trials are required.

Forensic revolution need maintenance of dental records of patients by the dentists: A descriptive study.

OBJECTIVES: With the growth of forensic odontology, dental records have become an essential source of information, especially for medicolegal cases in general practice. It is mandated by the law that every dentist must keep some kind of records for every patient they treat. After the death of an individual, remnants of teeth are usually damaged at the last among all body parts. Dental records assist in personal identification in cases of mass disasters, criminal investigations, and medicolegal issues. However, in India, rules for maintaining dental records are not very strictly followed. Thus, the aim of this study was to evaluate the knowledge regarding the maintenance of dental records among dentists in Punjab and Uttar Pradesh. MATERIALS AND METHODS: Data collection was performed via a questionnaire. The study population responded to the questions pertaining to knowledge regarding forensic odontology methods and the mode of maintaining dental records in their regular practice through a personal interview. A descriptive analysis was carried out for the data. The data were summarized and analyzed using the statistical software Statistical Package for the Social Sciences (SPSS) version 18.0. RESULTS: A very low percentage (22%) of the dentists were seen to be maintaining records on a regular basis. Seventy-eight percent of the dentists were not maintaining any records. CONCLUSION: This study clearly indicates that the dentists in Punjab and Uttar Pradesh need to be properly trained for any kind of forensic and medicolegal needs.