Prevalence and attributes of traumatic dental injuries to anterior teeth among school going children of Kolkata, India.

Background: Traumatic Dental Injuries (TDI) have emerged as a very significant public health and social problem, especially among children and adolescents. The aim of this study was to investigate the prevalence and associated risk factors of traumatic dental injuries to permanent anterior teeth in school going children of Kolkata aged 7-14 years. Method: A cross-sectional study was conducted among 3762 school going children attending various private and public schools of Kolkata aged 7-14 years. A multistage random clustering sampling technique was adopted to select the children.Type of trauma using Ellis and Davey classification of fractures along with Andresen's Epidemiological Classification of Traumatic Injuries to Anterior Teeth, including WHO codes, was used. All values were considered statistically significant at P < 0.05. Results: Prevalence of TDI to anterior teeth was found to be 9.89%. The mean age of children who presented with TDI was 11.06 ± 1.99.years. The most common place of occurrence of TDI was home. Falls were the most common causes of trauma. Children belonging to higher socioeconomic status were observed to have an increased prevalence of TDIs.The highest potential risk factor for the occurrence of trauma was a past history of trauma. Conclusion: Present study found a prevalence of 9.89%, and a very low percentage of children had received treatment.

Smart Glycopolymeric Nanoparticles for Multivalent Lectin Binding and Stimuli-Controlled Guest Release.

The synthesis and self-assembly of a polymer featuring a self-complementary supramolecular binding motif guanidiniocarbonyl pyrrole carboxylate zwitterion (GCP-zwitterion) bearing lactose moieties are reported. The GCP-zwitterion acts as a cross-linker to facilitate self-assembly of the polymeric chain into nanoparticles (NPs) at neutral pH in an aqueous medium. The formation of polymeric NPs can be controlled by addition of external stimuli (acid or base), which disfavors self-assembly of the GCP-zwitterion because of protonation or deprotonation of the GCP units in the polymer chain. The small-sized (<40 nm) NPs have a hydrophobic cavity and accessible lactose units on the outer shell for multivalent lectin binding. The multivalent interaction between NPs and the lectin peanut agglutinin was confirmed by agglutination experiments. In addition, the stimuli-responsive property of NPs was exploited for the uptake and release of a hydrophobic guest Nile red. Furthermore, the selectivity toward different cell lines (HEK 296T, HeLa, and Hep2G) was tested, and a cellular uptake of cargo-loaded NPs was found for Hep2G cells bearing the lactose-specific asialogylcoprotein receptor, whereas all other cells showed no NP interaction.

Microwave processing of a dental ceramic used in computer-aided design/computer-aided manufacturing.

Because of their favorable mechanical properties and natural esthetics, ceramics are widely used in restorative dentistry. The conventional ceramic sintering process required for their use is usually slow, however, and the equipment has an elevated energy consumption. Sintering processes that use microwaves have several advantages compared to regular sintering: shorter processing times, lower energy consumption, and the capacity for volumetric heating. The objective of this study was to test the mechanical properties of a dental ceramic used in computer-aided design/computer-aided manufacturing (CAD/CAM) after the specimens were processed with microwave hybrid sintering. Density, hardness, and bending strength were measured. When ceramic specimens were sintered with microwaves, the processing times were reduced and protocols were simplified. Hardness was improved almost 20% compared to regular sintering, and flexural strength measurements suggested that specimens were approximately 50% stronger than specimens sintered in a conventional system. Microwave hybrid sintering may preserve or improve the mechanical properties of dental ceramics designed for CAD/CAM processing systems, reducing processing and waiting times.

Evidence-based techniques to assess the performance of dental implants.

The clinical use of evidence-based medicine has been regarded as one of the most significant medical advancements of the last century. As the costs of medical care escalate, clinical decisions have to be made prudently and with a high degree of efficacy. One of the most expensive treatments in dentistry includes the use of dental implants to rehabilitate partial and fully edentulous patients. Due to the high costs of treatments and the ever increasing varieties of dental implants becoming available, the clinician is often faced with a challenging situation to decide the best prostheses for their patients. Furthermore, navigating through the vast database of literature pertaining to dental implants and their related research can be very time consuming and challenging to a dental surgeon before they can make appropriate clinical decisions. Similar to other orthopedic implants, dental implants need to be evaluated for their long-term efficacy in vivo before they are clinically acceptable. In order to help clinician(s) make patient oriented decisions, evidence-based techniques are becoming increasingly popular. This can be a very useful tool in translating research findings into clinical practice, thus narrowing the gap between research and clinical dentistry. This article discusses ways in which evidence-based techniques can help dental surgeons analyze and make informed clinical decisions about dental implant treatments.

Design and development of a patient-specific temporomandibular joint implant: Probing the influence of bone condition on biomechanical response.

Total temporomandibular joint (TMJ) replacement is widely recognized as an effective treatment for TMJ disorders. The long-term stability of TMJ implants depends on two important factors which are design concepts for fixation to anatomical locations in the mandible and bone conditions. Other factors include stress distribution, microstrain in the peri-implant, bone attributes like bone conditions leading to the clinical complications and failures. This study addresses these limitations by examining the influence of patient-specific design concepts and bone conditions on TMJ implant performance. Clinical evidences support the importance of implant design on healing ability. Previous studies have focused on achieving precise implant fit based on geometric considerations, however those published studies did not explore the impact of such. Against this perspective, the present study reports the extensive finite element analysis (FEA) results, while analyzing the impact of a newly designed patient-specific TMJ implant to address clinical complications associated with various bone conditions, particularly osteoporotic bone. In validating the FEA results, the performance of additively manufactured patient-specific TMJ implants was compared with designs resembling two commonly used clinically approved implant designs. By addressing the limitations of previous research and emphasizing the importance of bone conditions, the study provides valuable guidelines for the development of next-generation TMJ implants. These findings contribute to enhanced clinical outcomes and long-term success in the treatment of TMJ disorders.

Fractionation and characterization of particles simulating wear of total joint replacement (TJR) following ASTM standards.

Reactions of bone cells to orthopedic wear debris produced by the articulating motion of total joint replacements (TJRs) are largely responsible for the long-term failure of such replacements. Metal and polyethylene (PE) wear particles isolated from fluids from total joint simulators, as well as particles that are fabricated by other methods, are widely used to study such in vitro cellular response. Prior investigations have revealed that cellular response to wear debris depends on the size, shape, and dose of the particles. Hence, to have a better understanding of the wear-mediated osteolytic process it is important that these particles are well characterized and clinically relevant, both qualitatively, and quantitatively. In this study we have fractionated both ultra-high molecular weight polyethylene (UHMWPE) and Ti particles, into micron (1.0-10.0 µm), submicron (0.2-1.0 µm), and nanoparticle (0.01-0.2 µm) fractions, and characterized them based on the following size-shape descriptors as put forth in ASTM F1877: i) equivalent circle diameter (ECD), ii) aspect ratio (AR), iii) elongation (E), iv) roundness (R), and v) form factor (FF). The mean (± SD) ECDs (in µm) for micron, submicron, and nanoparticles of UHMWPE were 1.652 ± 0.553, 0.270 ± 0.180, and 0.061 ± 0.035, respectively, and for Ti were 1.894 ± 0.667, 0.278 ± 0.180, and 0.055 ± 0.029, respectively. The values for other descriptors were similar (no statistically significant difference). The nanofraction particles were found to be more sphere-like (higher R and FF values, and lower E and AR values) as compared to larger particles. Future experiments will involve use of these well characterized particles for in vitro studies.

Identification and characterization of polymeric and metallic wear debris from periprosthetic tissues after total hip revision surgery.

In spite of the growing interest in the field of orthopedic wear debris, there is no standardized technique to simultaneously isolate and analyze both ultra-high-molecular-weight polyethylene (UHMWPE) and metallic debris from periprosthetic tissues. Using a modification of the previously employed base-digestion protocol involving solvent and mechanical treatment, we were able to separate the wear particles from the tissue. Subsequently, using environmental scanning electron microscopy (ESEM) and energy-dispersive spectrometry (EDS), we characterized individual particulate species. Metallic debris, particularly Co, Cr, and Mo, appeared as irregular and amorphous-like structures, whereas UHMWPE and Ti appeared as crystalline-like structures, some as small as 15 nm. The investigation revealed that UHMWPE forms the bulk (~82%), followed by Ti (~8%-9%), Co (~5%-6%), and Cr (~3%-4%), along with many other trace elements, such as Mo, Pb, Fe, Pb, Fe, Si (~1%-2%).

Assessment of Jaw Bone Quality for Designing Patient-Specific Dental Implant Using Computed Tomography Data.

It is essential to assess bone density among mandible teeth as well as among patients and also to observe the variation in all mechanical parameters of the bone for accurate design of patient-specific dental implants. This information helps in the design of implants to create a more osseointegration-friendly environment at the bone adjacent to the implant. For this study, 40 patients were chosen irrespective of age, sex, and bone density. Hounsfield Units were calculated using cone beam computed tomography data. Seven teeth were studied: central incisor, lateral incisor, canine, first premolar, second premolar, first molar, and second molar. A total of 12 arbitrary points were chosen in both buccal and lingual sides which were further divided into external and internal. From the analysis, it was observed that the bone density of the central incisor and that of the canine is greater than that of the molars.

Oral and maxillofacial injuries in children: a retrospective study.

OBJECTIVES: The purpose of this retrospective epidemiological study was to determine the etiology and pattern of maxillofacial injuries in a pediatric population. MATERIALS AND METHODS: Data for pediatric maxillofacial trauma patients aged 12 years and younger who were registered at the Department of Pediatric and Preventive Dentistry, Dr. R. Ahmed Dental College and Hospital, Kolkata, India, were reviewed and examined. Patients who were treated between October 2016 and September 2018 were analyzed according to age, sex, cause of injury, frequency and site of facial fractures, and soft tissue injuries. The chi-square tests were carried out for statistical analyses with a significance level of 5%. RESULTS: Of 232 patients with a mean age of 6.77±3.25 years, there were 134 males (57.8%) and 98 females (42.2%). The overall male to female ratio was 1.39:1. The most common causes of injuries were falls (56.5%) and motor vehicle accidents (16.8%). Incidence of falls decreased significantly with age (P<0.001). Dentoalveolar injuries (61.6%) and soft tissue injuries (57.3%) were more common than facial fractures (42.7%). Mandibular fractures (82.8%) were the most common facial fractures, and perioral or lip injuries were the most prevalent injuries in our patient population. There was a positive association between facial fractures and soft tissue injury (P<0.01) (odds ratio 0.26; confidence interval 0.15-0.46). CONCLUSION: Falls were the leading cause of maxillofacial trauma in our sample of children, and the most common site of fractures was the mandible.

Ethics in biomaterials research.

There have been rapid advances in biomaterials research in the past few decades, which have influenced almost all areas of medicine and dentistry. Many ethical concerns related to the use of biomaterials fabricated from artificial substances including metals, polymers, and ceramics have been raised in the past. Most of these include safety and potential harmful effects on the human body. The development of biomaterials that incorporate biological materials such as cells with more traditional, non-biological materials will likely mean that new ethical questions will arise. With significant advances in molecular and cell biology and nanotechnology, the need for safe and effective therapies will also create unique ethical situations in the future. The use of animals in biomedical research has generated opposition from animal rights groups, which has created new challenges to scientists and researchers that warrant further actions. Responsible research by biomaterial scientists in the future will necessitate the incorporation of many new rules and regulations to the existing code of ethics. These will be necessary if new-age materials from emerging areas of science and technology are going to be morally and ethically acceptable to the scientific community and to society.

Manufacture of nanoparticles from bone: a preliminary study.

This study investigated a mechanical processing method using vibratory milling to reduce the particle size of bone ash to produce hydroxyapatite (HA) nanoparticles from bovine bone. Bovine femurs were cleaned of soft tissue, cut into small pieces, heated to 600 deg for 24 h, and ground into a coarse powder. A 50 wt% suspension was prepared, vibratory milled for 18 h, and then the milled suspension was filter pressed, dried, and ground into powder. The powder was analyzed with scanning electron microscopy and X-ray diffraction, which confirmed the particle size and the chemical composition of the powder-matched HA. The results of this study qualitatively showed that it is possible to produce HA nanoparticles from bone. This research explores a "green" manufacturing process that reuses a scrap material from the food industry and reduces the use of chemical precursors for synthetic nanoparticle synthesis. Such HA powder can potentially be used as a bone substitute and for coating orthopedic and dental implants.

Proposed frequencies of a vibrator used for implant retrieval at the time of hip joint revision surgery.

The number and the rate of success of hip implantation surgeries have increased significantly during last thirty years, not only in the USA, but also throughout the world. It has been reported that the failure rates of implanted hip joints are less than 8% after 10 years, and less than 20% after twenty years. Failures occur directly or indirectly due to wear, stress shielding and infection. Revision surgery is needed for those failed implant replacements. In the future, as the elderly population increases, the frequency of this type of revision surgery will also increase. At the time of revision surgery, removal of the existing cemented femoral implant can be a problem for the surgeon. Use of a vibrator for loosening of the existing cement layer between the bone and the implant may be a helpful solution. In this study, we investigated the optimum resonance frequencies of such a vibrator that might be used to loosen the cement layer easily and efficiently. Natural frequencies of different-sized implants and of different materials were determined. For harmonic analysis, CT scan data of a femur was processed in the image processing software MIMICS. Then the outline of the total hip was modeled and was analyzed by the finite element software ANSYS. The required portion of the femoral part was edited, implant and cement layer were introduced in that model, and elements were generated in that FEA software. Then elements of the femoral part, except the cement layer and the implant, were sent to MIMICS software again for assignment of different Youngs modulus of each element, which are proportionate to their densities. Then the elements were brought back to the FEA software. The harmonic analysis was performed for the total model in the FEA software ANSYS. For that particular boundary condition, the first three natural frequencies of the three types of implant sizes and materials varied by a maximum of 7-8%. Results of the numerical harmonic analysis showed that at the bone-cement interface, the resonance frequencies were at the ranges of 4 to 6 Hz, 26 to 29 Hz, and 43 to 49 Hz. The vibration response was similar for three cement-bone interface locations examined. This suggests that a vibrator that will produce a resonance frequency response may cause cracks in the bone-cement mantle and thus may facilitate the removal of the failed femoral component. Retrieval of hip implant may be easier using a vibrator in that band of frequencies with a moderate amplitude. The magnitude of those frequencies may not differ significantly from implant to implant as the natural frequencies of different types of implant, for that particular boundary conditions, are within a close range.

Reliability and validity of a newly proposed classification system for categorisation of parental behaviour (CCPB) in the dental setting.

AIM: To evaluate the reliability and validity of a newly proposed classification system for categorisation of parental behaviour (CCPB) in the dental setting. METHODS: Parents of patients aged 5-14 years were included. 127 parents were evaluated and rated on two scales: Parental Cooperation Scale (PCS; 1-4) and CCPB (0-5) by two trained examiners during the initial interaction of the parent with the examiners at their first visit in the dental setting. Kappa Score measurement of agreement was used to assess the inter-rater reliability. Spearman's rho correlation was used to assess the correlations between PCS and CCPB. RESULTS: The Kappa score between independent raters was 0.774 (substantial agreement) and Spearman's rho correlation coefficient was 0.778, which was statistically significant (p < 0.001). CONCLUSIONS: The CCPB refers to the same domain as the PCS and was found to be a reliable tool to be used in future research.

Electromagnetic Response of Bones Adjacent to the Dental Root Before and After Dental Implantation.

The aim of this study was relative variation quantification of the total electric field (EF) sum in a region very close to a dental root of the first molar tooth for two different materials: dentine (before implantation) and titanium (present in a screw after implantation), due to development of electrical charges generated by chewing force on the tooth. Because bone is a piezoelectric material, mechanical strain that is generated by chewing force on bone adjacent to the dental root produces electrical charges. Relative variations in the EF sum values with distance of nodes from the centerline of the root was observed for both cases and studied for two different boundary voltage conditions. Simulation and analysis were performed using the commercial finite-element analysis package ANSYS14. The detailed convergence analysis validated the effectiveness and accuracy of finite-element simulations. Before and after implantation, a significant variation in generation of electric charges at adjacent bone of the dental root was observed. We found that the differences in stress generation at the adjacent bone for those cases were just 5%, on average.

A Survey on the Use of Antibiotics among the Dentists of Kolkata, West Bengal, India.

INTRODUCTION: Dental infections are multimicrobial in origin with their etiological factors involving a combination of Gram-positive, Gram-negative, facultative anaerobes, and obligate anaerobic bacteria. Thus, antibiotics and analgesics account for a great majority of medicines prescribed by the dental surgeons. Inappropriate prescription of antibiotics by health care professionals has become a worldwide issue nowadays. AIM: The purpose of the present study was to:• Determine the pattern of antibiotic prescription among dentists of Kolkata.• Assess the attitude of dentists toward antibiotic resistance. MATERIALS AND METHODS: An electronic version of the questionnaire of cross-sectional survey regarding antibiotic use and attitude toward growing antibiotic resistance was constructed using Qualtrics (Qualtrics Pvt. Limited Provo, Utah), an internet online survey tool that was e-mailed to dental surgeons of Kolkata registered with Indian Dental Association (IDA), West Bengal. A reminder e-mail was given after 1 month to recollect the responses from them. RESULTS: The survey was e-mailed to 300 dental surgeons, out of which 115 dental surgeons completed the survey, thereby achieving a response rate of 38.33%. Majority of the respondents (60%) chose amoxicillin in nonallergic patients. Average minimum duration of antibiotic therapy was 5 days. The drug of first choice for patients with an allergy to penicillin was erythromycin. The prime determinant of antibiotic use was facial swelling (68%). The prime determinant to select a particular brand of antibiotics was affordability of that brand (61%). Almost all (99%) dental surgeons were aware of antibiotic resistance being a growing concern. As per their views, there was overprescription of antibiotics.How to cite this article: Kaul R, Angrish P, Jain P, Saha S, Sengupta AV, Mukherjee S. A Survey on the Use of Antibiotics among the Dentists of Kolkata, West Bengal, India. Int J Clin Pediatr Dent 2018;11(2):122-127.

Association between Obesity and Oral Health Status in Schoolchildren: A Survey in Five Districts of West Bengal, India.

INTRODUCTION: Childhood obesity, dental caries, and periodontal disease are major public health problems due to their adverse impact on the growth and development of children. Obesity and oral health are associated as both share some common risk factors. AIM: The specific aim of the study was to determine the correlation, if there is any, between obesity and oral health in children. MATERIALS AND METHODS: A cross-sectional survey was conducted in five districts of West Bengal, India. A total of 1,227 school-going children of 6 to 12 years were examined from the districts of Howrah, Hooghly, West Midnapore, South 24-parganas, and North 24-parganas. Following indices were analyzed: Decayed-missing-filled teeth (DMFT), decayed, extracted, filled teeth (deft), simplified oral hygiene index (OHI-S). Depending on their nutritional status, subjects were categorized as being normal weight, overweight, and obese. Logistic regression analysis were applied to the study to find out the association between the above-mentioned dental indices and independent variables: Gender and nutritional status. RESULT: A positive association was found between obesity and oral health status in children. CONCLUSION: Considering the results of this study, it was concluded that obesity is related to oral hygiene status of children. In order to improve oral hygiene status in children, dietary modifications need to be done.How to cite this article: Halder S, Kaul R, Angrish P, Saha S, Bhattacharya B, Mitra M. Association between Obesity and Oral Health Status in Schoolchildren: A Survey in Five Districts of West Bengal, India. Int J Clin Pediatr Dent 2018;11(3):233-237.

Rare molariform supernumerary teeth: Why are they bilateral?

Anterior supernumerary teeth in the permanent dentition may be supplemental or rudimentary. Rudimentary types are further classified as conical, tuberculate, and molariform. The molariform type has been only rarely reported. We report a rare variety of anterior supernumerary teeth - the molariform type, occurring bilaterally and in association with a midline supernumerary tooth. We also suggest a hypothesis for the bilateral occurrence of supernumerary teeth.

Tricho-dento-osseous syndrome and precocious eruption.

Tricho-dento-osseous syndrome (TDO), an uncommon form of ectodermal dysplasia is an autosomal dominant genetic disorder which is characterized by inherited defects in tissues arising from epithelial-mesenchymal interaction. Genetic studies have revealed that it is caused by mutation in the DLX3 gene. TDO presents with a great phenotypic heterogeneity and studies have suggested that this heterogeneity is the result of environmental factors or other genetic modifiers. In this article, we report a case of TDO in which the child had typical clinical features of hair, teeth and bone defects, as seen in TDO. Parents of the child were unaffected. Genetic analysis of the child revealed mutation in DLX3 gene. The child also showed precocious eruption of the permanent molars, a clinical feature which has been rarely reported. We suggest that the precocious eruption seen in TDO is probably due to a markedly increased osteoblastic activity. Key words:Tricho-dento-osseous syndrome, DLX3 gene, precocious eruption.

Distance M-Me: A novel parameter having significant potential as a predictor of mandibular growth.

OBJECTIVES: The purpose of the present study was to investigate the relationship of the measured distance between two mandibular points (distance M-Me) to chronological age and to find out whether the absolute values of distance M-Me could be classified age-wise into a unique range, which could be directly read for predicting the stage of mandibular growth. METHODS AND MATERIALS: The study sample consists of lateral cephalometric records of 65 patients (34 females and 31 males; age range: 6-21 years). Chronological age was calculated in decimal years. Lateral cephalograms were assessed by two independent examiners. Points M and Me were located on the lateral cephalograms, and linear distance between them was measured. RESULTS: Pearson product-moment correlation coefficients showed a high correlation between chronological age and distance M-Me (0.746 for females and 0.869 for males, p < 0.01). When the values of distance M-Me were compared with chronological age, it was possible to make four age groups (for females and males separately), where each group showed a unique range of value for distance M-Me. The values increased with increasing age. CONCLUSIONS: Increase in value of distance M-Me with age, showing reduced individual variation, depicts a well-conserved linear dimension. Values of distance M-Me can be directly read for predicting the stage of mandibular growth and can be used as a valuable adjunct or substitute to chronological age.

Evaluation of knowledge, awareness, and attitude toward emergency dental trauma management among the school teachers of Kolkata.

INTRODUCTION: Traumatic dental injuries (TDIs) are very common in childhood. Majority of TDI occur at home followed by schools. The prognosis of TDIs to a great extent is dependent on prompt emergency measures taken at the site of accident. Hence, it is of paramount importance to assess the knowledge of people present at the site of accident that generally includes parents, teachers, and sports coaches. AIM OF STUDY: The aim of the study was to assess the knowledge, attitude, and awareness of school teachers of Kolkata regarding management of TDIs. MATERIALS AND METHODS: A cross-sectional survey was conducted on 400 school teachers of Kolkata over a period of 2 months using a pretested close-ended questionnaire. The questionnaire had three parts: Part 1 contained questions on personal information, Part 2 contained questions based on two imaginary cases of trauma, and Part 3 related to their attitude toward dental trauma education. Chi-square test was done to describe the strength of the associations. RESULTS: The overall knowledge of school teachers regarding management of TDIs was not found to be satisfactory. It was observed that most of the teachers were in favor of taking immediate professional consultation for the emergency management, but most of them were unaware of the steps to be taken on their part to minimize complications and improve prognosis. CONCLUSION: Despite the lack of knowledge and awareness regarding management of dental trauma, school teachers of Kolkata had a good attitude toward management of dental trauma and its education.