Bleaching techniques in primary teeth: a systematic review.

OBJECTIVE: Discolouration of primary teeth, often attributed to trauma and pulpal infection, is a prevalent concern that can significantly impact the esthetics and self-esteem of children. To address this issue, bleaching techniques have emerged as a viable treatment option. This systematic review aims to provide a comprehensive summary of the effectiveness of bleaching agents in managing discoloured primary teeth. METHODS: Two reviewers independently conducted an electronic database search using PubMed, EMBASE, LILACS, CINAHL via EBSCO, Scopus, and Web of Science until September 26,2023. In vitro studies and case reports that assessed the quantifiable success were included. The present review utilized Distiller SR software for data extraction. The protocol of this study was registered in PROSPERO (International Prospective Register of Systematic Reviews) (CRD42022329831). The quality of studies was analysed with Cochrane tool and the JBI checklist. RESULTS: The search retrieved 1845 references of which 14 studies were included for qualitative analysis. There were 8 in vitro studies and 6 case reports included in this systematic review. There were 299 teeth samples in the in vitro studies and 18 teeth were assessed in the case reports. All the 18 teeth (6 case reports) showed considerable shade improvement within 7-14 days. However, only 3 teeth were followed up for a period of 12-24 months. Substantial shade improvement was also observed in samples in the in vitro studies. CONCLUSION: This systematic review has comprehensively examined the various bleaching agents and methods for the management of discoloured primary teeth. However, it is crucial to recognize that the available evidence is from case reports and is insufficient to make a clinical recommendation.

Early Childhood Caries and Iron Deficiency Anaemia: A Systematic Review and Meta-Analysis.

Identification of the association between Early Childhood Caries (ECC) and Iron Deficiency Anaemia (IDA) will aid paediatricians and paediatric dentists to enhance health promotion measures to reduce the related morbidity in children. This systematic review aims to determine an evidence-based association between ECC and IDA. A systematic search was carried out from MEDLINE via PubMed, EMBASE, LILACS, Cochrane Oral Health Group's Specialized Register, CINAHL via EBSCO, Web of Science, and Scopus up to May 2020. Hand searching and grey literature screening were also conducted. Cross-sectional, case-control, and cohort studies in English language which assessed the association was included. Two reviewers independently assessed the study quality and extracted the outcome data. A total of 1,434 studies were identified. Fourteen studies qualified for qualitative review and 7 of them for a meta-analysis. In comparison with children not affected by ECC, those affected had an increased likelihood of IDA (OR = 6.07 [3.61, 10.21]). The meta-analysis showed no statistical difference when comparing blood parameters (Hb, MCV, and serum ferritin) in children with and without ECC. This systematic review demonstrates an association between ECC and increased odds of IDA rather than it being the cause for IDA. Further longitudinal studies with robust methodology are required to determine an evidence-based association.

Comparative Efficacy of Hand Disinfection Potential of Hand Sanitizer and Liquid Soap among Dental Students: A Randomized Controlled Trial.

BACKGROUND: Hands are the most common medium for initiation and spread of infection in clinics. Hand hygiene is the simplest and most economic method for reducing the healthcare-associated infections (HCAIs). AIM: The aim of the present study was to compare the efficacy of hand sanitizer, liquid soap, and their combination for reducing the microbial colonies on hands. MATERIALS AND METHODS: The study was a single-blinded randomized controlled trial executed in a dental college on 90 participants, which were randomly assigned into three intervention groups of 30 each. The participants were instructed to contaminate their hands followed by a hand hygiene protocol for the liquid hand-wash group, the alcohol-based hand sanitizer (ABHS) group, and the combination group according to WHO guidelines. The swabs were collected pre- and post-intervention and mean colony-forming units were determined for each group. RESULTS: Median percentage reduction was highest for the combination group (100%), followed by the ABHS group (94.29%) and lowest for the liquid soap (92.31%). This difference in the amount of colony-forming units (CFU) among all the groups was nonsignificant (p = 0.114). CONCLUSION: The results of the study show that there was no significant difference in hand disinfection potential among hand sanitizer, liquid soap, or their combination. All the three interventions were equally effective with the reduction of total bacterial contamination from participants' hands. HOW TO CITE THIS ARTICLE: Khairnar MR, Anitha G, Dalvi TM, Kalghatgi S, Datar UV, Wadgave U, et al. Comparative Efficacy of Hand Disinfection Potential of Hand Sanitizer and Liquid Soap among Dental Students: A Randomized Controlled Trial. Indian J Crit Care Med 2020;24(5):336-339.

Evaluation of dental trials comparing baseline differences using p values.

INTRODUCTION: Significance testing for comparison of the baseline differences between the intervention arms has received a strong condemnation. The goal of this study was to assess the prevalence of randomized controlled trials (RCTs) comparing the baseline characteristics between intervention groups using significance tests in top ten impact factor dental journals. MATERIALS AND METHODS: RCTs published in 10 high impact factor dental journals were searched in PubMed database. Literature search was limited to time duration of 5 years from September 2012 to August 2017. RESULTS: We analysed 521 RCTs after excluding 47 non-RCT articles from the total of 568 articles. Baseline demographic characteristics table was not reported in 45.9% of the RCTs and 26.2% of the RCTs did not report table of baseline clinical characteristics. In 38.9% of the studies, significance testing was employed to compare baseline differences between the intervention arms. CONCLUSIONS: Many trials published in the reputed dental journals failed to follow the recommendations of CONSORT statement regarding reporting of baseline tables and avoiding comparison of baseline differences with significance test.

Development and validation of a questionnaire to assess commonality knowledge of traumatic dental injuries and management of emergencies.

BACKGROUND: Dental trauma represents a significant public health problem, causing a burden for both individuals and society. The aim of this study is to systematically develop and validate a questionnaire on 'traumatic dental injuries and management of emergencies' (TIME) for assessing the knowledge, attitude and practice (KAP) for a commonality. METHODS: The scale development phases included conceptual framework, systematic development of an item pool, refinement of the item pool by Focus-group discussion (n = 23), validity-testing using Content Validity Index (n = 5), translation and back-translation, Cognitive interviewing (n = 30,45), and reliability testing (n = 40). The conceptual framework was built based on six broad constructs, such as broken teeth, knocked-out (avulsion) teeth, pushed/moved-in and loosened teeth (luxation injuries), soft tissue injuries, follow-up and management, and prevention and protection. RESULTS: Reviews of existing questionnaires significantly helped to generate an initial pool of 68 items (refined to 51 items). Lawshe's content validity was 0.92. High test-retest reliability was demonstrated (kappa value = 0.98). The questionnaire showed a high level of reliability (Cronbach's alpha = 0.86) with great internal consistency. CONCLUSION: TIME is the first validated scale for recording knowledge, attitude and practices on traumatic dental injuries and management of emergencies for non-dental professionals. The 51-tem tool will allow dentists to evaluate KAP of commonality. KAP measured across the globe would have a significant impact on planning awareness programs by dentists and dental associations.

Child Temperament and Early Childhood Caries: A Systematic Review and Meta-Analysis.

Purpose: The purpose of this study was to perform a systematic review to assess current evidence for the association between child temperament and early childhood caries (ECC). Methods: A systematic search was conducted using MEDLINE® through PubMed®, EMBASE®, Scopus®, LILACS, Web of Science™, and EBSCO up to January 2023. Studies measuring ECC and child temperament for children younger than or equal to six years of age using questionnaires, interviews, and surveys through case-control studies, cohort studies, and cross-sectional studies were included. Literature reviews were excluded. Medical subject heading (MeSH) terms like "temperament" and "dental caries" were used by two authors who independently extracted the data, and a third author resolved disagreements. Risk of bias assessment was done using the Newcastle-Ottawa assessment scale for case-control and cohort studies and the Appraisal tool for Cross-Sectional Studies (AXIS). The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations approach (GRADE approach). A chi-square test and I-square index were used to evaluate heterogeneity. Results: A total of 5,072 records were screened, resulting in 15 included studies that yielded data for 6,667 participants; sevenstudies were high, and eight were of moderate quality. Seven studies qualified for meta-analysis, which revealed that persistence did not affectthe presence or absence of ECC. However, there was a strong association between difficult temperament and ECC (odds ratio equals 2.63). Conclusion: A positive association between a child's temperament and early childhood caries exists that is supported by quantitative findings, indicating a connection with very low certainty.

Association of exposures to environmental chemicals estimated through primary teeth biomatrix and health outcomes in children and adolescents - A systematic review.

Children's heightened susceptibility to environmental exposure arises from their underdeveloped detoxification mechanisms and augmented per-unit body-weight absorption capacity for chemical compounds. Primary teeth are an emerging biomatrix, which aid in storing crucial data on early exposure to harmful substances and developmental illnesses. This systematic review aimed to evaluate the association between environmental chemical exposure and health outcomes in children and adolescents using primary teeth as a matrix. The study protocol was registered with PROSPERO (CRD42023428013). The review spanned studies published between 1974 and 2023, identified through an extensive literature search on databases like MEDLINE, EMBASE, LILACS, CINAHL, the Cochrane Oral Health Group Specialized Register, Scopus, and Web of Science. Distiller SR software was used to assess study quality and extract the outcome data. The NTP-OHAT scale assessed evidence quality, and case-control, cross-sectional, and cohort studies in English were included. Comprehensively reviewing 5287 articles resulted in 29 studies being included in the final analysis, comprising 15 cross-sectional, seven case-control, and seven cohort studies. All 29 studies qualified for qualitative analysis. Eleven studies analyzed lead (Pb) effects on health outcomes, four analyzed manganese (Mn), and 14 investigated other element groups. Primary teeth biomatrix assessed various health outcomes: neurobehavior, childhood behaviour, ADHD, birth outcomes, fetal alcohol syndrome disease, inflammatory bowel disease, and dental caries. This study contributes to existing evidence, reinforcing a link between environmental metal exposure and health consequences. The evidence extends to prenatal and postnatal periods, substantiated by primary teeth biomatrix analysis. Lead level fluctuations can influence neuropsychological functioning, potentially causing cognitive impairments. Altered manganese levels correlate with behavioral issues, adverse effects on visuospatial development, and birth weight changes. Primary teeth biomatrices aid fetal alcohol spectrum disorders diagnosis, and correlations between organo-chemical exposure and autism were observed.

Comparative Efficacy of Analdent (Herbal Analgesic Preparation) and Aceclofenac on Pain Intensity After Tooth Extraction: A Split-Mouth Randomized Clinical Trial.

Background and Aim: Pain management following tooth extraction is crucial in minimizing patient suffering and risk of infection and hastening the recovery. Safety issues with routinely prescribed drugs such as NSAIDs for pain management call for search of an effective and safe alternative. Advances in the field of alternative medicine have led to the use of various natural products for pain management in the field of dentistry. The aim of the study was to compare the efficacy between the analdent and aceclofenac in terms of alleviation of post-operative pain and facial swelling after extraction of tooth. Methods: A split-mouth randomized clinical trial was conducted on 22 participants in the age range of 13-25 years requiring extraction of first permanent premolars for orthodontic reason. The extraction sites were randomized to receive either analdent or aceclofenac post-orthodontic extraction. Post-extraction dental pain was assessed after 8 h, 24 h, 48 h and 72 h post-operatively using a visual analog scale, and incidence of swelling was recorded. Results: Pain score showed a significant reduction (p = 0.001) post-operatively within analdent (herbal drug) group as well as Zerodol (aceclofenac) group. However, there was no significant difference in pain intensity between the two groups at each interval. Two participants in analdent group and one participant in aceclofenac group reported swelling after 8 h of extraction which subsided after cold pack application. Conclusion: Analdent was found to be equally effective as aceclofenac in managing pain after the tooth extraction with relatively no side effects.CTRI Registration Number: CTRI/2020/ 03/024296 dated 27/03/2020.

Arginine: A New Paradigm in Preventive Oral Care.

Dental caries is ubiquitous and one of the most prevalent oral diseases and the foremost cause of dental pain and poor quality of life (QoL). Fluoride is an effective caries preventive agent; however, despite its use, there remain some gaps in prevention of dental caries. Arginine, an amino acid, helps to maintain a noncariogenic plaque. It shows synergistic effects with fluoride in dental caries and can help nourish the tooth by enhancing the remineralization effect of fluoride. Supplementing fluoride dentifrices with arginine can bridge the gap in caries prevention. Several clinical studies with 1.5% arginine + fluoride provide evidence for its use in prevention of dental caries. This report throws light on the benefits of arginine in dental caries and guides on its use with fluoride. Recommendations given in the report will help in effective prevention of dental caries. How to cite this article: Goyal V, Damle S, Puranik MP, et al. Arginine: A New Paradigm in Preventive Oral Care. Int J Clin Pediatr Dent 2023;16(5):698-706.

Evaluation of retracted publications in Dentistry: A systematic review.

BACKGROUND: The objective of retracting flawed publications is to maintain the integrity of scientific literature. Retractions in the dental literature have been on the rise in recent years. Hence, we aimed to review retracted articles related to dentistry. METHODS: A search was conducted of the MEDLINE database for retracted articles in the dental literature published between April 1, 1993 and March 31, 2020. The retracted articles and the notices of retraction were reviewed, and the findings are presented. RESULTS: During the selected period, 143 articles were retracted. Redundant publication (n=50, 35%) was the most common reason for retraction, followed by plagiarism (n=43, 30.1%) and data manipulation (n=42, 29.4%). Around 70.6% (n=101) of retracted articles were original articles. Eight (5.6%) of the articles were single authored. The retracted articles have been cited by about 1300 publications, after the date of publication of the retraction notice. The gap between publication and retraction was longer for funded articles than for non-funded articles, and for articles retracted for data manipulation than for articles retracted for other types of misconduct. Twenty-one journals and nine authors retracted two or more papers. The majority of authors of retracted articles (224, 37%) were from India. CONCLUSION: Our study showed that the retraction of publications due to misconduct such as duplicate publication, plagiarism, data manipulation is a matter of concern and calls for strict measures to curb the menace of research misconduct.

Needlestick and sharps' injury in healthcare students: Prevalence, knowledge, attitude and practice.

Purpose: Needlestick and sharps injury is an occupational hazard, and it presents with a constant risk of exposure to blood-borne pathogens. Students are particularly at risk due to a lack of experience and handling skills. The present study was designed to assess the prevalence of needle stick injury and evaluate the knowledge, attitude, and practice regarding its prevention and management among students of a medical campus. Methods: A cross-sectional, questionnaire-based study was conducted among healthcare students of the medical campus in Sangli, Maharashtra. Overall, the study included 942 participants belonging to medical, dental, and nursing faculties. Results: Overall, the prevalence rate of needlestick and sharps injury was found to be 25.2%. The prevalence was highest amongst nursing students. The students had adequate knowledge about blood-borne virus (BBV) transmission and prevention of needlestick injury. However, there was a substantial shortfall in post-exposure prophylaxis knowledge amongst the students. A deficit in translation between knowledge to practice was noted, particularly in the case of needlestick injury prevention and management. Conclusion: The present study found that one in four students experience needlestick injury; overall knowledge regarding prevention and management of needlestick injury was lesser than desired, and gaps in knowledge and practice were identified in the present study. This can be rectified by curricular reforms, periodic educational programs and stern reinforcement of guidelines. Instilling reporting centers and devising a standing operating procedure in the event of needlestick injury are the needs of the hour.

Association of bedtime with recurrent aphthous stomatitis: A cross-sectional study among health-care professional students.

Background: Although recurrent aphthous stomatitis (RAS) is the most common oral mucosal disease, the etiology remains poorly understood till date. In addition, RAS lacks definitive therapeutic options, and hence, it becomes even more important to know the etiological factor so as to relieve the symptoms and render treatment effectively. Recently, late bedtime has been shown to be associated with RAS. Due to prolonged duty hours along with lengthy learning and training periods, late bedtime is a frequent observation among health-care professional students. However, this is a less explored field in the previous studies on RAS. Aims: This study aimed to evaluate the role of bedtime in the causation of RAS among health-care professional students. Methods: This present cross-sectional survey was carried out among medical, dental and nursing students studying in our medical campus, using an anonymous, self-administered questionnaire consisting of 18 items. The collected data was statistically analyzed and interpreted. Descriptive analysis and Chi-square tests were employed to assess the association of RAS with various variables. Results: Among a total of 1111 students who participated in the study, 39.8% (n = 442) experienced RAS. Factors such as history of digestive tract disease, family history and stress showed a positive correlation with RAS. Interestingly, both during examination and nonexamination period, RAS was more prevalent among students with bedtime >11pm than in students with bedtime <11 pm. Conclusion: The study indicates that late bedtime is an independent risk factor for RAS and thus clinicians should focus on recommending a healthy lifestyle with adequate sleep to patients with RAS. This would benefit patients with RAS, especially health-care professional students, and could probably contribute to long-term remission in RAS.

Effect of training on evidence-based practice to undergraduate dental students: pre and postexperimental study.

BACKGROUND: Evidence-based practice (EBP) training is essential for undergraduate students in making sound clinical decisions during patient care. However, EBP training is not included in the curriculum of undergraduate dental students in India and there is a dearth of research that assessed the effectiveness of EBP training in India. Hence, this study aimed to assess the effectiveness of EBP training to dental undergraduate students. METHODS: Final year undergraduate students and interns of a dental institution participated in this pre and postexperimental study. All the participants received a 2-day workshop (didactic lectures, hands-on and group activities) in a classroom setting. A validated 35 item instrument titled EBP Knowledge, Attitudes, Access and Confidence questionnaire was used for the outcome assessment of EBP training. RESULTS: Fifty undergraduate students (33 interns and 17 final year) participated in the study. Statistically significant improvement was observed in six out of 10 items related to EBP knowledge. All the items related to attitude showed a significant positive change in scores. Only four out of nine items related to accessing evidence showed a statistically significant change. Participants reported moderate confidence gain in critical appraisal skills. CONCLUSION: The current study demonstrated moderate improvement in the effectiveness of EBP training in improving EBP knowledge, accessing evidence and critical appraisal skills.

Dental treatment needs using a sociodental approach among south Indian youths: a cross-sectional study.

AIM: The aim of this study was to compare the normative dental needs and sociodental needs in a sample of 18-21-year-old students in Davangere city in South India. METHOD: This cross-sectional survey was conducted on a sample of 250 students aged 18-21 years. Data was collected using a self-administered questionnaire and clinical examination. The normative needs were assessed by different indices. The impact of oral diseases on their quality of life was assessed using the standard Oral Impact on Daily Performance (OIDP) scale and propensity-related needs (PRNs) were assessed using three standard questions. RESULTS: About 85.6% of the subjects fulfilled the criteria for professionally judged normative treatment need. Among them, 42% of the subjects were suffering from emergency/progressive oral conditions and the remaining 43.6% subjects were suffering from non-progressive oral conditions. In turn, a total of 28.4% of the subjects with non-progressive oral conditions fulfilled the criteria of impact-related treatment need. Finally, only 1.2% had sociodental needs (high PRNs). CONCLUSIONS: A substantial reduction in treatment needs were found with the sociodental approach among youths in India. The considerable proportion of the children with impact-related need (IRN) did not have a high behavioral propensity, hence potentially needing alternative interventions and programs.

Survey on attitude of dental professionals about plagiarism in Maharashtra, India.

PURPOSE: Plagiarism is a type of research misconduct that consists of copying other's work or ideas without giving them proper credit. The rise of plagiarism cases has become a serious concern in the scientific world. Hence, a cross-sectional survey was carried out to assess the attitude among dental faculty members and postgraduate (PG) students toward plagiarism. Objectives were to compare the attitudes of dental faculty members and PG students toward plagiarism and to analyze the association of attitude toward plagiarism (ATP) with age, gender, and number of publications of the participants. MATERIALS AND METHODS: ATP was measured using a self-administered questionnaire consisting of two sections; first section consisting of demographic details of the participants and second section consisting of the ATP questionnaire measuring positive attitude, negative attitude, and subjective norms. Ninety faculty members and 126 PG students from four dental institutions participated in the study. The data were analyzed using Chi-square test and linear regression analysis. RESULTS: PG students showed more positive attitude and less negative ATP as compared to faculty members. Positive ATP decreased with increase in age (ß = -0.147; P = 0.008), number of publications (ß = -0.195; P = 0.001), and from males to females (ß = -1.209; P = 0.044) whereas negative ATP increased with age (ß =0.093; P = 0.001). CONCLUSION: The study showed negligence of PG students toward plagiarism which calls for improvement in awareness regarding plagiarism and research education.

Challenges in Learning Preclinical Prosthodontics: A Survey of Perceptions of Dental Undergraduates and Teaching Faculty at an Indian Dental School.

INTRODUCTION: Preclinical dental education promotes development of competency and expertise before students work on patients, but this phase is devoid of exposure to real patients leading to challenges in teaching-learning. AIM: The aim of this study was to explore the challenges faced by students during the process of learning preclinical prosthodontics. MATERIALS AND METHODS: Two Focus Group Discussions (FGDs) were conducted with two different groups of students and one FGD was held with prosthodontics faculty. The FGDs explored the student's and faculty perceptions on the topics which were difficult for the students to understand and their suggestions on how these topics can be made easier to understand. The discussions were audio taped with prior consent and transcribed. RESULTS: The students and the faculty felt that the subject of prosthodontics is vast, difficult to visualize and also difficult to correlate theory with practical aspects. Lack of clinical exposure coupled with use of conventional methods of teaching were identified as reasons for difficulty in understanding the subject. Both students and faculty members suggested that use of simulation, demonstrations, and videos could augment the learning process for the students. Early clinical exposure will help solve many problems encountered during learning and contribute to a better understanding. CONCLUSION: The students and faculty expressed a "need" for early clinical exposure to enhance the learner's understanding of the preclinical aspects of the subject. The present study highlights the need for change in instruction methods to enhance the learning experiences in preclinical prosthodontics of dental undergraduate students in India.

The Mouthwash War - Chlorhexidine vs. Herbal Mouth Rinses: A Meta-Analysis.

INTRODUCTION: Mouthwashes are often prescribed in dentistry for prevention and treatment of several oral conditions. In the recent times the use of naturally occurring products what is otherwise known as grandmothers remedy are used on a large scale. This has now called for a newer age of mouth washes but is the new age mouth washes at par with the gold standard or even better than them this study investigates. AIM: The aim of the present study was to compare the effect of two broad categories of mouth washes namely chlorhexidine and herbal mouth washes. MATERIALS AND METHODS: Eleven randomized control studies were pooled in for the meta-analysis. The search was done from the Pub Med Central listed studies with the use keywords with Boolean operators (chlorhexidine, herbal, mouth wash, randomized control trials). The fixed effects model was used for analysis. RESULTS: This meta-analysis brings to light, the fact that a wide range of newer herbal products are now available. As with a plethora of herbal mouthwashes available it is the need of the hour to validate their potential use and recommendation. This study found that only two studies favor the use of herbal products and four studies favor the use of chlorhexidine, of the 11 studies that were analyzed. CONCLUSION: More studies are required under well controlled circumstances to prove that herbal products can equate or replace the 'gold standard' chlorhexidine. Herbal products are heterogeneous in nature, their use should be advised only with more scientific proof.

Comparative Evaluation of Ciprofloxacin Levels in GCF and Plasma of Chronic Periodontitis Patients: Quasi Experimental Study.

INTRODUCTION: For any antimicrobial approach to be successful in periodontal therapy, it is important that the antimicrobial agent targets the sub-gingival biofilm by attaining sufficient concentration at the sub-gingival site. AIM: The purpose of the present study was to determine and compare the concentrations of ciprofloxacin present in Gingival Crevicular Fluid (GCF) and plasma after its systemic administration. MATERIALS AND METHODS: A total of 20 subjects, in the age group of 30-60 years satisfying the inclusion and exclusion criteria, were chosen from the outpatient Department of Periodontology, Government Dental College and Hospital, Hyderabad and consent was obtained. Subjects were put on oral ciprofloxacin therapy (Baycip, Bayer Corporation) of 500mg twice daily doses for five days to establish steady state tissue levels of the agent. GCF and serum samples were collected at the 72(nd) hour after the first dose of ciprofloxacin and were compared using unpaired t test. RESULTS: The mean gingival index value of the subjects was 1.8 ± 0.59 and the mean probing depth of the subjects taken in the study was 5.724 ± 0.47mm. The results of this study showed that ciprofloxacin concentrations were significantly higher (p<0.001) in GCF than in plasma. CONCLUSION: Results from the present study and those from the earlier studies clearly indicate the ciprofloxacin's ability to reach and concentrate in infected periodontal sites via GCF. This property of ciprofloxacin may be useful for eradication of periodontal pathogens, thus improving the outcome of periodontal therapy.