Profile of Patients with Maxillofacial Space Infections and Associated Risk Factors.

Objective: To evaluate the profile of patients operated for maxillofacial space infections and associated risk factors for the length of hospital stay. Materials and Methods: We conducted a retrospective study among patients operated for maxillofacial infections at our center from 2010 to 2020. Information collected from the records were age, sex, type and number of spaces involved, clinical signs and symptoms (pain, swelling, toothache, sore throat, otalgia, hoarseness, headache, cough, neck swelling, rancid breath, sialorrhea, gingival swelling, muffled voice, trismus, fever, dysphagia, odynophagia, malaise, lymphadenopathy, dyspnoea, pus discharge), treatment modality, total leukocyte count, evidence of bacterial growth, comorbidities, complications if any and length of hospital stay. Results: A total of 128 medical records were examined, out of which 59 were female. The mean age was 38.59 ± 19.7 and the length of hospital stay was 7.56 ± 3.8 days. The most commonly involved space was submandibular space (46.1%) and the common symptoms reported were swelling (99.2%), pain (86.7%), and trismus (68%). Four patients had complications like necrotizing fasciitis (1.6%), pneumonia (0.8%), and death in one patient (0.8%). Logistic regression showed that patients more than 36 years of age, male sex, evidence of bacterial growth, and diabetics had higher odds of increased hospital stay (>6 days). Multiple logistic regression analysis showed that age (P = 0.015; OR: 2.98) and evidence of bacterial culture (P = 0.001; OR:6.64) were potential predictors associated with increased hospital stay. Conclusion: Our study showed that the age of the patient and evidence of bacterial culture were potential predictors of prolonged hospital stay among patients operated for maxillofacial space infections.

Utility of Panoramic Radiographs in the Screening of Individuals with Edentulous Arches: A Need-Analysis Study

Abstract Objective: To evaluate the utility of panoramic radiographs in pre-prosthetic screening of edentulous arches. Material and Methods: Panoramic radiographs taken for three years were retrospectively analyzed. Observations from the radiographs shall be categorized and classified into either of the two categories, namely: 'findings with minimal impact on denture fabrication' and 'findings which affect denture fabrication and require further evaluation.' Anatomic variations, jaw pathologies, and residual ridge resorption patterns were assessed. Results: This study included the initial screening of 23,020 panoramic radiographs, out of which 505 (showing either one or both edentulous arches) were included for the study purpose. The age range of the subjects was from 21 to 94 years. 52.6% of the radiographs showed positive findings. More than half of the radiographs belonged to the males (52.5%). Hyperpneumatization of the maxillary sinus, crestal position of the mental foramen, and retained root fragments were the most common entities noted in the radiographs. Changes in the mental foramen were significantly higher in males than females (p=0.002). Conclusion: Observations from this study showed that panoramic radiographs have high utility for screening edentulous arches, and they should be used in routine clinical practice before denture fabrication.

A survey on insight of blood donors during COVID pandemic in Southern India

ABSTRACT Introduction: Knowledge, Attitude and Practices (KAP) surveys prove beneficial to the transfusion services by providing an insight into the donors and, thus, aiding in mobilizing and retaining voluntary blood donors. We aim to study the knowledge, attitude and practices of donors towards blood donation in a pandemic setting. Methods: A cross-sectional observational study to assess the knowledge, attitude and practices of blood donors was conducted between June to and October 2020. Non-parametric tests (Mann - Whitney U and Kruskal - Wallis) were performed to evaluate the relation of knowledge, attitude and practices overall scores with age group, gender and history of blood donations (first us. repeat). The Chi-Square test/Fisher's Exact test was used to evaluate the differences in the distribution of Knowledge, Attitude and Practices items within the groups. Results: A total of 403 of 2,748 individuals who came for whole blood donation participated in the study. The mean age of the study population was 31.1years (SD ± 8.4 range: 18 - 58), with 75% of the donors donating for the first time. The fear of acquiring COVID-19 infection was perceived as a major reason for the eligible population not to donate. The overall knowledge, attitude and practice score among the donors was satisfactory, being 76.14%, with a significant association with age. The overall positive attitude and practices scores of blood donors were 85.48% and 78.04%, respectively. Conclusion: The KAP scores were satisfactory among the donors. Timely communication of the precautionary measures at blood centers to contain the spread of the COVID-19 infection and effective counseling would help in motivating and retaining blood donors.

Quantitative and Qualitative Correlation of Mandibular Lingual Bone with Risk Factors for Third Molar Using Cone Beam Computed Tomography.

Background: Lingual plate thickness, density, and proximity to the tooth are linked as risk factors for various complications associated with third molar extraction. The present study aimed to assess the lingual plate thickness, and density in the mandibular third molar region using cone beam computed tomography and to estimate its correlation with type and level of impaction, number of roots, age, and gender as the risk factors. Methods: This was a retrospective study on CBCT images of 648 mandibular third molars. The lingual plate thickness at three different root levels - cervical, mid-root, and apex along with the position of the tooth, number of roots, density of lingual plate, age, and gender were evaluated. The measurements were done on Invivo 5-Anatomage software. Statistical comparison of the categorical variables was done by Chi-square test, and Fisher's exact test, and univariate and multivariate analysis were done using binomial logistic regression. Results: Lingual plate thickness of the third molars at the cervical, mid root, and apex were 1.28 mm, 1.42 mm and .01 mm (mean). A significantly higher proportion of subjects with thin lingual plates at mid-root (p-value=0.01) and apex (p-value=0.05) were in the 21-30 age group. Lingual bone density was significantly associated with the thickness of the lingual plate at the mid-root. A significantly higher proportion of thinner lingual plates at the mid-root level were associated with mesioangularly placed third molars (p-value=0.002). Conclusion: Our study presented that lingual plate thickness has a strong association with age, angulation, and the number of roots. Knowledge about these risk factors is imperative during the management of third molar impactions.

Effect of in-office bleaching agent on the surface roughness and microhardness of nanofilled and nanohybrid composite resins.

Background: To compare the surface roughness and microhardness of Ceram.x® SphereTEC™ one and Filtek Z350 XT after in-office bleaching with Pola office. Methods: Twenty samples each of (10 mm diameter and 2 mm height) Ceram.x® SphereTEC™ one and Filtek Z350 XT were prepared. The samples were subjected to three bleaching sessions with 35% hydrogen peroxide (Pola office) with a seven-day interval between each session. Surface roughness and microhardness of the prepared samples prior to and after the bleaching regimen were measured using a profilometer and Vickers hardness tester, respectively. Results: A significant reduction (p <0.001) in the surface hardness of Filtek Z350 XT from 27.67 ± 2.10 to 17.83 ± 1.36 Vickers hardness number (VHN) was observed after the bleaching whereas no significant reduction in surface hardness was observed with Ceram.x® SphereTEC™ one. The adjusted mean (estimated marginal mean) microhardness after bleaching for Ceram.x ® SphereTEC™ one (35.79 ± 1.45) was significantly higher than Filtek Z350 XT (19.54 ± 1.45) (p < 0.001). However, in-office bleaching of these materials did not significantly alter their surface roughness. Conclusions: In office-bleaching with 35% hydrogen peroxide can reduce the microhardness of nanofilled composite. However, the surface roughness was not influenced by the bleaching procedure in both nanohybrid and nanofilled composite resin materials.

Worldwide prevalence of carpal tunnel syndrome among dental health care personnel - A systematic review and meta-analysis.

Background: Carpal Tunnel Syndrome (CTS) is one such common disorder among dental health care personnel caused due to the entrapment neuropathy of the median nerve in the carpal tunnel. We aimed to evaluate the pooled estimates of the CTS among dental healthcare personnel. Methods: We systematically reviewed the existing literature from six databases till January 1 st, 2022. Studies reported in English along with the prevalence of CTS or where prevalence could be calculated were included. Independent screening of title and abstracts, and the full text was done by two examiners. Information collected was authors, year of publication, geographic location, type of dental healthcare personnel, sample size, distribution of age, sex, CTS, method of diagnosis, and risk of bias. The random effect model was used to estimate the pooled estimates. Results: Thirty-seven studies yielded 38 estimates. A total of 17,152 dental health care personnel were included of which 2717 had CTS. The overall pooled prevalence of CTS among the included studies was 15%, with a high heterogeneity. Meta-analysis showed no significant difference in the pooled estimates of CTS between male and female dental healthcare personnel (OR: 0.73; 95% CI: 0.52 -1.02; I 2= 69.71). The pooled estimates among the dentist and dental auxiliaries were 20% and 10%, respectively. The pooled prevalence of CTS with self-reported measures, clinical examination and NCS were 21%, 13% and 8% respectively. Meta-regression showed that the prevalence estimates were significantly associated with publication year (coefficient: 0.006; 95% CI= 0.002-0.01). Conclusion: One out of seven dental health care personnel may be affected by CTS. No significant difference was seen in the prevalence of CTS between male and female dental healthcare personnel.

Role of CBCT in Prediction of Oro-antral Communication Post Third Molar Extraction: A Retrospective Study.

OBJECTIVE: Oro-antral communication (OAC) is one of the most frequently encountered complications during third molar extraction. Various radiographic factors, like excessive maxillary sinus pneumatization, long periods of edentulism, periapical lesions, etc., have been considered high-risk factors for OAC. However, a panoramic radiograph has not proven to be accurate in predicting the chances of OAC. Through this retrospective study, we evaluated the efficacy of a CBCT in predicting the incidence of OAC after maxillary third molar extraction. MATERIALS AND METHODS: We conducted a retrospective study in our department, which included the patients who had undergone extraction of a maxillary third molar over five years with the presence of panoramic X-rays and/or CBCT scans prior to extraction. Primary outcomes assessed from the case files were intra-operative complications like OAC, root fracture, tuberosity fracture, pterygoid plate fracture, etc. The incidence of these complications was correlated with the presence or absence of CBCT before extraction. RESULTS: Out of 920 extracted maxillary third molar, only 148 teeth (16.1%) had a CBCT record before extraction. The most commonly encountered complication was broken inaccessible root piece/s (4.9%), followed by OAC (3.5%). An inter-group comparison showed that a significantly higher percentage of patients (p < 0.001) with CBCT records had an incidence of OAC (11.5%) as against the group of patients with no CBCT record (1.9%). CONCLUSION: A CBCT scan prior to cases with high-risk factors for OAC can be a valuable tool in accurately predicting the chances of OAC after maxillary third molar extraction.

Efficacy of Preemptive Dexamethasone versus Methylprednisolone in the Management of Postoperative Discomfort and Pain after Mandibular Third Molar Surgery: A Systematic Review and Meta-Analysis.

The corticosteroids have been used for preemptive management of surgical sequelae after mandibular third molar extraction. The aim of this article was to review the efficacy of methylprednisolone versus dexamethasone in the management of postsurgical pain, swelling, and trismus after mandibular third molar surgery. Randomized, double-blinded studies from PubMed, CINAHL, Scopus, DOSS, Cochrane central, and Web of Science were identified by using a search strategy. Randomized controlled trials evaluating the efficacy of use of dexamethasone versus methylprednisolone for mandibular third molar extraction were only considered. The studies involving the use of any other corticosteroid agent were excluded. Outcomes assessed were postoperative pain, the number of rescue analgesics required, swelling, trismus, and adverse events. The search strategy yielded 1046 articles for title and abstract screening, out of which only seven studies were included in the systematic review after full text screening. There was considerable heterogeneity between the studies with regards to the method as well as the parameters assessed. Risk of bias was low in three studies and unclear in other four studies. On pooled analyses, there was no significant difference with respect to pain, rescue analgesics, and swelling in the test and the control group. Forest plot analysis showed that dexamethasone had lesser trismus in early postoperative period (postoperative day 2) as compared to methylprednisolone. None of the included studies reported any adverse effects. Both the corticosteroids have similar efficacy in reducing the postoperative pain and swelling; however, dexamethasone showed statistically significant difference from methylprednisolone in reducing trismus (estimated standardized mean difference of -0.69 mm; 95% CI: -1.01 to -0.38; p < 0.0001) in the early postoperative period. However, due to statistical heterogeneity, quality of the evidence for the review was low to moderate. Hence, more studies with larger study sample and low risk of bias are needed to confirm these results.

Effect of Real-Time Environment on Mechanical Properties of Preformed Stainless Steel Archwires: An In Vivo Study.

Introduction: Clinicians should be aware of any effect the oral environment may have on archwires. Laboratory models fail to closely imitate intraoral conditions. The aim was to evaluate the change in mechanical properties of preformed stainless steel archwires after 15 weeks of exposure to the oral environment. Methods: Three commercially manufactured 0.019 × 0.025″ stainless steel archwires were evaluated. Young's modulus, yield strength, spring factor, and hardness were studied. The unexposed distal end cuts (control samples) and archwires were tested after 15 weeks of intraoral exposure (test samples). Tension tests, Vickers microhardness tests, and nanoindentation tests were carried out. Results: Normality was tested using the Shapiro-Wilk test. Statistical analyses included the paired t-test for intragroup comparisons and Kruskal-Wallis ANOVA with the post hoc Dunn test for comparison of mean percentage reduction in values. At T15, Young's modulus showed a statistically significant decrease. Changes in yield strength and spring factor were not significant for groups other than American Orthodontics wires. The reduction in hardness was significant in 3M Unitek. Vickers, tension, and nanoindentation tests demonstrated an expansive range between hardness and Young's modulus so determined. Conclusion: 3M Unitek archwires showed the highest difference in Young's modulus. Yield strength values increased in Ortho Organizers archwires. Spring factor decreased only in 3M Unitek archwires. Hardness values obtained from various tests did not produce identical results.

Sugar content and erosive potential of commonly prescribed Orodispersible tablets- An in vitro study.

Background: Dental caries is a major non-communicable disease of public health concern caused due to freely available dietary sugars. We aimed to compare the sugar content and erosive potential with duration of use and drug classes of orodispersible tablets (ODTs).  Methods: We conducted an  in vitro evaluation of the total sugar content (TSC), Potential of Hydrogen (pH), solubility, and Titratable Acidity (TA) of commonly prescribed 62 ODTs. TA was measured by titrating the samples with known amount of. 0.1N sodium hydroxide (NaOH) with phenolphthalein indicator and pH was determined by digital pH meter. TSC was evaluated by phenol sulphuric acid. Solubility was assessed by filtration.  Results: Out of the 62 ODTs, majority were Antimicrobials (n=30). One-quarter of the ODTs (26%) had a mean pH below ≤5.5. No significant difference was seen in the mean pH with respect to different drug classes (p=0.082) and duration of use of ODTs. A significant difference was seen in the mean percentage solubility with respect to drug classes (p<0.001). Antimicrobials had the least percentage of solubility as compared to other drug classes. Antiemetics and proton pump inhibitors (24.33 ± 17.34) had significantly higher mean percentage sugar content than Antimicrobials (23.25 ± 17.16). No significant difference was seen in the mean TSC with respect to various drug classes (p=0.718) and between the duration of use of drugs (P=0.568) respectively. No significant difference was seen in the mean percentage TA with respect to drug class (p=0.123) and duration of use of drugs (p=0.424).   Conclusion: Overall, we can conclude that one in four ODT formulations had a pH below 5.5 (critical pH).  Only one ODT formulation did not have a sugar content. No difference was seen in the mean pH, sugar content, and TA with respect to duration of use of drugs and drug classes.

A comparative evaluation of calcium ion release and pH change using calcium hydroxide nanoparticles as intracanal medicament with different vehicles - An in vitro study.

Context: Nano-calcium hydroxide (NCH) has been proven to have several advantages over normal calcium hydroxide, supporting in its possible use as an intracanal medicament. Aim: The aim is to evaluate and compare calcium ion release and pH change using NCH with different vehicles as intracanal medicament. Subjects and Methods: Sixty freshly extracted premolars were decoronated at the cementoenamel junction level and the length was standardized. Canals were enlarged to F3 size using protaper rotary system. The samples were divided into three groups (n = 20), namely NCH + distilled water (Group 1), NCH + propylene glycol (Group 2), and NCH + chitosan (CT) (Group 3). Each sample was suspended in 6 ml of distilled water using silicone putty with only the apical third of the roots immersed. The pH and calcium ions were assessed at 24 h, 7 days, 15 days, and 30 days using a pH meter and ultraviolet spectrophotometer, respectively. Statistical Analysis: Comparison of mean calcium release and pH change was made using Kruskal-Wallis ANOVA with post-hoc Dunn's test. The level of significance was set at 5%. Results: A significant difference was seen in the calcium ion release and pH change among the three groups at 24 h, 7 days, 15 days, and 30 days. Conclusions: NCH mixed with propylene glycol showed alkaline pH and adequate release of calcium ions till 30 days. NCH mixed with CT exhibited a high pH at the end of 30 days. Both combinations proved their efficacy as intracanal medicaments.

Epidemiology of Saccharomyces fungemia: A systematic review.

Fungemia due to Saccharomyces species is reported in considerable numbers, and the increase is attributed to using Saccharomyces boulardii probiotics in clinical settings. The present systematic review addresses the underlying diseases and risk factors in Saccharomyces fungemia patients, along with the treatment and outcome of the disease. The MEDLINE, Scopus, Embase, and Web of Science databases were searched systematically with appropriate keywords from June 2005 to March 2022. This review identified 117 Saccharomyces fungemia cases; 108 cases were included in the analysis. Saccharomyces fungemia is commonly seen in patients treated with S. boulardii probiotics (n = 73, 67.6%), and 35 (32.4%) patients did not receive probiotic therapy. The underlying disease and risk factors significantly associated with S. boulardii probiotic-associated fungemia were intensive care unit stay (n = 34, 31.5%), total parenteral nutrition or enteral feeding (n = 32, 29.6%), patients with gastrointestinal symptoms such as diarrhea (n = 23, 21.3%), and diabetes mellitus (n = 14, 13.0%). In patients without probiotic therapy, immunosuppression (n = 14, 13.0%), gastrointestinal surgery (n = 5, 4.6%), and intravenous drug use (n = 5, 4.6%) were the significant risk factors for Saccharomyces fungemia. The all-cause mortality rate of the total cohort is 36.1%. No significant variation in the mortality rate is observed between S. boulardii probiotic treated patients (n = 29, 26.9%) and patients without probiotic therapy (n = 10, 9.3%). In conclusion, S. boulardii probiotic therapy in debilitated critical care patients may have contributed to increased Saccharomyces fungemia cases. Further, clinicians should be vigilant in preventing S. boulardii fungemia in patients with prophylactic probiotic therapy.

Saccharomyces boulardii probiotic administration in patients on prolonged intensive care unit stay, total parenteral nutrition or enteral feeding, and pre-existing gastrointestinal illness such as diarrhea should be monitored carefully, as these groups of patients are at high risk of acquiring Saccharomyces fungemia.

A survey on insight of blood donors during COVID pandemic in Southern India.

INTRODUCTION: Knowledge, Attitude and Practices (KAP) surveys prove beneficial to the transfusion services by providing an insight into the donors and, thus, aiding in mobilizing and retaining voluntary blood donors. We aim to study the knowledge, attitude and practices of donors towards blood donation in a pandemic setting. METHODS: A cross-sectional observational study to assess the knowledge, attitude and practices of blood donors was conducted between June to and October 2020. Non-parametric tests (Mann - Whitney U and Kruskal - Wallis) were performed to evaluate the relation of knowledge, attitude and practices overall scores with age group, gender and history of blood donations (first vs. repeat). The Chi-Square test/Fisher's Exact test was used to evaluate the differences in the distribution of Knowledge, Attitude and Practices items within the groups. RESULTS: A total of 403 of 2,748 individuals who came for whole blood donation participated in the study. The mean age of the study population was 31.1years (SD ± 8.4 range: 18 - 58), with 75% of the donors donating for the first time. The fear of acquiring COVID-19 infection was perceived as a major reason for the eligible population not to donate. The overall knowledge, attitude and practice score among the donors was satisfactory, being 76.14%, with a significant association with age. The overall positive attitude and practices scores of blood donors were 85.48% and 78.04%, respectively. CONCLUSION: The KAP scores were satisfactory among the donors. Timely communication of the precautionary measures at blood centers to contain the spread of the COVID-19 infection and effective counseling would help in motivating and retaining blood donors.

Structural and functional abnormalities of the tongue: An epidemiological study from a tertiary care center in India.

Background: The tongue is a prominent muscular organ of the oral cavity and the integrity of the tongue mucosa frequently can reflect the overall health of an individual. Many notable structural and functional alterations can affect the tongue. These changes may be symptomatic or asymptomatic. Hence, the aim of the study was to determine the prevalence of structural and functional abnormalities of the tongue in a population reporting to a tertiary care center. We also assessed the prevalence of the normal variants and evaluated the normal tongue protrusion measurement in the study population. Methods: The cross-sectional study included 1,143 dental outpatients above 18 years of age who visited the Department of Oral Medicine and Radiology between October 2021 to February 2022. Demographic details of the patients were noted. Participants were asked questions regarding any symptoms or abnormalities noticed on the tongue. The tongue was examined thoroughly for any structural/ functional abnormalities. The maximal tongue protrusion for each participant was measured by asking them to extend their tongue out. Medical history, drug history, and social history were recorded. Results: The study included 564 male and 579 female participants; tongue lesions were positive in 66.5% of the study population. Coated tongue (26.2%) was the most frequent structural abnormality that was noted in the present study. Taste dysfunction (4.6%) was the most frequent functional abnormality. The lesions were mostly in the anterior two-thirds (4.2%) of the tongue. Functional abnormalities of the tongue were noted in 8.7% of the study participants. Conclusions: The results of the present study showed that structural and functional abnormalities of the tongue were present in 66.5% of the population. Careful and detailed evaluation of the tongue examination is mandated in routine dental checkups. This shall help in the prompt identification of various etiological factors causing structural and functional abnormalities of the tongue.

Efficacy of Buccal Infiltration with or without Palatal Injection for Posterior Maxillary Teeth Extraction - A Split-Mouth Randomized Trial

ABSTRACT Objective: To evaluate the feasibility of posterior maxillary teeth extraction buccal infiltration with or without the use of palatal injection. Material and Methods: A total of 70 patients underwent extraction of bilateral maxillary posterior teeth under 2% lignocaine hydrochloride with 1:2,00000 adrenaline infiltration in this single-centric split-mouth randomized trial. The test side was administered with a buccal infiltration of 2 mL of anesthetic alone. An extended waiting period of 10 minutes was given before the commencement of the procedure. A standard protocol was followed for the control side. A single operator performed all extractions. Results: A total of 140 posterior maxillary teeth were extracted. Patients marked pain perception on a visual analogue scale in three different instances. During the administration of injections for the test side, the pain score was less than that of the control side and was statistically significant. The overall pain during the extraction procedure was comparable and statistically insignificant. The overall success of the method was 90%. Conclusion: Extraction of posterior maxillary teeth was feasible with a single buccal infiltration without palatal injection in most cases using an extended waiting period. Dentists can attempt extraction without palatal injections with optimal success. However, the alternate technique could be used when there is a necessity for rescue palatal anesthesia.

Prevalence of musculoskeletal disorders among dental healthcare providers: A systematic review and meta-analysis.

Background: Work-related musculoskeletal disorders (MSD) are common in dentistry due to the prolonged static work involved during patient care, making dental health care personnel vulnerable to musculoskeletal complaints. We aimed to pool the prevalence estimates of MSD among various dental healthcare providers, including dentists, dental students, dental hygienists, and auxiliaries. Methods: A systematic search of five databases was performed (Scopus, Embase, CINAHL, Web of Science, Dentistry & Oral Sciences Source). The studies that reported the prevalence of MSD among dental healthcare workers and those written in English were selected. Screening and data extraction were performed by two review authors independently. Discrepencies were resolved by another review author. Risk of bias assessment was done using a nine-item questionnaire developed by Hoy et al. Pooled estimates were calculated using meta-analysis of proportions (random effects model). Results: Among the 3090 publications screened, 234 publications were included for full-text screening. Meta-analysis was performed for 89 estimates from 88 publications. Females showed significantly higher prevalence [OR = 1.42 (95% CI = 1.09-1.84); I 2 = 66.02; N = 32]. The analysis yielded a pooled estimate of 78.4% (95% CI = 74.8-82). The meta-regression showed similar prevalence over the years (Coefficient: 0.001; P-value: 0.762). Conclusions: A high prevalence of MSD was noted among dental healthcare providers, with about seven out of ten having experienced MSD in the past. This emphasizes the need for awareness and adoption of appropriate ergonomic postures by dental healthcare providers from early in their careers to minimize work-related MSD.

Rhinocerebral mucormycosis: a systematic review of case reports and case series from a global perspective.

OBJECTIVE: Rhinocerebral mucormycosis (RCM) is the most common variant and the presenting features in the head and neck region are seldom pathognomonic. The aim of this systematic review was to obtain a thorough insight into the predisposing factors, clinical features, disease course, management protocol, outcome, and prognosis. STUDY DESIGN: An electronic search was carried out using MEDLINE by PubMed, Scopus, Google Scholar, Web of Science, and EMBASE databases. Articles in which the clinical findings on the extra- and intraoral features of RCM were included for systematic review. Descriptive statistics was applied to obtain the results. RESULTS: A total of 124 case studies (90 case reports, 34 case series) which yielded 219 patients. Diabetes mellitus (57.40%) was the most common comorbid condition. Neurologic manifestations were noted in 23.3% of the individuals. Maxillary/hard palate involvement was a common occurrence (59.2%). Intra-oral necrotic lesions with eschar were noted in 75/219 patients. Amphotericin B was the commonly used drug for the management, and surgical debridement was performed in majority of the cases. The mortality rate was 18.4%. CONCLUSIONS: The clinical manifestations often mimic odontogenic symptoms, hence a sound knowledge about the pathogenesis and course of the disease will aid in the prompt diagnosis and management.

Impact of the COVID-19 pandemic on graduating dental interns: the students' perspective.

Background: COVID 19 pandemic has caused an unprecedented change in the way of life of the individual as well as of the society globally. Medical and healthcare education has become virtual, complex, and challenging with minimal real-time experience. Dental education has faced major impacts affecting the skills and preparedness of the graduates. This study aimed to assess the overall impact of the COVID 19 pandemic on graduating dental interns. Methods: This cross-sectional survey was conducted among the graduating dental interns from various states across India. A specially designed questionnaire was used in our study which consisted of multiple-choice, Likert scale, dichotomous response, open-ended response questions. The 15 item questionnaire focused on 5 domains (i) demographic details (ii) perceptions regarding disrupted academic schedule and switch to E-education (iii) perceptions on its impact on the career (iv) items concerning the mental health and stress (v) potential solutions suggested by the interns. Results: 316 dental interns responded to this survey. Only 13.6% of them felt that the e-platforms were useful tools for learning. The dental interns felt that Conservative Dentistry and Oral Surgery postings had the maximum impact on clinical skills. Less than one-fourth (23.1%) of them agreed with the fact that they were under parental pressure; 43.4% agreed that the pandemic had affected the confidence and preparedness to start their clinical practice. Conclusion: It was observed that the interns faced major challenges due to the missed hours of clinical practice, which affected them in terms of preparedness and confidence in facing their future.

Analysis of Erosive Nature of Fruit Beverages Fortified with Calcium Ions: An In Vitro Study Evaluating Dental Erosion in Primary Teeth.

Background: Since children frequently consume acidic fruit beverages, dental erosion is common in children. The erosive effects on primary teeth are more profound due to the lesser thickness of enamel and dentin. This study evaluated if calcium fortification of fruit beverages could reduce their erosive potential. Methodology. Tropicana Orange Delight was the fruit beverage chosen and fortified with calcium carbonate. Forty noncarious extracted primary teeth were equally distributed into four groups. Samples in group A were exposed to calcium-fortified fruit beverages and group B to nonfortified fruit beverages for 1, 2, and 3 min. The pH and calcium ion concentration of both the fruit beverages were evaluated from baseline through the test period. Samples in groups C and D were then exposed to fortified and nonfortified fruit beverages for 10, 20, and 30 min. The surface roughness and microhardness of these samples were analysed. Results: Due to fortification, the pH and calcium ion concentration of fortified beverages was higher compared to nonfortified beverages at baseline. The calcium ion concentration of fortified beverages decreased from baseline in contrast to an increase in the nonfortified beverage group. This indicates that fortified beverage is less erosive in nature. The surface roughness of samples in the fortified beverage group did not decrease significantly from baseline. In the nonfortified beverage group, surface roughness values at 20 and 30 min of exposure were higher than baseline, suggesting that significant erosive changes occur at the prolonged duration of exposure. The microhardness values of samples in the fortified beverage group increased from baseline through the test period, suggestive of resistance to erosion offered by calcium fortification. The microhardness values of samples in the nonfortified beverage group decreased through the test period, suggestive of erosion. Conclusion: Calcium fortification of this fruit beverage significantly reduces its erosive potential on primary teeth.

Dental practitioners' knowledge, attitudes, and practices of ergonomics - a cross-sectional web-based survey.

BACKGROUND AND AIM: Dentistry is a profession known to have many occupational hazards, including biomechanical, ergonomic, and work factors. We aimed to evaluate dental practitioners' knowledge, attitudes, and practices of ergonomics and to evaluate the significant differences with age, sex, educational qualification and clinical experience. METHODS: We conducted a cross-sectional multi-centric web-based survey among dental practitioners of south India. Dentists who were involved in clinical practice in India with a minimum of 1-year experience were invited to participate in this study. Information on demographics (age, sex, education) and years of practice of the dental practitioners was collected. Knowledge attitude and practice questionnaire was adapted from El Salamy et al. Results: The mean age of the participants was 30.57 (SD=6.95). More than half of the respondents were female (60.1%). Dental practitioners who were less than 28 years old (OR: 0.57), graduates (OR: -0.47), and clinical experience less than three years (OR: -0.53) had a higher probability of having poor or fair knowledge scores. Dental practitioners who were more than 28 years old had a significantly higher probability of positive attitudes (OR: 0.6) and good practices (OR: 0.54). Practitioners with a master's degree had a higher probability of good practices (OR: 1.92). Practitioners with more than three years of clinical experience had a higher likelihood of good practices (OR: 1.72; 95% CI: 1.03 - 2.9). CONCLUSIONS: Overall, we could conclude that dental professionals had predominantly fair to good knowledge, positive attitudes and a high proportion of bad practices.