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.

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.

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.

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.

Influence of Lidocaine including Buprenorphine for Postoperative Analgesia after the Extraction of Mandibular Third Molars: A Randomized Controlled, Double-Blind, Split-Mouth Study.

BACKGROUND: The presence of opioid receptors around the peripheral nerves offers the possibility of providing postoperative analgesia, thereby encouraging the study of the effect of opioids in combination with local anesthesia (LA). Studies have also reported the efficacy of peripherally administered opioids in achieving adequate analgesia in regions with inflammation. Applying the concept of peripheral opioid receptors, our study aimed to evaluate the effectiveness of opioid analgesia in managing postoperative pain. The split-mouth study was carried out to evaluate the efficacy of buprenorphine added to lidocaine 2% in providing postoperative analgesia after the surgical extraction of the impacted mandibular third molar. MATERIALS AND METHODS: We conducted a randomized, double-blinded, split-mouth trial among 21 patients with impacted mandibular third molars bilaterally. In all patients, bilateral impacted mandibular third molars were extracted at different periods. The primary outcomes assessed were postoperative analgesia by the VAS score and the number of rescue analgesics consumed by patients at 24, 48, and 72 hours of interval via a questionnaire. RESULTS: There was a statistical significant difference in postoperative analgesia duration at 24 (P = 0.012) and 48 hours (P = 0.024), respectively, between the test and control group. Even though the mean number of rescue analgesics consumed by the test group was less than that of the control group, no significant difference was seen. CONCLUSION: Buprenorphine added to lidocaine 2% showed a minimal decrease in the pain score and duration of postoperative analgesia with no difference in the frequency of rescue analgesics consumed between the test and control.

Sex Assessment by Morphological Analysis of Palatal Rugae Patterns in a South Indian Adult Population.

BACKGROUND: Palatal rugae are asymmetric and irregular ridges on the anterior palatal region, which have proven to be useful in the field of forensic dentistry. This study aims to use morphological analysis of palatal rugae patterns to assess sex in a South Indian adult population. MATERIALS AND METHODS: This cross-sectional study was undertaken to evaluate a total of 300 maxillary dental casts (150 males and 150 females). The rugae patterns were marked by one observer and classified as per Thomas and Kotze criteria by another observer. The rugae patterns were classified based on the total number of rugae, shape, predominant direction of rugae, and unification of rugae. RESULTS: The palatal rugae in female participants showed a higher incidence of circular rugae and backward directed rugae, while male participants showed more forward-directed rugae. The logistic regression analysis showed a significant association of with circular (OR=1.48; 95% CI= 1.02-2.13), forward (OR=0.87; 95% CI= 0.78-0.97) and backward (OR=1.23; 95% CI= 1.08-1.41) palatal rugae with sex. CONCLUSION: Certain palatal rugae patterns can be used for the assessment of sex with limited accuracy.

Efficacy of Lignocaine with Buprenorphine versus Lignocaine in the Management of Postoperative Pain after Minor Oral Surgical Procedures: A Systematic Review and Meta-analysis.

We aimed to review the efficacy of lignocaine with buprenorphine versus lignocaine alone in the management of postoperative pain after minor oral surgical procedures. Randomized controlled trials evaluating the efficacy of use of lignocaine with buprenorphine versus lignocaine for intra-oral procedures were included by searching multiple databases. Outcomes assessed were onset of the time of anesthesia in seconds, duration of postoperative analgesia, postoperative pain (maximal follow-up), the number of rescue analgesics required, and adverse events. The search strategy yielded 167 publications for the title and abstract screening out of which only two trials were included for full-text screening. There was considerable heterogeneity among the included studies with regards to the outcomes assessed. The need for rescue analgesics was the only outcome that was included for meta-analyses. Forest plot showed that lignocaine with buprenorphine compared to lignocaine showed a significantly lower requirement of rescue analgesics (-0.22[-2.9,-1.55]). No trial reported any adverse effects. The results show that lignocaine with buprenorphine is effective in reducing the number of rescue analgesics required by the patient.

Power of BODE Index in Predicting Future Exacerbations of COPD: A Prospective Observational Study in Indian Population.

BACKGROUND: BODE index is a multidimensional measure of survival in chronic obstructive pulmonary disease (COPD). It is composed of body mass index (B), the degree of airflow obstruction (O), dyspnoea (D), and exercise capacity (E). Studies have shown that BODE index can predict future exacerbations, but similar data in Indian population is unavailable. This study was aimed at evaluating the power of BODE index to predict the frequency of exacerbations of COPD in Indian cohort. METHODS: We conducted a prospective observational cohort study that included stable COPD subjects aged above 40 years. We assessed the BODE index at baseline and recorded the number of exacerbations at the end of 12 months. Spearman's Rho and Poisson regression model were used to correlate the BODE index with the frequency of exacerbations. RESULTS: We analysed 78 COPD patients. A significant correlation was seen between BODE index at baseline and number of exacerbations at 12 months (Spearman's Rho 0.738). A unit change in BODE index at baseline would have 1.25 times higher number of exacerbations at 12 months (95% CI: 1.17-1.33). CONCLUSIONS: BODE index has significant power to predict the frequency of future exacerbations in Indian COPD patients.

Efficacy of triphala mouth rinse (aqueous extracts) on dental plaque and gingivitis in children.

AIM: The aim of the present study was to evaluate the efficacy of triphala mouth rinse (aqueous) in the reduction of plaque and gingivitis among children. METHODS: The study was a randomized, double-blinded, controlled trial, with a total of 60 school children (n = 30 in each group; triphala and chlorhexidine groups). Plaque and gingival indices were used to evaluate baseline and follow-up plaque and gingivitis. RESULTS: A total of 57 children completed the study. Both chlorhexidine and triphala groups showed significantly lower mean gingival and plaque index scores at follow up than baseline (P < 0.001). There was no significant difference in the percentage change in the mean gingival index between the two groups (P = 0.826). The percentage change in the mean plaque index was significantly higher in the chlorhexidine group compared to the triphala group (P = 0.048). CONCLUSION: The effectiveness of triphala in the reduction of plaque and gingivitis was comparable to chlorhexidine, and can be used for short-term purposes without potential side-effects. It is a cost-effective alternative in reducing plaque and gingivitis.

Smoking re-initiation after cessation program: Comparison of associated factors between young and older adults.

OBJECTIVE: To evaluate the associated factors in reinitiating the smoking habit among the participants of a smoking cessation program conducted in a tobacco cessation clinic of Manipal University, Manipal. MATERIALS AND METHODS: This cross-sectional study was conducted among participants of a smoking cessation program who reinitiated smoking habit. A self-administered questionnaire was used that had information on demographic, habit history, knowledge on harmful effects of smoking behavior related to oral cavity and associated factors due to which individual was unable to quit the habit. RESULTS: A total of 102 males (mean age = 39.91 ± 9.57) constituted the final sample. The results showed that habitual smokers were more likely to be ≥40 years and occasional smokers were all reported to be <93 years (P < 0.001). Cigarette smokers were more likely to be of younger age group while majority of the Beedi and cigarette + Beedi smokers were older adults (P < 0.001). The mean duration of the habit was significantly higher for older adults than young adults (P < 0.001). There was no significant difference in the number of packs between the age groups (P = 0.054). A significantly higher proportion of young adults than older adults were aware about oral cancer (P < 0.001). Significantly higher proportion of older adults than young adults tend to have a closest person to be a smoker (P = 0.05). A significant higher proportion of young adults reason their habit as for pleasure (84.6%) and relaxation (68.8%), while older adults reason it to be as tension (64.1%) or combined factors (70.6%). Peer pressure was almost same in both the age groups (P = 0.006). There were no significant differences in the withdrawal symptoms among young and older adults (P = 0.41). CONCLUSION: Considerable differences were noticed between younger and older age groups in the factors which might play a role in re-intiating the smoking habit. A structured cessation program focused more on the above characteristics should be planned in public health programs based on the characteristics of the participants.

Work stress and oral health-related quality of life among Indian information technology workers: an exploratory study.

OBJECTIVES: To assess the relationships among work stress, oral health and oral health-related quality of life (OHRQoL) in information technology (IT) professionals in south India. METHODS: The study population consisted of 134 IT industry workers in four mid-size IT companies in south India. A self-administered questionnaire consisting of the eight-item Oral Impact on Daily Performance (OIDP) scale and a 25-item modified version of the original 167-item Work Stress Questionnaire was given, following which an oral examination was carried out. RESULTS: Mean ± standard deviation scores on the Work Stress Questionnaire, the decayed, missing and filled teeth (DMFT) index and the Community Periodontal Index of Treatment Needs (CPITN) for the sample population were 53.82 ± 15.07, 4.23 ± 3.47 and 1.81 ± 0.58, respectively. A comparison of clinical oral health status data against respondents' work stress and OIDP scores showed that mean DMFT and CPITN scores were significantly greater among those who reported oral impact on their daily performance. However, although participants who reported oral problems had consistently higher work stress scores, the differences were statistically significant only for gingival bleeding and sensitive teeth. Multivariate analysis after controlling for age and sex showed that higher levels of work stress and periodontal disease were significant predictors for poor OHRQoL in the sample population. CONCLUSIONS: Work stress may be an important predictor for poor OHRQoL and hence requires to be studied in greater detail.