Phytochemicals in vital tooth bleaching: Spectrophotometric evaluation of efficacy with papaya, pineapple, or kiwi extracts and 30% hydrogen peroxide.

Context: Dental bleaching, a common cosmetic treatment, typically uses hydrogen peroxide (H2O2). Yet, the search for natural options has prompted an investigation into fruit extract efficacies such as papain, bromelain, and actinidin for tooth whitening. Aim: The aim of this study was to evaluate the efficacy of 30% hydrogen peroxide and fruit extracts (papaya, pineapple, and kiwi) on human enamel using a spectrophotometer at different time intervals. Study Design: Eighty maxillary anterior teeth were stained with tea solution and evaluated for baseline color. They were then divided into four groups: hydrogen peroxide alone and hydrogen peroxide combined with papaya, pineapple, or kiwi extracts. Each group was further divided based on bleaching duration: 10 or 20 min. Materials and Methods: The color value of the bleached teeth was measured using a reflectance spectrophotometer. In order to analyze the data, one-way ANOVA, post hoc Tukey, and paired t-tests were used. The significance level was established at α =0.05. Results: Combining hydrogen peroxide with pineapple extract showed the highest efficacy, followed by papaya and kiwi extracts. Hydrogen peroxide alone also demonstrated significant bleaching efficacy, albeit lower than the combinations with fruit extracts. Conclusion: Combining hydrogen peroxide with pineapple and papaya extracts notably improves dental bleaching efficacy, as shown by reduced color difference (ΔE) values. This underscores the potential of natural enzymes in tooth whitening.

Assessment of Smear Layer Removal and Push-Out Bond Strength Efficacy of Traditional and Herbal Root Canal Irrigants Across Different Root Levels: An In Vitro Study.

INTRODUCTION: Endodontic therapy requires meticulous root canal debridement, pathogen elimination, and effective obturation to prevent microbial intrusion. The presence of the smear layer hinders sealer penetration, compromising sealing effectiveness. Sodium hypochlorite and chlorhexidine are esteemed endodontic irrigants. Herbal extracts like neem and tulsi, with antimicrobial and anti-inflammatory properties, show promise for root canal irrigation. The study aimed to evaluate the efficacy of various irrigants in removing the smear layer and enhancing push-out bond strength at different root canal levels. MATERIALS AND METHODS: One hundred mandibular premolars with single canals were collected, and 50 samples each were used for the smear layer and push-out bond strength analysis. Neem and tulsi extracts were prepared for irrigation. Teeth were decoronated, and up to 30 (6%) canals were prepared and were randomly divided into five groups based on irrigants used. A smear layer examination was conducted after longitudinally sectioning the tooth and sections were observed in a scanning electron microscope (SEM). Obturation was done in the remaining samples, and the push-out bond strength was assessed using a universal test machine. RESULTS: Sodium hypochlorite showed the highest smear layer removal efficacy followed by chlorhexidine, neem, tulsi leaves with rose water extract, and normal saline. Chlorhexidine exhibited the highest push-out bond strength, with the coronal third presenting the strongest values, followed by neem, tulsi with rose water, normal saline, and sodium hypochlorite. CONCLUSION: The study underscores the potential of herbal irrigants in endodontic therapy, indicating promising results while emphasizing the necessity for further clinical trials to validate their efficacy and other properties.

Mucormycosis and COVID-19: An epidemic within a pandemic in India.

IMPORTANCE: Coronavirus disease (COVID-19) causes an immunosuppressed state and increases risk of secondary infections like mucormycosis. We evaluated clinical features, predisposing factors, diagnosis and outcomes for mucormycosis among patients with COVID-19 infection. METHODS: This prospective, observational, multi-centre study included 47 consecutive patients with mucormycosis, diagnosed during their course of COVID-19 illness, between January 3 and March 27, 2021. Data regarding demography, underlying medical conditions, COVID-19 illness and treatment were collected. Clinical presentations of mucormycosis, imaging and biochemical characteristics and outcome were recorded. RESULTS: Of the 2567 COVID-19 patients admitted to 3 tertiary centres, 47 (1.8%) were diagnosed with mucormycosis. Mean age was 55 ± 12.8years, and majority suffered from diabetes mellitus (n = 36, 76.6%). Most were not COVID-19 vaccinated (n = 31, 66.0%) and majority (n = 43, 91.5%) had developed moderate-to-severe pneumonia, while 20 (42.6%) required invasive ventilation. All patients had received corticosteroids and broad-spectrum antibiotics while most (n = 37, 78.7%) received at least one anti-viral medication. Mean time elapsed from COVID-19 diagnosis to mucormycosis was 12.1 ± 4.6days. Eleven (23.4%) subjects succumbed to their disease, mostly (n = 8, 72.7%) within 7 days of diagnosis. Among the patients who died, 10 (90.9%) had pre-existing diabetes mellitus, only 2 (18.2%) had received just one vaccine dose and all developed moderate-to-severe pneumonia, requiring oxygen supplementation and mechanical ventilation. CONCLUSIONS: Mucormycosis can occur among COVID-19 patients, especially with poor glycaemic control, widespread and injudicious use of corticosteroids and broad-spectrum antibiotics, and invasive ventilation. Owing to the high mortality, high index of suspicion is required to ensure timely diagnosis and appropriate treatment in high-risk populations.