Comparative effectiveness of Propolis with chlorhexidine mouthwash on gingivitis - a randomized controlled clinical study.

BACKGROUND: To assess and compare the effectiveness of propolis mouthwash with chlorhexidine mouthwash in the reduction of plaque and gingivitis. METHODS: A single centre, latin-square cross-over, double masked, randomized controlled clinical trial was conducted on 45 chronic generalized gingivitis subjects who were chosen from the dental clinic of MAHSA University, Malaysia. A total of 45 subjects were randomly assigned into one of the three different groups (n = 15 each) using a computer-generated random allocation sequence: Group A Propolis mouthwash; Group B Chlorhexidine mouthwash; and Group C Placebo mouthwash. Supragingival plaque and gingival inflammation were assessed by full mouth Plaque index (PI) and gingival index (GI) at baseline and after 21 days. The study was divided into three phases, each phase lasted for 21 days separated by a washout period of 15 days in between them. Groups A, B and C were treated with 0.2% Propolis, Chlorhexidine, and Placebo mouthwash, respectively, in phase I. The study subjects were instructed to use the assigned mouthwash twice daily for 1 min for 21 days. On day 22nd, the subjects were recalled for measurement of PI and GI. After phase I, mouthwash was crossed over as dictated by the Latin square design in phase II and III. RESULTS: At baseline, intergroup comparison revealed no statistically significant difference between Groups A, B and C (p > 0.05). On day 21, one-way ANOVA revealed statistically significant difference between the three groups for PI (p < 0.001) and GI (p < 0.001). Bonferroni post-hoc test showed statistically significant difference between Propolis and Chlorhexidine mouthwash (P < 0.001), with higher reduction in the mean plaque and gingival scores in propolis group compared to chlorhexidine and placebo groups. CONCLUSIONS: Propolis mouthwash demonstrated significant improvement in gingival health and plaque reduction. Thus, it could be used as an effective herbal mouthwash alternative to chlorhexidine mouthwash. TRIAL REGISTRATION: The trial was retrospectively registered on 25/07/2019 at clinicaltrials.gov and its identifier is NCT04032548.

Effect of Dental Practicality Index training using an online video on decision-making and confidence level in treatment planning by dental undergraduates.

Objectives: The purpose of this study was to evaluate the effect of Dental Practicality Index (DPI) training using an online video on the treatment planning decisions and confidence level of dental undergraduates (DUs). Materials and Methods: Ninety-four DUs were shown 15 clinical case scenarios and asked to decide on treatment plans based on 4 treatment options. The most appropriate treatment plan had been decided by a consensus panel of experienced dentists. DUs then underwent DPI training using an online video. In a post-DPI-training test, DUs were shown the same clinical case scenarios and asked to assign the best treatment option. After 6 weeks, DUs were retested to assess their knowledge retention. In all 3 tests, DUs completed the confidence level scale questionnaire. Data were analyzed using the related-samples Wilcoxon signed rank test and the independent-samples Mann-Whitney U test with the level of significance set at p < 0.05. Results: DPI training significantly improved the mean scores of the DUs from 7.53 in the pre-DPI-training test to 9.01 in the post-DPI-training test (p < 0.001). After 6 weeks, the mean scores decreased marginally to 8.87 in the retention test (p = 0.563). DPI training increased their confidence level from 5.68 pre-DPI training to 7.09 post-DPI training. Conclusions: Training DUs using DPI with an online video improved their decision-making and confidence level in treatment planning.

Comparison of the effectiveness of Morus alba and chlorhexidine gels as an adjunct to scaling and root planing on stage II periodontitis - A randomized controlled clinical trial.

OBJECTIVES: The present study aimed to assess and compare the effect of Morus alba and chlorhexidine gel as an adjunct to scaling and root planing (SRP) in treating stage II periodontitis. METHODS: A single-blind, randomized controlled trial was conducted on 180 patients with stage II periodontitis who received full-mouth SRP. They were randomly assigned to receive chlorhexidine digluconate (CHX) gel, Morus alba (MA) and placebo gel for Groups A, B and C, respectively, at the baseline, 15 days and 30 days. Plaque index (PI), Gingival index (GI), periodontal pocket depth (PPD) and quantitative analysis (culture) of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Tannerella forsythia were assessed at baseline and 45 days. Analysis of variance was used to compare the significant difference in PI, GI, PPD and microbiological parameters between the three groups after the intervention, followed by post hoc Mann-Whitney U and Tukey's HSD test for clinical and microbiological parameters, respectively. RESULTS: Intergroup comparison of the PI, GI and microbiological parameters between the MA and CHX groups at the end of 45 days did not show a statistically significant difference (p > 0.05), whereas a statistically significant difference was observed for PPD between MA and CHX groups with the mean difference of 0.18 mm (p = 0.002). CONCLUSION: Morus alba gel was found to be effective in decreasing PPD. However, there was no difference between Morus alba and chlorhexidine gel as an adjunct to SRP in treating stage II periodontitis.

Nicotine dependence and associated factors among persons who use electronic e-cigarettes in Malaysia - an online survey.

BACKGROUND: Nicotine dependence, factors associated with dependence, and self-reported side effects among people who use e-cigarettes are scarce in developing countries. METHODS: A sample of 302 persons who currently use e-cigarettes was recruited from discussion forums on Reddit, Facebook, and the forum 'lowyat'. The online Google form survey collected data on demographics, e-cigarette use, and the reasons, for cigarette smoking, Fagerstorm Test for Nicotine Dependence adapted for e-cigarettes (eFTND), and side effects experienced. RESULTS: The mean age was 25.5 years (6.5), 60.6% were males and 86% had higher education. About 47% were using e-cigarettes only, 27.8% were currently using dual products (both electronic and conventional cigarettes), and 25.2% had also smoked cigarettes in the past. 'Less harmful than cigarettes' (56.3%), 'because I enjoy it' (46.7%), and 'it has a variety of flavors (40.4%) were the common reasons for e-cigarette use. The mean eFTND score was 3.9 (SD = 2.2), with a median of four side effects (IQR 3-6), sore or dry mouth/throat (41.4%), cough 33.4%, headache (20.5%), dizziness (16.2%) were commonly reported side effects. eFTND score and side effects were higher among persons using dual products. By multiple linear regression analysis, males (ß = 0.56 95% CI 0.45, 1.05, p = 0.033), dual-use (ß = 0.95 95% CI 0.34, 1.56, p < 0.003), and use of nicotine-containing e-cigarettes (ß = 0.66 95% CI 0.07, 1.25 p = 0.024) had higher eFTND score. CONCLUSION: Our findings of the study call for the placement of disclaimers about possible nicotine addiction and side effects of e-cigarette products.

An assessment of oral cancer knowledge, attitudes, and practices among undergraduate students in Malaysian dental schools.

BACKGROUND: Oral cancer is a significant public health concern worldwide. Early detection and prevention are crucial in reducing the morbidity and mortality rates associated with this disease. As future dental professionals, dental undergraduates play a vital role in promoting oral health and identifying potential oral cancer cases. METHODS: This study aimed to evaluate the level of oral cancer awareness, knowledge, attitudes, and practices among dental undergraduates in Malaysia. A total of 595 students from years 3, 4, and 5 in both public and private universities participated. RESULTS: The results showed that a higher percentage of dental undergraduates from private universities were aware of oral cancer and had satisfactory knowledge compared to those from public universities (p < 0.05). Moreover, 59.4% of respondents felt less confident in diagnosing oral cancer during routine dental practice, and 96.1% agreed on the need to increase public awareness of oral health. Interestingly, students from private universities exhibited higher levels of awareness and knowledge regarding oral cancer than those from public universities. CONCLUSIONS: To enhance oral cancer detection and prevention, it is essential to reinforce the current curriculum and provide training to improve diagnostic skills for every dental undergraduate. This will ensure that they are well-equipped with the necessary knowledge and competence to detect and prevent oral cancer effectively.

Association of Salivary Statherin, Calcium, and Proline-Rich Proteins: A Potential Predictive Marker of Dental Caries.

Background: Salivary factors modulate the balanced dynamic mineralization process of the dental enamel. Salivary proteins such as statherin and acidic proline-rich proteins (PRPs) protect oral surfaces by regulating oral calcium homeostasis and remineralization of enamel. Thus, they possibly play vital roles in dental caries. Aim: The present study aims to find the association of salivary statherin, proline-rich protein, and calcium levels with dental caries. Methods: A descriptive, cross-sectional study was conducted among 188 healthy participants (age between 18 and 50 years), from dental clinic of MAHSA University, Malaysia. Dental caries was measured using standard WHO criteria. Stimulated whole mouth saliva was collected, and salivary statherin, acidic PRP (aPRP), and calcium levels were estimated using ELISA Kit and calorimetric assay kit, respectively. Data were analyzed using Spearman's rho and Pearson's correlation coefficient (SPSS statistical package-version 25.0) to find correlation of salivary statherin, calcium, and proline-rich protein levels with dental caries. Results: A statistically significant (P < 0.001) moderate negative correlation (r = -0.500) was found between salivary statherin and proline-rich protein levels. There was no statistically significant association of dental caries with salivary statherin, calcium, and aPRP levels. Conclusion: Salivary statherin and aPRP levels appear to perform mutually complementing functions and thus may have potential role in the maintenance of tooth integrity.

Influence of WhatsApp and electronic mail reminders on oral hygiene compliance of orthodontic patients using planimetry : A randomized clinical trial.

PURPOSE: To determine the effect of WhatsApp (Facebook Inc., Menlo Park, CA, USA) and electronic mail reminders on oral hygiene compliance of orthodontic patients. METHODS: A randomized, parallel group, double blinded study was conducted on 54 patients undergoing orthodontic treatment at a university clinic. They were randomized to 3 groups, i.e., WhatsApp (W) group, electronic mail (email) (E) group and control (C) group with 18 subjects in each group. Group (W) and group (E) received oral health messages once a week through WhatsApp and email reminders, respectively, while group (C) did not receive any reminders. Plaque was measured at baseline (T0), after 4 weeks (T1), and after 8 weeks (T2). For each subject, intraoral photographs were taken after application of a plaque-disclosing agent; and the area covered by plaque was measured on teeth 12, 13, 43, 22, 23 and 33 by planimetry. Data were analyzed using SPSS (version 22, IBM Corp., Armonk, NY, USA). Mixed analysis of variance (ANOVA) was used to compare plaque scores between and within the groups. RESULTS: A total of 54 subjects (14 males and 40 females) with mean age of 22.43 years completed the study. At the end of 8 weeks, no statistically significant difference in the mean plaque score was found between the groups at the different time intervals (p = 0.201). CONCLUSION: WhatsApp and email reminders did not significantly influence the oral hygiene compliance of orthodontic patients.

Association of Salivary Statherin, Calcium, and Proline-Rich Proteins on Oral Hygiene: A Cross-Sectional Study.

BACKGROUND: Saliva, as a complex biofluid, plays a pivotal role in maintaining oral health and tooth integrity. There has been inconsistent data available on the relationship between salivary parameters and oral health. This study aims to investigate the association between salivary statherin, acidic proline-rich proteins (aPRP), and calcium with oral hygiene status. METHODS: One hundred and eighty-eight healthy subjects aged between 18 and 50 years with varying oral hygiene status who gave consent to participate were included in this cross-sectional study. The subjects were recruited from primary oral health care of MAHSA University. Oral hygiene of all the participants was measured using Oral Hygiene Index-Simplified (OHI-S). Stimulated saliva collected using paraffin wax was analyzed for salivary statherin, aPRP, and calcium. The relationship between salivary statherin, aPRP, and calcium levels with OHI-S was assessed using Spearman's Rank correlation coefficient; the strength of relationship was assessed by multiple linear regression analysis. RESULTS: The study found a weak positive correlation (r = 0.179, p = 0.014) between salivary statherin and OHI-S; weak negative correlation (r = -0.187, p = 0.010) between salivary aPRP and OHI-S; and moderate negative correlation between salivary statherin and salivary aPRP levels (r = -0.50, p < 0.001) which were statistically significant. CONCLUSION: Poor oral hygiene is associated with increased statherin and reduced aPRP levels in saliva. Thus, these salivary components may have a role in predicting oral hygiene status.

An Overview on Betel Quid and Areca Nut Practice and Control in Selected Asian and South East Asian Countries.

Background: Areca nut (AN) and betel quid (BQ) chewing are ancient practices followed by an extensive proportion of the world's population. These practices are endemic in larger parts of South and Southeast Asia and selected Western Pacific countries. The prevalence of these habits varies across regions, age, gender, cultural practice, and socioeconomic status groups. Considerable variations exist between countries with respect to prevention/intervention programs, and policy guidelines of BQ usage. Objectives: (1) To provide an overview of the BQ chewing prevalence, practices, preventive interventions and policies in selected Asian and Western Pacific countries. (2) To explore the different terminologies associated with BQ use. Method: A narrative review of the current literature related to BQ, AN, and oral cancer was conducted by searching PUBMED, CINAHL, and GOOGLE databases. Results: The literature review revealed that the prevalence of BQ was found to be highest in Papua New Guinea, followed by Bangladesh, India, Pakistan, Myanmar and Sri Lanka. While, Cambodia, Malaysia, Indonesia and Taiwan had comparatively lower prevalence. Smokeless tobacco, BQ with tobacco, BQ without tobacco, AN were some of the terminologies used for BQ in various studies. Conclusions: The prevalence, and the interventional policies related to BQ and AN chewing habits varies widely among the selected countries. With the increasing awareness and association of BQ with oral cancer, there is a need to have better awareness, prevention and interventional strategies in place. We also found considerable variation in the use of terminologies associated with BQ.

Assessing oral cancer awareness among dental and medical students of a Malaysian private university.

OBJECTIVE: Dental and medical practitioners play a pivotal role in detecting early stages of oral cancers. Hence, future dental and medical practitioners need to have adequate knowledge of oral cancer. This study was conducted to assess the current level of knowledge, attitude and practices regarding oral cancer among dental and medical students of a Malaysian private university. METHODS: A cross-sectional study was conducted on third-, fourth- and final-year students of the dental and medical courses of MAHSA University, Malaysia. A total of 557 students participated in the survey. Oral cancer awareness, knowledge about risk factors, signs and symptoms of oral cancer, attitude and practices towards oral cancer were assessed using 43 questions. The questionnaire was pretested, and internal consistency, assessed using Cronbach's alpha, was acceptable (α > 0.7). The data were analysed using IBM SPSS version 21. The chi-square test was used to analyse the difference in oral cancer awareness between medical and dental students. RESULTS: Among 557 participants, there were 351 (63%) medical students and 206 (37%) dental students. Based on the results obtained, dental students had a higher level of knowledge than medical students regarding oral cancer (P < 0.05). More than 90% of the dental students were able to identify smoking, alcohol consumption, betel quid chewing, human papilloma virus infection and exposure to radiation as risk factors associated with oral cancer compared to more than 50% of medical students (P < 0.05). CONCLUSIONS: Through education and training, awareness amongst medical students can be reinforced, which will promote early detection of precancerous lesions and oral cancers.

Correlation of Salivary Statherin and Calcium Levels with Dental Calculus Formation: A Preliminary Study.

BACKGROUND: Salivary constituents have a wide range of functions including oral calcium homeostasis. Salivary proteins such as statherin inhibit crystal growth of calcium phosphate in supersaturated solutions and interact with several oral bacteria to adsorb on hydroxyapatite. Concurrently, saliva, which is supersaturated with respect to calcium phosphates, is the driving force for plaque mineralization and formation of calculus. Thus, the aim of the present study was to estimate and correlate salivary statherin and calcium concentration to the dental calculus formation. METHODS: A cross-sectional study was conducted to assess the relationship between salivary statherin, calcium, and dental calculus among 70 subjects, aged 20-55 years. Subjects were divided into 3 groups based on the calculus scores as interpreted by Calculus Index which was followed by collection of whole saliva using Super•SAL™. Salivary calcium levels were assessed by calorimetric method using Calcium Assay kit (Cayman Chemical, Michigan, USA) and statherin levels by using ELISA Kit (Cusabio Biotech). RESULTS: Statherin levels showed a weak negative correlation with the calcium levels and with calculus formation. The mean salivary statherin and calcium concentration were found to be 0.96 µg/ml and 3.87 mg/ml, respectively. Salivary statherin levels differed significantly among the three groups (p < 0.05). CONCLUSIONS: Our preliminary data indicates that statherin could possibly play a role in the formation of dental calculus.

Dental Anxiety among Medical and Paramedical Undergraduate Students of Malaysia.

Aim. To assess the dental anxiety level among dental, medical, and pharmacy students of MAHSA University, Malaysia. Materials and Methods. A cross-sectional questionnaire study was conducted among 1500 undergraduate students of MAHSA University. The Modified Dental Anxiety Scale (MDAS) was used to measure dental anxiety among the study population. The responses were assessed by 5-point likert scale ranging from 1 to 5. The level of anxiety was categorized into lowly anxious (5-11), moderately anxious (12-18), and severely anxious ≥19. Out of 1500 students enrolled, 1024 students (342 males and 682 females) completed and returned the questionnaire having response rate of 68.26%. Results. There was a statistically significant difference (P < 0.001) when the mean dental anxiety scores were compared among the three faculties and dental students had lowest mean score (11.95 ± 4.21). The fifth year (senior) dental students scored significantly (P = 0.02) lower mean anxiety score as compared to the first dental students (junior). The students were anxious mostly about tooth drilling and local anesthetic injection. Conclusions. Dental students have a significantly low level of dental anxiety as compared with medical and pharmacy students. Incorporation of dental health education in preuniversity and other nondental university curriculums may reduce dental anxiety among the students.

In vitro antibacterial activity of ethanolic extract of Morus alba leaf against periodontal pathogens.

CONTEXT: Antibiotic resistance is a major problem with inadvertent usage. Thus, there is a need to search for new antimicrobial agents of herbal origin to combat antibiotic resistance. One such plant is Morus alba which has a long history of medicinal use in traditional Chinese medicine. AIM: To compare the antibacterial activity of ethanolic extract of M. alba leaves with chlorhexidine gluconate against Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Tannerella forsythia. SETTINGS AND DESIGN: Experimental in vitro study. METHODOLOGY: Crude extract from the leaves of M. alba were prepared by Soxhlet extraction method by using ethanol as a solvent. Minimum inhibitory concentration (MIC) of the extract was assessed against A. actinomycetemcomitans, P. gingivalis and T. forsythia, and compared with that of chlorhexidine gluconate by broth dilution method. RESULTS: P. gingivalis was the most sensitive organism against the M. alba extract with an MIC value of 1.95 mg/ml; while T. forsythia and P. gingivalis both were most sensitive organisms against chlorhexidine gluconate with MIC values of 0.00781 mg/ml. CONCLUSION: M. alba possess good antibacterial activity against A. actinomycetemcomitans, P. gingivalis and T. forsythia and thus would be beneficial for the prevention and treatment of periodontal disease. However, chlorhexidine gluconate was found to be more effective when compared to M. alba.

Dens invaginatus type II associated with an impacted mesiodens: a 3-year follow-up.

Dens invaginatus is a developmental anomaly resulting in a deepening or invagination of the enamel organ into the dental papilla prior to calcification of the dental tissues. The prevalence has been reported to vary from 0.04% to 10%. Dens invaginatus commonly affects lateral incisors and very rarely affects the mesiodens. This article presents a rare case of type II dens invaginatus affecting an impacted mesiodens in a 13-year-old boy and describes its gross and histological features. The associated tooth was dilated and showed invaginated enamel and dentin extending beyond the cement enamel junction. In this case, the clinical diagnosis was confirmed by histological evaluation of the internal morphology using a hard tissue microtome to section the tooth.

Comparative evaluation of marginal integrity of glass ionomer and resin based fissure sealants using invasive and non-invasive techniques: an in vitro study.

BACKGROUND: Occlusal surfaces of the molars are highly susceptible to dental decay. Pit and fissure sealants are one of the best methods of preventing fissure caries. The main problem encountered is microleakage leading to deterioration of material and increased possibility of the development of secondary caries. AIMS: To assess and compare the marginal integrity of glass ionomer (Fuji VII) and resin based (Clinpro) fissure sealants using invasive and non-invasive technique. SETTING AND DESIGN: Experimental in-vitro study. MATERIALS AND METHODS: An in-vitro study was conducted on 40 healthy, extracted premolars. The teeth were divided into 4 groups. Group I: Clinpro-invasive technique, group II: Clinpro-non-invasive technique, group III: Fuji VII-invasive technique, group IV: Fuji VII-non-invasive technique. Sealants were applied and subjected to an evaluation under SEM (scanning electron microscopy) for the width of the marginal gap. ANOVA (analysis of variance) and Duncan's multiple range tests were used for the statistical analysis. RESULTS: The mean width of the marginal gap was 0.4089 µm in group I as compared to 3.0485 µm in group III; and the difference was statistically highly significant (P<0.001). In non-invasive technique, Clinpro and Fuji VII showed a mean marginal gap width of 0.4486 µm and 3.0485 µm, respectively. This difference was statistically highly significant at a P<0.001. There was no statistically significant difference in the mean widths between invasive and non-invasive techniques. CONCLUSION: Clinpro performed better in terms of marginal adaptation than did the Fuji VII sealant. The techniques (Invasive and non-invasive) does not influence the marginal integrity significantly.