Assessing the status of oral health integration in South East Asian Regional Office countries' Universal Health Coverage-A scoping review.

BACKGROUND: Oral diseases affect close to 3.5 billion people worldwide and there has been a call by the World Health Organization (WHO) to integrate oral health into the Universal Health Coverage (UHC) agenda. OBJECTIVES: To collate and synthesise information regarding the status of integration of oral health into the health systems covered by UHC across the 11 countries in the South East Asian Regional Office. METHODS: Drawing on the framework of the six building blocks of health systems as devised by WHO, we compared the public dental care coverage models, with a focus on outpatient dental care in these countries. We gathered this information from publicly available resources, databases and peer-reviewed publications to populate the template guided by the WHO Health System Building Blocks. RESULTS: We found a poor access to oral health care, lopsided distribution of manpower, rickety health information systems, and private sector domination and inadequate or absent financing mechanisms for outpatient procedures. The private sector was dominant in all countries except Thailand and Srilanka. Financing was absent in most countries and deficient in Thailand and Indonesia. Dental workforce was deficient in most countries except India, Srilanka, and Thailand. Health information systems were weak with no dental items under price control. Better UHC indicators did not guarantee a lower oral disease burden. CONCLUSIONS: Our review highlighted the close connection between service quality and human resources, governance, and finance. There is a need to establish standardised dental treatment guidelines that are uniformly adopted across countries, integrate oral health into national health and development programs, push for functional oral health research through collecting robust surveillance, economic, and social impact data and the development of cost-effective strategies tailored to each country's unique needs.

Quantifying health utilities of young adult orthodontic patients using the time trade-off method: a cross-sectional study.

OBJECTIVE: To study the feasibility of time trade-off (TTO) method in quantifying health utility ratings in different types of malocclusion. MATERIAL AND METHODS: In this cross-sectional study, 70 orthodontic patients aged 18 years or above, reporting for treatment/consultation, were included and interviewed. Malocclusion-related health utilities were assessed through the TTO method, and oral health-related quality of life was measured with the help of Orthognathic Quality of Life Questionnaire (OQLQ). Angle's classification of malocclusion was recorded. Bivariate analyses and multivariate Poisson's regression were done to find out an association between the oral health utility values, OQLQ and demographic and clinical characteristics. RESULTS: Patients with skeletal Class III malocclusion had lower health utility values than those with Class I and Class II malocclusions (p=0.013). Poisson's regression showed that Angle's Class II division 1 (0.90, CI 0.84 to 0.97), Class III (0.68, CI 0.59 to 0.95) and Skeletal malocclusion (0.79, CI 0.71 to 0.87) and OQLQ scores (1.0, CI 1 to 1.003) were found to be significant predictors of TTO utility scores. CONCLUSIONS: TTO utilities were found to be valid and well correlated with clinical findings. Health utilities could serve as useful and reliable markers of health-related quality of life (HRQL) among individuals or communities and help cost-effective preventive or intervention programs planning.

Effects of wearing personal protective equipment (PPE) and its role in affecting the work efficiency of dentists during the COVID-19 pandemic.

BACKGROUND: The risk of exposure to COVID-19 infection through droplets/aerosol in dental clinics has renewed focus on the utility and possible adverse effects of using personal protective equipment (PPE) on dentists. OBJECTIVE: To obtain information from a cross-section of dentists regarding their PPE usage and to evaluate the possible risk factors that can influence their work efficiency. METHODS: A 31-item cross-sectional survey with a structured multiple-choice questionnaire was designed. Social media and emails were used to circulate the questionnaire among dental professionals worldwide. A total of 317 respondents returned the completed forms. RESULTS: A total of 184 (55%) participants reported getting soaking wet while wearing PPE at the end of the working hours (approximately eight hours of working). Many respondents (n = 286, 90%) reported that the use of PPE resulted in reduced visibility of the operating field. The majority of respondents (84%) felt that their overall work efficiency had reduced after using PPE. Binary logistic regression had shown that two significant factors that were associated with reduced work efficiency included, pre-existing systemic illness and getting soaking wet from wearing a PPE. CONCLUSION: Definite protocols should be introduced that mandate the doffing of PPE for every patient, in a separate well-ventilated area where the skin can recuperate from the heat and pressure points caused by the PPE. Dentists should take greater care in choosing the appropriate PPE to prevent exacerbation of pre-existing illnesses, which may reduce their work efficiency.

Do residential care and low social capital negatively influence oral health-related quality of life (OHRQoL) among older adults? A cross-sectional study.

OBJECTIVES: To compare oral health status, OHRQoL and social capital between dependent older adults living in a residential care setting (RC) and community dwellers living independently (CD) and to assess the possible role of social capital and residential status as independent predictors of OHRQoL in a sample of older adults in the Udupi region of Karnataka, South India. BACKGROUND: As the global population ages, a greater number of older adults are now living in residential care settings than ever before. This study provides insights into the role of residential care and social capital in influencing the oral health-related quality of life (OHRQoL) among older adults. MATERIALS AND METHODS: A total of 296 older adults, comprising 148 dependent older adults living in residential care (RC) and 148 community dwelling older adults living independently (CD), completed the General Oral Health Assessment Index (GOHAI) and a Social Capital Scale after undergoing clinical oral examination for dentition and periodontal status. RESULTS: The caries experience in both the residential care group (RC) and the community dwelling group (CD) was high with mean DMF scores of 21.6 (SD = 9.6) and 20.1 (SD = 10.7) respectively. The Mean Social Capital score was significantly higher (P = .01) among the RC group (33.2, SD = 5.1) than the CD group (31.5, SD = 5.7), whereas the mean GOHAI score was significantly higher (P = .02) among the CD (61.5, SD = 6.8) than the RC group (59.5, SD = 7.9). Linear regression showed lower DMFT scores (ß: -0.26, P Ë‚ .001), being a community dweller (ß: 0.14, P = .01) and having higher social capital (ß: 0.11, P = .04) were associated with better OHRQoL (higher GOHAI scores) after adjusting for possible confounders. CONCLUSION: Dependent older adults living in residential care had higher social capital but poorer OHRQoL. Caries experience, residential status and social capital were independently associated with OHRQoL.

COVID-19 Related Knowledge, Attitude, Practice Evaluation among Indian Dental Patients: A Cross-Sectional Survey

ABSTRACT Objective: To assess the awareness about COVID-19 among dental patients and determine the association between COVID-19 awareness and perceived stress among dental patients. Material and Methods: A selfadministered knowledge, attitude and practices (KAP) questionnaire and perceived stress scale (PSS) were employed to assess the knowledge and attitude among dental patients visiting the outpatient department. A p-value of ≤ 0.05 was considered statistically significant. An independent t-test was used to compare the KAP and PSS scores based on age, gender, occupation and the responses to unscorable questions. Spearman's correlation was employed to assess the association between KAP and PSS scores. Results: The older participants (mean KAP score = 16±2.2), the participants who answered that the Coronavirus outbreak changed their daily routine (mean KAP score = 15.8±2.2) and the participants who answered that they changed their plans due to the Coronavirus outbreak (mean KAP score = 16±2.14) had significantly higher KAP scores when compared to their respective counterparts. The Spearman's correlation value of -0.45 suggested a moderate negative association between the KAP and PSS scores, but this correlation was not statistically significant. Conclusion: The participants had a moderate to good level of knowledge related to COVID-19 and were positive in their approach and outlook on overcoming the pandemic.

Quantifying health utilities of young adult orthodontic patients using the time trade-off method: a cross-sectional study

ABSTRACT Objective: To study the feasibility of time trade-off (TTO) method in quantifying health utility ratings in different types of malocclusion. Material and Methods: In this cross-sectional study, 70 orthodontic patients aged 18 years or above, reporting for treatment/consultation, were included and interviewed. Malocclusion-related health utilities were assessed through the TTO method, and oral health-related quality of life was measured with the help of Orthognathic Quality of Life Questionnaire (OQLQ). Angle's classification of malocclusion was recorded. Bivariate analyses and multivariate Poisson's regression were done to find out an association between the oral health utility values, OQLQ and demographic and clinical characteristics. Results: Patients with skeletal Class III malocclusion had lower health utility values than those with Class I and Class II malocclusions (p=0.013). Poisson's regression showed that Angle's Class II division 1 (0.90, CI 0.84 to 0.97), Class III (0.68, CI 0.59 to 0.95) and Skeletal malocclusion (0.79, CI 0.71 to 0.87) and OQLQ scores (1.0, CI 1 to 1.003) were found to be significant predictors of TTO utility scores. Conclusions: TTO utilities were found to be valid and well correlated with clinical findings. Health utilities could serve as useful and reliable markers of health-related quality of life (HRQL) among individuals or communities and help cost-effective preventive or intervention programs planning.

RESUMO Objetivo: Estudar a viabilidade do método Time trade-off (TTO) para quantificar escores de valoração da saúde em diferentes tipos de má oclusão. Material e Métodos: Neste estudo transversal, foram incluídos e entrevistados 70 pacientes ortodônticos com idade igual ou superior a 18 anos, que compareceram para tratamento/consulta. A valoração da saúde em relação à má oclusão foi avaliada por meio do método TTO e a qualidade de vida relacionada à saúde bucal foi medida com a ajuda do Questionário de Qualidade de Vida Ortognática (Orthognathic Quality of Life Questionnaire, OQLQ). A classificação da má oclusão segundo Angle foi registrada, e análises bivariadas e regressão multivariada de Poisson foram feitas para verificar qualquer associação entre os escores de valoração da saúde bucal, OQLQ e características demográficas e clínicas. Resultados: Os pacientes com má oclusão esquelética de Classe III apresentaram escores de valoração da saúde mais baixos do que aqueles com má oclusão de Classe I e Classe II (p=0,013). A regressão de Poisson mostrou que a Classe II de Angle divisão 1 (0,90, IC 0,84 a 0,97), Classe III (0,68, IC 0,59 a 0,95), má oclusão esquelética (0,79, IC 0,71 a 0,87) e os escores do OQLQ (1,0, IC 1 a 1,003) foram considerados preditores significativos dos escores de valoração pelo método TTO. Conclusões: Os escores do TTO foram considerados válidos e bem correlacionados com os achados clínicos, e podem servir como marcadores úteis e confiáveis da qualidade de vida relacionada à saúde (health-related quality of life, HRQL) entre indivíduos ou comunidades, e ajudar no planejamento de programas de prevenção ou de intervenção, com uma boa relação custo-benefício.

Measurement of association between malocclusion, nutritional status, and dental trauma in adolescents: A cross-sectional study.

Background: With the decrease in the incidence of dental caries globally, traumatic dental injury (TDI) has emerged as a major cause of morbidity and distress among adolescents. The aim of this study was to assess the prevalence of TDI and explore its association with malocclusion and nutritional status among adolescent population of Udupi taluk, Karnataka state, India. Methods: The sample consisted of 770 children, from randomly selected schools in Udupi taluk. An anthropometric measurement was done to record the "body mass index", an oral examination was done to record the "Dental Aesthetic Index" for malocclusion and "Andreasen classification" for TDI. Statistical analysis included chi-square test and bivariate and multivariate binary logistic regression. A p value of ≤0.05 was considered statistically significant. Results: The prevalence of TDI was 11.8%. The prevalence of overweight and obesity was 20.3%. The prevalence of malocclusion recorded in the study population was 49.8%. When prevalence of TDI was compared against gender, the type of school attended, and presence/absence of malocclusion, it was found that there was a statistically significant difference in prevalence of trauma between the aforementioned parameters (p ≤ 0.05). Results of the multivariate analysis through logistic regression indicated that being a male [3.87 (3.21-4.72)], attending a public school [1.41 (1.19-1.63)], and having malocclusion [1.55 (1.32-1.71)] significantly increased the odds of sustaining TDI. Conclusion: The results indicated a strong association between TDI, gender, the type of school attended, and malocclusion, and they have important implications toward the health and well-being of the individual communities.

Effect of life course factors on dental fear among adult dental patients attending out-reach clinics in a rural area of Southern India.

Objectives: The aim of the study was to assess the effect of life course factors on dental fear among adult dental patients attending out-reach clinics in a rural area of South India. The objectives were to measure dental fear and changes in socio-economic status during the life course among the study population and to know whether social mobility reduced/increased dental fear. Methods: Dental fear scale and life course data were collected from 403 respondents. The improvement status of individual life course criteria was categorised into "less/minimal", "stable", or "upwardly mobile". Results: The odds of dental fear in the group showing less or minimal upward social mobility was two times that of the stable group [p = 0.022; 95% confidence interval (C.I): 1.104-3.598], whereas the odds of dental fear in the group showing more or good upward social mobility were 4.5 times that of the stable group [p = 0.001; 95% C.I: 1.928-10.515] when adjusted for covariates, that is, participant age, gender, and education and past history of dental avoidance. Conclusion: Social mobility was found to be a risk indicator for dental fear. Dental services may have been affected even with increased standards of living because of psychological factors such as dental fear.

Nicotine dependence and its association with health utility ratings among a sample of Indian dental patients.

OBJECTIVES: To measure utility ratings and quality-adjusted life-years(QALYs) for nicotine dependence-related health states using the standard gamble approach among a sample of dental patients; investigate the possible associations of nicotine dependence, and study the influences on tobacco-related health state utilities estimates among patients. METHODS: A sample of 200 adult outpatients who were current or former consumers of tobacco were included in the cross-sectional study. Demographic, oral health self-rating and tobacco-related data (Fagerstrom scale for nicotine dependence, type of tobacco consumed, frequency and duration of the habit) were collected. A standard gamble method of utility valuation was also carried out. RESULTS: Older age, lower educational attainment, higher frequency of consumption, increased duration of the habit, consumption of chewing tobacco, as opposed to smoking tobacco, and poor oral health were associated with higher nicotine dependence. Lower nicotine dependence, better oral health and quitting the habit were associated with better health utility estimates. QALYs lost due to the habit among the 'low to moderate' and 'significant' nicotine dependence groups were 2.7 (sd, 3.7) and 6.7 (sd, 8.0) years, respectively. CONCLUSIONS: Higher health utility ratings were seen among patients with 'low to moderate' nicotine dependence, better oral health status and quitters of the tobacco habit. Quality of life weights generated through this method could be used for cost-utility analyses of tobacco cessation/prevention interventions in different settings and cultures.

A Call for Action to Safely Deliver Oral Health Care during and Post COVID-19 Pandemic.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak started just a couple of months ago and it grew rapidly causing several deaths and morbidities. The mechanism behind the transmission of the virus is still not completely understood despite a multitude of new specific manuscripts being published daily. This article highlights the oral cavity as a possible viral transmission route into the body via the Angiotensin converting enzyme 2 receptor. It also provides guidelines for routine protective measures in the dental office while delivering oral health care.

The Impact of Lifestyles on Dental Caries of Adult Patients in Udupi District: A Cross-Sectional Study.

BACKGROUND: Dental caries is preventable if favorable health behavior is successfully established. Exploring the broader concept of lifestyle will be useful to determine that how lifestyle of people can affect dental caries. AIM: The aim of this study was to determine the impact of overall lifestyle of an individual (analyzed using health practice index) on dental caries of adult population. MATERIAL AND METHODS: This cross-sectional study comprising structured questions on health practice index, sociodemographic variables, and oral health-related behavior was conducted on 800 study subjects of age 20-50 years attending outreach dental setups of a dental school in India. Dental caries was recorded with decayed, missing, and filled teeth (DMFT) index.Statistical analysis was carried out using frequency distribution for variables related to lifestyle, mean ± standard deviation for DMFT, and negative binomial regression to predict a dependent variable (DMFT) that consisted of "count data." RESULTS: The study subjects who were older age, women, unemployed, and unskilled; those with lower education, lesser income, and lower socioeconomic status; those never visited dentist; and those with lesser frequency of cleaning teeth, overall poorer lifestyles, and moderate lifestyles were more prone to have dental caries than their counterparts. CONCLUSION: Dental caries is a multifactorial disease. Patients' involvement in self-care by promoting healthy behaviors such as brushing twice a day, visiting dentist regularly, negating orally abusive substance addiction, having breakfast every day, eating a balanced diet, and reducing stress leads to an overall good lifestyle. These factors along with sleeping a minimum of 7-8h per night and working for 8-9h per day and ample daily exercise may help patients improve or protect their oral health for years to come.

Efficacy of GC Gold Label 9 and GC Miracle Mix® Restorations using Atraumatic Restorative Treatment (ART) in Rural Settings: A Randomized Controlled Trial.

Objectives: This study compared the longevity of high strength posterior glass ionomer and metal-reinforced glass ionomer using ART in rural settings within an 18-month observation period. Study Design: A nonblinded parallel design randomized controlled trial was conducted among children who attended dental outreach programs in a rural area of Southern India. Atraumatic Restorative Treatment (ART) was performed in 92 permanent posterior teeth with either high strength posterior glass ionomer or metal-reinforced glass ionomer restorations. The allocation ratio was 1:1. Restorations were evaluated at 1, 6, 12 and 18 months after placement. Results: The success rate of metal-reinforced glass ionomer restorations was 100%, 95.4%, 90.4% and 87.2% as compared to high strength posterior glass ionomer whose success rates were 100%, 93%, 85% and 61.8% at the four follow ups respectively. There was a statistically significant difference between the success rate of the two materials at the end of 18 months with the metal-reinforced glass ionomer restorations having a higher success rate (p=0.015). Conclusions : Although the clinical performance of both materials were largely similar, the metal-reinforced glass ionomer restorations had a higher success rate than the conventional GIC at the end of 18 months of follow-up.

Risk assessment for osteoradionecrosis of the jaws in patients with head and neck cancer.

OBJECTIVES: To identify the potential risk factors for the occurrence of osteoradionecrosis (ORN) of the jaws among patients who have been treated with radiotherapy for head and neck malignancy. METHODS: The study comprised of 231 patients treated with radiotherapy for head and neck malignancy at a tertiary referral center. The following details were recorded for each patient: age, gender, histopathological diagnosis, clinical staging, tumor site, treatment modality, radiation dose, radiation field, number of fractions, type of accelerator used, radiation area and duration of follow-up. Patient's tobacco, alcohol habit history, and history of extraction of teeth before/during/after radiotherapy were also noted. RESULTS: Thirteen patients had osteoradionecrosis (frequency 5.62%). Among the radiotherapy variables assessed, increased radiation area was found to be significantly associated with the occurrence of osteoradionecrosis. Among the 13 ORN cases, 10 (76.9%) had a history of tobacco consumption, 8 (61.5%) had a time interval between radiotherapy and occurrence of ORN of less than 1-year duration. CONCLUSIONS: We found a low cumulative incidence of osteoradionecrosis and a tendency to occur within a year of starting radiotherapy. Patients of older age, those with a prior tobacco habit may be considered more liable to develop osteoradionecrosis. A larger radiation field may also put patients at hazard for developing osteoradionecrosis.

Validation of an Indian (Kannada) translation of the Family Impact Scale questionnaire and the impact of malocclusion on the families of adolescent school children.

OBJECTIVES: The objectives of this study were to validate an Indian translation of the Family Impact Scale (FIS) questionnaire and assess the impact of malocclusion on the families of adolescent school children between 12 and 15 years old across socio-economic strata (SES). MATERIALS AND METHODS: The sample consisted of 768 school children aged between 12 and 15 years from randomly selected schools in Udupi district. The FIS and informed consent forms were sent through the children to be completed by their parents. Information was collected on socio-demographic details, past dental visit in the last year, type of school and SES. Clinical examination for malocclusion using the Dental Aesthetic Index was conducted by a single trained and calibrated examiner. RESULTS: The prevalence of malocclusion was 59.9%. The intra-class correlation for the total FIS score of 0.95 and Cronbach's alpha value of 0.88 demonstrated internal consistency. There was a significant difference in the overall and subscale scores of FIS between parents of children with and without malocclusion (P < 0.001). Parents of children who had malocclusion had significantly higher FIS scores across all SES (P < 0.001). Parents of children with malocclusion had 1.86 (P < 0.001, 95% CI = 1.60-2.17) times higher FIS scores than parents of children without malocclusion after adjusting for age, gender, SES, and past dental visits in the last year. CONCLUSION: The psychometric properties of the FIS were found satisfactory for assessing the effect of a child's oral condition on his/her family. Malocclusion in children had a significant negative influence on the family impact scores.

Children's perception of other children with dental fluorosis - A cross-sectional study.

BACKGROUND: Dental appearance may influence how others perceive individuals. This study would help to understand whether young people make judgments about other young people with dental fluorosis. AIM: We aimed to evaluate the perception of children aged 12-15 years about other children with visible dental fluorosis. MATERIALS AND METHODS: A self-administered social attribute questionnaire was used to capture dental appearance-related judgments of 455 children aged 12-15 years, from 6 schools. All the children were given either a set of full-face photographs of a boy and a girl, without dental fluorosis or digitally modified anterior teeth to show visible dental fluorosis. The Total Attribute Score (TAS) was measured by totaling the participant's ratings for each characteristic, ranging from 11 (most negative score) and 44 (most positive). RESULTS: A total of 437 children participated, 53.8% (235) were males with a mean age of 13.99 ± 0.825. The mean TAS for photographs with fluorosis (25.9 ± 4.73) was significantly lower than without fluorosis (34.8 ± 4.83) (p < 0.001). Concerning gender, age, and SES, photos with fluorosis had significantly lower mean TAS than without fluorosis (p < 0.001, <0.001, <0.001 and < 0.001), respectively. CONCLUSION: Children in our study perceived that fluorosis could have a negative impact on their appearance.

School Interventions-based Prevention of Early-Childhood Caries among 3-5-year-old children from very low socioeconomic status: Two-year randomized trial.

OBJECTIVES: To assess the effectiveness of school-based interventions to prevent early childhood caries (ECC) among preschool children from very low socioeconomic background over a period of 2 years. MATERIALS AND METHODS: Four hundred and twenty preschool children between the ages of 3-5 years participated in this double blind, three parallel arm clinical trial. School only interventions such as prohibition of sugary snack consumption in school, teacher supervised daily brushing using fluoridated toothpaste, and oral health education were implemented with regular follow-up at 6 months, 1, and 2 years. The study group had all three interventions, in active control-tooth brushing and oral health education, and in negative control, only oral health education. Decay at d1/d2 using World Health Organization criteria, visible plaque and gingival inflammation were assessed at all follow-ups. The value of P < 0.05 was considered significant. RESULTS: Absolute caries risk reduction in the study group was 20 percent and 12 percent when compared to active, negative controls after 2 years. Mean caries increment in the study group was 0.4 for d1/d2, for the active control group was 0.9 and negative control 0.8. The effect of interventions to prevent ECC in each group was calculated using the Çohen's d, and the study group had a score of 0.6 when compared with active controls and 0.9 in comparison to the negative control group. CONCLUSIONS: Prohibition of sugary snacking in school and daily supervised tooth brushing, with or without oral health education is effective in preventing ECC among preschool children with health neglect in very low-resource settings.

Evaluation of Sugar Content and Erosive Potential of the Commonly Prescribed Liquid Oral Medications

Abstract Objective: To assess the total sugar content, endogenous pH, total soluble solids content (TSSC) and titratable acidity of the commonly prescribed long-term and short-term liquid oral medicines (LOM) for children and to compare the erosive potential with the total sugar content and total soluble solids of the LOM. Material and Methods: Twenty-three most commonly prescribed pediatric LOM were evaluated in-vitro for the cariogenic and erosive potential. Manufacturers' information on labels, endogenous pH, titratable acidity, TSSC, and the total sugar content was determined. Descriptive statistics and the Mann-Whitney U test were applied. Results: Overall, 22 LOM contained sugar. Only 3 LOM revealed the sugar content of the formulation but did not disclose the quantity (Cheston, Ventorlin and Eptoin). None of the samples revealed the sugar content as well as endogenous pH in their labels. The overall mean total sugar content was 6.92 ± 3.49 g/100ml, ranging from 3.40 ± 0.00 (corticosteroids) to 9.67 ± 0.61 (antitussive/expectorant). The mean endogenous pH for the total sample of medicines was 5.91 ± 1.51 (range of 3.5 to 10.3). Eptoin (0.013%) presented the lowest titratable acidity and Imol (1.171%) presented the highest titratable acidity with an overall mean of 0.40 ± 0.73. Omnacortil and Epilex presented the highest TSS content (19.3%), and Ventorlin presented the lowest TSS content (18.7%) with an overall mean of 18.97 ± 0.19. Over twelve medicines were identified to have the potential to cause dental erosion. No significant differences were seen in the total sugar content, total soluble solids, titratable acidity, and the endogenous pH between the short-term and long-term LOMs (p=0.145, p=0.263, p=0.067 and p=0.107), respectively. Conclusion: The pediatric LOMs showed the presence of the sugar, low endogenous pH, high titratable acidity and high total soluble solids.

Adherence of Randomized Controlled Trials to Consolidated Standards of Reporting Trials 2010 Guidelines: A Survey of Randomized Controlled Trials Published in 2011-2016 in 3 Periodontology Journals.

OBJECTIVE: To assess the quality of reporting of randomized controlled trials (RCTs) in the Journal of Clinical Periodontology (JCP), Journal of Periodontology (JOP), and Journal of Periodontal Research (JPR), published in the years 2011 until 2016, using Consolidated Standards of Reporting Trials (CONSORT) 2010 guidelines. METHODS: A thorough search of PubMed for RCTs published between January 2011 and December 2016 in the three journals was carried out. The CONSORT 2010 checklist (36 questions) was used to evaluate the adherence of these RCTs to these guidelines. A modified CONSORT score was calculated and categorized as "perfect" (100%), "excellent" (80%-99%), "good" (60%-79%), "modest" (40%-59%), and "poor" (<40%). RESULTS: A total of 369 RCTs were published in the three periodontology journals from 2011 until 2016. Based on the modified CONSORT score among all the RCTs, title, abstract, and introduction sections of the included RCTs showed good adherence to the CONSORT 2010 guidelines (60%-79%), whereas the adherence was poor for half the items in methodology (<40%), results (<40%), and discussion (40%). The highest modified CONSORT score was obtained for the trials published in the JCP from 2011 to 2016, whereas the lowest score was achieved by the RCTs in the JPR. Overall, none of the RCTs in any of the journals were perfect in reporting the trials as per the guidelines. Almost half of the RCTs in the JCP showed good adherence (51.1%), whereas almost three-fourths of the RCTs in the JOP (72%) and JPR (82.7%) showed modest to poor adherence as per the reporting guidelines (P < .001). CONCLUSION: Among the three periodontology journals assessed, the JCP showed better adherence than the JOP and JPR from 2011 until 2016.

Efficacy of chlorhexidine, hydrogen peroxide and tulsi extract mouthwash in reducing halitosis using spectrophotometric analysis: A randomized controlled trial.

BACKGROUND: To evaluate the efficacy of tulsi extract mouthrinse in reducing halitosis as compared to chlorhexidine and hydrogen peroxide mouthrinses using spectrophotometric analysis. MATERIAL AND METHODS: It was a parallel, single center, double blinded randomized controlled trial of 15 days duration. A total of 300 participants were screened, out of which 45 subjects those fulfilled inclusion criteria of age range 17-35 years were included in the trial. The participants were randomly provided with tulsi, hydrogen peroxide or chlorhexidine mouthwashes (control group) to use 10 ml twice daily for 15 days. Clinical measurements were taken at baseline and 15 days using arbitrary 0-5 scale for organoleptic odor assessments, spectrophotometric analysis for Volatile Sulphide Compounds (VSCs) from saliva samples, Löe & Silness gingival index and Silness & Löe plaque index. RESULTS: After intervention, organoleptic, VSCs, gingival and plaque scores showed statistically significant decrease in all the three study groups. The mean percentage reduction in VSC and organoleptic scores was significantly greater in chlorhexidine and hydrogen peroxide groups than in the tulsi group and the mean percentage reduction in plaque and gingival scores was significantly greater in chlorhexidine group than in hydrogen peroxide and tulsi group. CONCLUSIONS: Tulsi may not have the efficacy of chlorhexidine and hydrogen peroxide mouthrinses. But, Tulsi is effective in reducing halitosis, plaque and gingivitis and with its lack of side effects & cost effectiveness, can be an effective & economic tool to deal with halitosis. The spectrophotometric technique appears to be a promising method for evaluation of oral malodor. Key words:Halitosis, tulsi mouthwash, chlorhexidine, hydrogen peroxide, spectrophotometric analysis.

Factors affecting the interrelationship between cynical hostility and dental anxiety among dental patients.

OBJECTIVES: The objectives of this study were to assess the relationship between dental anxiety and cynical hostility in a sample of dental patients and to study the possible role of socioeconomic status (SES) in this relationship. MATERIALS AND METHODS: A total of 288 dental patients completed a self-administered questionnaire consisting of the cynical distrust scale (CDS) and the modified dental anxiety scale (MDAS). Data on sociodemographic characteristics were also collected. RESULTS: Dental anxiety as reflected by mean MDAS scores was significantly higher among the younger age group (P = 0.002), among females (P = 0.025), and the lower SES groups (P = 0.001). Cynical hostility was significantly higher among the older age group (P = 0.03), among males (P = 0.02), and among the lower SES groups, respectively, (P = 0.001). When the CDS scores for individuals with and without dental anxiety were compared within the context of the three socioeconomic strata, there was a statistically significant difference (P = 0.029) in scores between the two anxiety groups in the middle socioeconomic strata where the cynical distrust scores were lower among the anxiety group. DISCUSSION: Mediation analysis revealed that SES played an important role in the association between dental anxiety and cynical hostility. It also showed that the mediating effect is not uniform across socioeconomic strata and may be different in different societies with their own unique population structures and classes.