Preventing Early Childhood Caries through Oral Health Promotion and a Basic Package for Oral Care: A Pragmatic Trial.

Introduction: Untreated caries in mothers is one of the common risk factors for early childhood caries (ECC). Aim: The aim of the study was to investigate the impact of an oral health promotion program on ECC. Methodology: We conducted a pragmatic trial at 12 primary health centers in a rural community of India with 311 pregnant women using fluoride toothpaste, oral health information through pamphlets, and referral to urgent dental care or atraumatic dental treatment as the test intervention. Data were collected through structured interviews at baseline and oral examination of the children at 2 years of age. Results: Of the 311 women who participated, 274 children were followed up with at 2 years of age. ECC was low and comparable in both groups. When compared with the control group, significantly, more children from the intervention group were breastfed for over 6 months of age (P = 0.012) and consumed less sugar (P < 0.001). The number of mothers' decayed teeth (P = 0.01), children's sweet scores (P < 0.001), and the age at which brushing commenced for children (P = 0.04) increased the likelihood of tooth decay in children. Conclusion: The oral health promotion program had some beneficial effects in preventing caries in children when provided to pregnant women.

A comparative effect of various surface chemical treatments on the resin composite-composite repair bond strength.

AIM: The aim of this in vitro study was an attempt to investigate the effect of different surface treatments on the bond strength between pre-existing composite and repair composite resin. MATERIALS AND METHODS: Forty acrylic blocks were prepared in a cuboidal mould. In each block, a well of 5 mm diameter and 5 mm depth was prepared to retain the composite resin (Filtek™ Z350, 3M/ESPE). Aging of the composite discs was achieved by storing them in water at 37°C for 1 week, and after that were divided into 5 groups (n = 8) according to surface treatment: Group I- 37% phosphoric acid, Group II-10% hydrofluoric acid, Group III-30% citric acid, Group IV-7% maleic acid and Group V- Adhesive (no etchant). The etched surfaces were rinsed and dried followed by application of bonding agent (Adper™ Single Bond 2. 3M/ESPE). The repair composite was placed on aged composite, light-cured for 40 seconds and stored in water at 37°C for 1 week. Shear bond strength between the aged and the new composite resin was determined with a universal testing machine (crosshead speed of 0.5 mm/min). STATISTICAL ANALYSIS: The compressive shear strengths were compared for differences using ANOVA test followed by Tamhane's T2 post hoc analysis. RESULTS: The surface treatment with 10% hydrofluoric acid showed the maximum bond strength followed by 30% citric acid, 7% maleic acid and 37% phosphoric acid in decreasing order. CONCLUSION: The use of 10% hydrofluoric acid can be a good alternative for surface treatment in repair of composite resin restoration as compared to commonly used 37% orthophosphoric acid.

The role of hemisection in the prosthetic management of a distal extension ridge--a case report.

UNLABELLED: This case report illustrates the use of hemisection to minimize the distal extension span. The LR6 was the only molar next to a distal extension of the lower Kennedy's Class II ridge. Its unrestorable distal root was removed and its mesial portion was retained to serve as an effective antagonist and abutment tooth and lessen the extent of right distal extension. CLINICAL RELEVANCE: Regarding the prosthetic rehabilitation of distal extensions, hemisection can be advantageous and offered as an alternative to other treatment modalities.

Restoration of incisal half with edge-up technique using ceramic partial crown in turner's hypoplasia: A case report.

This case report describes a rare treatment modality for Turner's hypoplasia done with a very conservative approach for the esthetic and functional problem of the defect. Diagnosis was made as Turner's hypoplasia of upper two central incisors with proximal caries. Treatment planning was done after considering many factors such as conservation of tooth structure, esthetics, occlusion and economy. Tooth preparation was done to receive Edge-up, all ceramic partial crowns for both the upper central incisors,using pressable all ceramic material and cemented with resin cement.

Pulp hyperthermia during tooth preparation: the effect of rotary--instruments, lasers, ultrasonic devices, and airborne particle abrasion.

The rise in pulp temperature during restorative therapy can compromise vitality of the dental pulp. Of the various reasons for the increase in intrapulpal temperature, tooth preparation is considered to be the primary cause. This article describes the reasons for the rise in pulp temperature during various modalities of tooth preparation. The article also comments on the measures that need to be taken to avoid the risk of pulp hyperthermia during tooth preparation.

Assessment of the wetting behavior of three different root canal sealers on root canal dentin.

AIM: The objective of the present study was to evaluate and compare the wetting behavior of three different root canal sealers on the root canal dentin surface treated with irrigants and their combination. MATERIALS AND METHODS: Decoronation and apical third resections of 27 extracted single-rooted human mandibular premolars were done. The roots were then split longitudinally into two halves, and randomly assigned into three treatment groups (n=18). The root dentin surfaces in Group1, Group 2 and Group 3 were treated with 17% ethylene diamine tetra acetic acid (EDTA), 3% sodium hypochlorite (NaOCl) and combination of 17% EDTA and 3% NaOCl, respectively. Each group was subdivided into three subgroups of 6 specimens each, depending on the the sealer used, i.e. sub group A. zinc oxide (ZnOE), sub group B. AH plus, subgroup C. Guttaflow sealer, respectively. The contact angle was measured using First Ten Angstroms (FTA) 200 dynamic contact angle analyzer. RESULTS: The contact angle values for AH Plus sealer were significantly lower when compared to the other two sealer groups. CONCLUSION: The wettability of AH Plus sealer on the root surface dentin was found to be better than Gutta-Flow and ZnOE sealer.

Indian dental students' preferences regarding lecture courses.

Teaching and learning activities in the dental clinic or hospital are a challenging area for students as well as teachers. With various teaching methodologies being used in dental schools around the world, gaining greater understanding of students' attitudes toward these methodologies would be useful for dental educators. The objective of this study was to explore the preferences of dental students in India about various aspects of lecture courses. A structured survey consisting of ten closed-ended questions was developed, and 2,680 undergraduate students from forty-three dental schools in India were approached via e-mail with a follow-up postal mailing. Of these, 1,980 students responded, for a response rate of 73.8 percent. Most of the students reported preferring lectures with the aid of PowerPoint and chalkboard. They preferred morning lectures from 8 am to 10 am for a maximum of thirty to forty minutes for each lecture, and they preferred to receive information about the lecture topic in advance. The students said that delivery of clinical demonstrations was beneficial after the lectures, and they preferred learning-based rather than exam-oriented education. The respondents also said that attendance should be made compulsory and that numerical marking of examinations should not be replaced by a grading system.

Management of supernumerary teeth.

Supernumerary paramolars are the rare anomalies of the maxillofacial complex. These are more common in the maxilla than in the mandible. This article reviews the etiology, frequency, classification, complications, diagnosis and management of supernumerary teeth (bilateral maxillary paramolars).

Microleakage of bonded amalgam restorations using different adhesive agents with dye under vacuum: an in vitro study.

AIM: In an effort to minimize tooth preparation, yet provide additional retention to compromised tooth structure, bonded amalgam restorations were introduced. Various resin-based adhesives have been tried earlier under bonded amalgam restorations. Still there are controversies regarding the outcome of bonded amalgam restorations regarding their adaptability to the tooth structure and microleakage. Therefore, this study was undertaken to compare the microleakage of bonded amalgam restorations using different adhesive materials. MATERIALS AND METHODS: Standard Class I cavities were prepared on occlusal surfaces of 60 human molars. Teeth (n=60) were divided into three groups according to the material employed, as follows: group I: amalgam with glass ionomer cement (GIC) (type I); group II: amalgam with resin cement (Panavia F 2.0) and group III: amalgam with Copalex varnish as a control. Following restoration, the teeth were submitted to thermal cycling. The teeth were subsequently immersed in 2% rhodamine B dye under vacuum for 48 hours and sectioned to allow the assessment of microleakage under stereomicroscope. RESULTS: The values were tabulated and the results were statistically analyzed using analysis of variance (ANOVA), Tukey's post hoc test and Kruskal-Wallis test. Amalgam with type I GIC showed the least leakage with no statistically significant difference (P value 0.226) when compared to amalgam with Panavia F 2.0 and amalgam with varnish (P value 0.107). CONCLUSION: It can be concluded that bonded amalgam with type I GIC is a good alternative to amalgam with resin cement (Panavia F 2.0) and amalgam with varnish for large restorations, with the added advantages of GICs. CLINICAL SIGNIFICANCE: Bonded amalgam restorations prevent over-preparation and reduce the tooth flexure. GIC type I under amalgam provides chemical bonding in between amalgam and tooth structure and thus reduces the microleakage.

Management of dentinal hypersensitivity: a review.

Dentinal hypersensitivity is a very common clinical finding that can cause considerable concern for the patient. Clinicians must understand the various etiological factors, their complexities, and numerous treatment options available. This article reviews the etiology, management, and prevention of dentinal hypersensitivity.

A review of root fractures: diagnosis, treatment and prognosis.

UNLABELLED: Tooth fractures (crown or root fractures) are commonly encountered emergencies in a dental clinic. Root fractures are defined as fractures involving the dentine, cementum and pulp. They are broadly classified as horizontal and vertical root fractures. They may be clinically challenging cases to treat as, usually, treatment of such cases requires an interdisciplinary/multidisciplinary approach for complete rehabilitation of teeth. For a successful outcome, it is imperative to arrive at an appropriate diagnosis and design a treatment plan accordingly as soon as possible.This review article discusses the various types of root fractures, their diagnosis and treatment, along with the factors affecting their healing and prognosis. CLINICAL RELEVANCE: Treatment of root fractures depends on a number of factors such as, position of fracture line, mobility of tooth and pulpal status. Thus clinicians must have thorough knowledge and adequate clinical experience to treat them properly.

Effects of saliva contamination and decontamination procedures on shear bond strength of self-etch dentine bonding systems: An in vitro study.

OBJECTIVE: This study aims to evaluate the effect of saliva contamination on the shear bond strength of two self-etch dentine bonding systems and also investigate the effect of decontamination procedure on the recovery of bond strength. MATERIALS AND METHODS: Sixty premolars extracted for orthodontic reason were obtained and the buccal surfaces of teeth were reduced to create a flat dentine surface. The samples were randomly divided into three sub-groups for AdheSE (ASE) (Ivoclar - Vivadent, Schaan, Liechtenstein) and three sub-groups for Adper Prompt Self-Etch Adhesive (ADP) (3M ESPE, St Paul, MN, USA) of 10 each. For AdheSE (ASE); ASE-I was the control group (primer applied to fresh dentine surface), ASE-II was the contamination group (primer applied, followed by saliva contamination and then air dried) and ASE-III was the decontamination group (primer applied, followed by saliva contamination, air dried and then primer reapplied). For Adper Prompt (ADP); ADP-I was the control group (self-etch adhesive applied to fresh dentine surface), ADP-II was the contamination group (self-etch adhesive applied, followed by saliva contamination and then air dried) and ADP-III was the decontamination group (self-etch adhesive applied, followed by saliva contamination, air dried and then self-etch adhesive reapplied). Followed by the bonding procedure, a 5 mm composite resin block with Filtek P-60 (3M ESPE, St Paul, MN, USA) was built on the substrate. Shear bond strength (SBS) was tested with Instron Universal testing machine (Instron Corporation, Canton, MA, USA) with a cross head speed of 1 mm per minute. Data obtained was subjected to one way ANOVA test, while the inter group comparison was made using Tukey's multiple comparison and Unpaired t-test. RESULTS: In AdhSE group (ASE), the sub-group ASE-II (contamination group) [5.4 ± 2.2 MPa] showed lower SBS than ASE-I [11.8 ± 2.6 MPa] and ASE-III [8.9 ± 3.3 MPa], which was statistically significant. There was no significant difference in the bond strength between the ASE-I (control group) and ASE-III (decontamination group). In Adper Prompt group (ADP), there was a severe decrease of bond strength in ADP-II (contamination group) [4.6 ± 1.1 MPa] when compared to ADP-I (control group) [7.4 ± 1.4 MPa] and ADP-III (decontamination subgroup) [14.1 ± 2.2 MPa] which was statistically significant. The bond strength of ADP-III wherein Adper Prompt bonding agent was reapplied after salivary contamination was found to be statistically significant than ADP-I and ADP-II. CONCLUSION: Saliva contamination reduces the dentine bond strength of both the self-etch systems; AdheSE and Adper Prompt. Re-application of the primer for the AdheSE and re-application of the adhesive for the Adper Prompt after air drying the saliva off can recover the dentine bond strength. In the Adper Prompt group, the added application of adhesives to decontaminate saliva not only recovered the bond strength but also improved it significantly.

Comparison of the shear bond strength of RMGIC to a resin composite using different adhesive systems: An in vitro study.

AIM: This study evaluated and compared the role of newer dental adhesives to bond composite resin to the resin modified glass ionomer (RMGIC) liner. MATERIALS AND METHODS: Thirty-six specimens were prepared on acrylic blocks, with wells prepared in it by drilling holes, to retain the RMGIC. The specimens were randomly divided into three groups of 12 specimens each. In group I, a thin layer of an adhesive, which was a Total-etch type (Adper Single bond-2), was applied between RMGIC and the composite resin. Ingroup II, a Self-Etch adhesive (Adper prompt-L pop) was applied, and in group III there was no application of any adhesive between RMGIC and the composite resin. After curing all the specimens, the shear bond strength was measured using an Instron universal testing machine. RESULTS: The results were drawn and tabulated using ANOVA-fishers and Tukey's statistical tests. The maximum shear bond strength values were recorded in group II specimens with the self-etch adhesive (Adper prompt-L pop), showing a mean value of 5.826 when compared to the group I adhesive-Total-etch type with a mean shear bond strength of 4.6380, while group III specimens, where no adhesive was used, showed a minimum mean shear bond strength of 2.8385. There was a great and significant difference between group I and group II (P value 0.003), whereas, both group I and group II showed a vast and significant difference from group III (P value 0 - 001). CONCLUSION: Hence, this present study concludes that application of Self-Etch adhesive (Adper prompt-L pop) in between RMGIC and composite resin increases the shear bond strength between RMGIC and the resin composites, as compared to the Total-etch type adhesives (Adper Single Bond 2), as well as, without application of the adhesive agent.

Asthma and oral health: a review.

Asthma is a chronic inflammatory condition that causes the airways to constrict and produce excess mucus, making breathing difficult. It is characterized by the obstruction of airflow which is variable over a short period of time. This condition is reversible, either spontaneously or can be controlled with the help of drugs. Asthma medication comprises bronchodilators, corticosteroids and anticholinergic drugs. Most of these drugs are inhaled using various forms of inhalers or nebulizers. The effect of these drugs on oral health is the subject of debate among dental practitioners. Patients taking asthma medication may be at risk of dental caries, dental erosion, periodontal diseases and oral candidiasis. Hence, patients with bronchial asthma on medication should receive special prophylactic attention. This article reviews the correlation between asthma and oral health, and suggests various measures to counter possible oral health problems related to asthma.

Use of a natural tooth crown as a pontic following cervical root fracture: a case report.

The loss of anterior teeth can be psychologically and socially damaging to the patient. Despite a wide range of treatment options available, traumatised teeth may be inevitably lost on certain occasions. This paper describes the immediate replacement of a right central incisor using a fibre-composite resin with the natural tooth crown as a pontic. The abutment teeth can be conserved with minimal or no preparation, thus keeping the technique reversible, and can be completed at chair side thereby avoiding laboratory costs. It can be used as an interim measure or a definitive prosthesis.

A comparative histological analysis of human pulp following direct pulp capping with Propolis, mineral trioxide aggregate and Dycal.

BACKGROUND: Permanent teeth pulp exposures have traditionally been treated with calcium hydroxide pulp capping. The aim of this study was to investigate the response of human pulp tissue which were mechanically exposed to a new material, Propolis and compare it with two existing and commonly used pulp capping agents (mineral trioxide aggregate and Dycal). METHODS: Thirty-six intact human premolars were mechanically exposed. Teeth were divided into six groups of 6 teeth each and were capped with Propolis, mineral trioxide aggregate and Dycal. Final restoration was done with posterior composite resin using light cured glass ionomer cement as a liner. The teeth were then extracted on the 15th or the 45th day and processed for histological evaluation. RESULTS: Differences in inflammatory response and dentine bridge formation of the exposed pulp to the three different materials were statistically calculated using chi-square test and were found to be non-significant. There was more pulp inflammation in teeth treated with Dycal than with Propolis and MTA on the 15th as well as on the 45th day. Propolis and MTA showed bridge formation in more teeth, and the bridges were in closer proximity to pulp capping material than teeth treated with Dycal on the 45th day. CONCLUSIONS: The response of pulps to Propolis as a pulp capping agent was comparable to MTA and Dycal.

Strategies to overcome polymerization shrinkage--materials and techniques. A review.

UNLABELLED: Stress generation at tissue/resin composite interfaces is one of the important reasons for failure of resin-based composite (RBC) restorations owing to the inherent property of polymerization shrinkage. Unrelieved stresses can weaken the bond between the tooth structure and the restoration, eventually producing a gap at the restoration margins. This can lead to postoperative sensitivity, secondary caries, fracture of the restorations, marginal deterioration and discoloration. As polymerization shrinkage cannot be eliminated completely, various techniques and protocols have been suggested in the manipulation of, and restorative procedures for, RBCs to minimize the shrinkage and associated stresses. Introduction of various newer monomer systems (siloranes) may also overcome this problem of shrinkage stress. This review emphasizes the various material science advances and techniques advocated that are currently available or under trial/testing phase to deal with polymerization shrinkage in a clinical environment. CLINICAL RELEVANCE: Minimizing the shrinkage stresses in RBC restorations may lead to improvement in the success rate and survival of restorations. Thus, it is important for dental practitioners to be aware of various techniques and materials available to reduce these shrinkage stresses and be updated with the current knowledge available to deal with this issue.

Bilateral maxillary paramolars and endodontic therapy: a rare case report.

Supernumerary paramolars are a rare anomaly of the maxillofacial complex. They are more common in the maxilla than the mandible. This article reports a rare case of bilateral maxillary paramolars, their complications and management.

A comparative in vitro evaluation of cytotoxic effects of EDTA and maleic acid: root canal irrigants.

OBJECTIVE: The objective of this study was to compare aqueous solutions of ethylenediaminetetraacetic acid (EDTA) with that of maleic acid (MA) for their cytotoxic effect on Chinese hamster fibroblasts (V79) cells growing in vitro. STUDY DESIGN: Exponentially growing V79 cells were treated with various concentrations of EDTA (0.05% to 1.0%) or MA (0.05% to 1.0%) alone for 30 minutes. After treatment, the media was removed, cells were trypsinized, and the cytotoxic effect of EDTA or MA was analyzed by Pratt Willis test and MTT assay. Similarly surviving fraction (clonogenic assay) was performed by treating the V79 cells with different concentrations of EDTA (0.0025% to 0.25%) or MA (0.025% to 0.25%) for 30 minutes. The statistical significance between the various groups was evaluated using the one-way analysis of variance (ANOVA) and Student t test (unpaired) for 2 group comparisons. RESULTS: There was a significant (P < .01) decrease in the cell viability in a dose-dependent manner indicating the cytotoxic effect of both EDTA and MA when compared with the control group. However, all the dilutions of EDTA were significantly (P < .01) more cytotoxic over that of MA in all 3 assays. CONCLUSION: This study for the first time, clearly demonstrated the significantly less toxic effect of MA at a comparable dose of EDTA, suggesting its potential for use as root canal irrigant.

Susceptibility of Candida albicans and Enterococcus faecalis to Chitosan, Chlorhexidine gluconate and their combination in vitro.

The aim of the present study was to analyse the sustain release of Chlorhexidine with Chitosan and to investigate the antimicrobial activity of 2% Chlorhexidine gel, 2% Chitosan gel and their combination against Candida albicans and Enterococcus faecalis. Sustain release of Chlorhexidine with Chitosan was determined using UV spectrophotometer. Then the inoculae of these organisms were used to make the lawn culture on sabouraud's dextrose agar and blood agar plates. Wells were prepared in these lawn cultures and filled with 2% Chlorhexidine gel, 2% Chitosan gel and their combination. The agar plates were incubated overnight at 37 degrees C and the zone of inhibition was examined after 48 h. Release of Chlorhexidine with Chitosan was better than plain Chlorhexidine release. Combination of Chlorhexidine and Chitosan showed maximum inhibitory zone for C. albicans (25.2 mm) and E. faecalis (26.0 mm). Plain Chlorhexidine gel showed intermediate inhibitory zone for C. albicans (20.6 mm) and E. faecalis (21.4 mm) and plain Chitosan gel showed minimum inhibitory zone for C. albicans (16.6 mm) and E. faecalis (11.0 mm). Carbopol which served as control did not have any antimicrobial effect. The present study suggests that 2% Chlorhexidine gel in combination with 2% Chitosan gel has the highest antimicrobial effect against C. albicans and E. faecalis compared with 2% Chlorhexidine gel or 2% Chitosan gel alone.