An in vitro study of comparative evaluation of efficacy of electrochemically activated water as a root canal irrigant in smear layer removal.

AIM: The aim was to compare and evaluate the efficacy of electrochemically activated water (ECA) against maleic acid, Mixture of tetracycline, acid and detergent. ie; 3% doxycycline, 4.25% citric acid, and 0.5% Tween 80 detergent (MTAD), Sodium hypochlorite (NaOCl), and saline as root canal irrigants in removing the smear layer. MATERIALS AND METHODS: Twenty single canal mandibular premolars were randomly divided into five groups (n = 4), decoronated, prepared to working length, and instrumented till F3 using protaper gold rotary files. Each group was assigned a different irrigant. Saline-negative control and NaOCl-positive control. Teeth were sectioned and subjected to Scanning Electron Microscopic analysis. ECA was prepared using a custom-made apparatus having two chambers of capacity 50 ml each separated by a polymer membrane. About 40 ml of tap water was collected in each chamber. Two graphite electrodes were connected to the top of the compartments, linked to a power supply which initiates electrolysis, and the solutions obtained in anodic and cathodic compartments were collected. Statistical analysis was done using one-way ANOVA and Post hoc Tukey analysis. RESULTS: NaOCl, maleic acid, and ECA had similar smear layer removal efficacy. MTAD was less efficient than the other irrigants tested. Saline did not remove the smear layer. CONCLUSION: Electrochemically activated water has promising smear layer removal efficacy and is comparable with conventional root canal irrigants.

Do Children of Working Mothers Experience More Dental Caries?

BACKGROUND: Pain and discomfort due to untreated dental caries lead to eating and sleep disruptions, behavioral changes, and poor quality of life. Among adolescents, severe dental caries may lead to activity restriction, school absenteeism, and poor academic performance. Dietary factors, parent's socioeconomic status, and family income have been associated with dental caries experience. The employment status of the mother is a measure of socioeconomic status of the family. AIMS: This study aims to estimate the prevalence of dental caries and to find out its sociodemographic, oral health behavioral, and clinical determinants among older adolescent (15-18 years) students in Kerala. SETTINGS AND DESIGN: This was a cross-sectional study conducted at higher secondary schools. METHODS: Oral examination and sociodemographic and oral health behavioral data collection were done among 1065 older adolescent students in the age group 15-18 across five districts of Kerala by a multistage cluster sampling design. Decayed, missing, and filled teeth (DMFT) and Significant Caries (SiC) index were taken. STATISTICAL ANALYSIS USED: SPSS version 16 software was employed. Multiple regression analysis was done to estimate adjusted odds ratios (OR) of predictors of dental caries experience. RESULTS: The overall dental caries experience for the group was 59.8% (95% confidence interval [CI]: 56.9-62.7). About 40% of students had no caries experience, 43% had DMFT score 1-3, and only 16.8% had DMFT score 4 and more. Mean DMFT was 1.67 (95% CI: 1.56-1.79). Diet preference, timing of sugar intake, and sugar form were not significantly associated with caries. Mean SiC index was 3.90 (95% CI, 3.75-4.05). In the unadjusted analysis, age, gender, place of residence, mother's employment status, school type, frequency of sugar intake, oral hygiene status, and timing of last dental visit were significant. In the adjusted analysis, however, age, male gender, government schools, timing of last dental visit, and employed mothers were significant predictors for higher dental caries experience. CONCLUSIONS: Mother's employment was the strongest predictor (OR 2.82, 95% CI: 2.15-3.69) for dental caries experience among adolescents when adjusted to other variables in the final multivariate model.

Patient Reported Outcome Assessment of Periodontal Therapy: A Systematic Review.

INTRODUCTION: Patient Reported Outcomes (PROs) are now regarded as a fundamental measure of therapeutic success. Patient's opinion regarding the impact of disease and its treatment is assessed using scales such as Oral Health Related Quality Of Life (OHRQoL) tools. Patient centred outcome assessment is now being considered as a primary outcome measure in clinical trials. AIM: To evaluate whether treatment of periodontal disease could influence OHRQoL based on available literature. MATERIALS AND METHODS: An electronic search was done in Google, Google Scholar and Pubmed for articles in English language using the terms Quality of Life or ORHQoL or PROs or patient centered outcome and periodontal therapy. The search commenced on 1st September 2016 and ended on 15th December 2016. Studies that employed one or more than one multi-item OHRQoL instrument to assess PROs related to either non-surgical or surgical periodontal therapy were reviewed. RESULTS: Initially 423 relevant articles were obtained, from which based on screening titles and abstracts 396 were excluded. Full text of remaining 27 articles were retrieved. Nineteen clinical studies with 1345 participants and 2 systematic reviews were included after the full text review. CONCLUSION: Both surgical and Non-surgical Periodontal Therapy (NSPT) significantly influenced the OHRQoL scores. However the change in scores after surgical therapy when compared to nonsurgical therapy was not statistically significant. There is a need for a specific PROs scale that could potentially tap the entire dimension of the change in patients' perception brought about by periodontal therapy.

How to develop and validate a questionnaire for orthodontic research.

The use of psychometric tools to assess various psychological aspects of malocclusion and treatment is increasing in orthodontics. Mere evaluation of an orthodontic patient with normative criteria is not enough; instead, the psychological status should be assessed using a questionnaire. Many generic and few condition-specific tools are available for assessing quality of life (QoL) in orthodontics. The steps involved in the development of such tools are complex and unknown to many. This article outlines the methodology involved in the development and validation of a psychometric tool for dental and orthodontic use. It also helps the clinician to translate and cross-culturally adapt an existing QoL tool to a different setting.

Oral Health and Quality of Life: Current Concepts.

The recognition of health related quality of life began ever since WHO expanded the definition of health in 1948. This has resulted in the paradigm shift of health and disease from a medical model to a biopsychosocial model. Oral health too denotes not merely the absence of disease but the general well being so that the person can perform functions like eating, talking and smiling and also can contribute creatively to the society. Health related quality of life is a trade-off between how long and how well people live. To explain the concept various theoretical models have been proposed, of which the conceptual model of Wilson and Cleary 1995 is a comprehensive one. Even after much research and thousands of publications the definition of oral health related quality of life is still vague. But the patient's self perception about his oral health and related life quality are significant in clinical dental practice, dental education and research. It is widely shown that oral conditions can have varied impacts on daily living. To assess this, many measures or scales are available. They differ depending on the response format, number of items, context of use and the population in which it is applied. Patient reported outcome assessment is a less developed area in clinical dentistry and research and in future it has the potential to become the primary or secondary outcome measure in clinical interventional research.

Resistance to torsional failure and cyclic fatigue resistance of ProTaper Next, WaveOne, and Mtwo files in continuous and reciprocating motion: An in vitro study.

AIMS: The purpose of this study was to evaluate the resistance to torsional failure and cyclic fatigue resistance of ProTaper Next (PTN), WaveOne, and Mtwo files in continuous and reciprocating motion. SETTINGS AND DESIGN: Randomized control trial in a tertiary care setting. SUBJECTS AND METHODS: A total of 10 new size 25.06 taper PTN X2, 25.06 taper Mtwo files, and 25.08 taper WaveOne primary files each was selected. A custom fabricated cyclic fatigue testing device with a 70° angle of curvature and 3 mm width; curvature starting at 6 mm from the tip was used. All instruments were rotated and reciprocated till fracture occurred and time till fracture of each instrument was recorded in seconds. For torsional failure testing 5 mm tip of each file was embedded in composite resin block and uniform torsional stresses (300 rpm, 2.0 Ncm) were applied repetitively by an endodontic motor with auto stop mode until file succumbed to torsional failure. Number of load applications leading to failure was recorded. STATISTICAL ANALYSIS USED: Data were analyzed using t-test for equality of means, Pearson correlation, and ANOVA test. RESULTS: All the files showed superior resistance to cyclic fatigue in reciprocating motion when compared with continuous rotation mode. WaveOne primary files displayed maximum resistance to cyclic fatigue both in continuous and reciprocating motion. WaveOne primary files also demonstrated maximum resistance to torsional failure followed by PTN with Mtwo files exhibiting least resistance. CONCLUSIONS: Operating files in reciprocating motion enhances their cyclic fatigue resistance. WaveOne files showed maximum resistance to cyclic fatigue and torsional failure due to their cross-sectional diameter coupled M-Wire technology.

Periapical tissue reaction to calcium phosphate root canal sealer in porcine model.

BACKGROUND: Calcium phosphate cements (CPC) are a group of biomaterials possessing wide scope of use in various branches of medical science. These materials have been proposed to be highly biocompatible and osteoconductive. This study is based on a newly developed CPC formulation (Chitra-CPC) and is aimed at the evaluation of its biocompatibility through an Endodontic Usage Test in a porcine study model. OBJECTIVE: To evaluate the periapical tissue reaction to Chitra-CPC when used as a root canal sealer/filler material in comparison with a resin sealer, AH Plus (Dentsply). MATERIALS AND METHODS: The procedure was done on porcine animal model following the ISO 7405 criteria. The material was implanted intentionally into the periapical area of 36 teeth through a root canal procedure carried out in six animals which were divided equally among 1-month and 3-month time periods. Results were based on the histological evaluation of the autopsied specimens after the prescribed time periods. RESULTS: Mild to moderate periapical tissue reaction was found in Chitra-CPC samples belonging to the 1-month time period, whereas majority of the 3-month CPC samples showed an absence of inflammation. Samples of AH Plus in 1-month period showed severe to moderate inflammation, whereas 3-month AH Plus samples had a mild to moderate inflammation. CONCLUSIONS: Chitra-CPC is a biocompatible material.

Surgical exposure and crown lengthening for management of complicated fractures of maxillary anterior teeth. A case report.

When a tooth fracture occurs, the fracture line can extend in a variety of directions, and the direction of the fracture line often dictates the treatment plan. In cases where fracture lines extend apical to the gingival margin, exposure of fractured margins becomes necessary. And management of such tooth fractures often requires an interdisciplinary approach involving endodontic, periodontic and restorative procedures. This article describes a case in which severely traumatized maxillary anterior teeth were managed by a combined approach involving surgical exposure and crown lengthening, endodontic and restorative procedures.

Remineralization potential of fluoride and amorphous calcium phosphate-casein phospho peptide on enamel lesions: An in vitro comparative evaluation.

AIM: This in vitro study was conducted on enamel blocks of human premolars with the aim of evaluating the remineralization potential of fluoride and ACP-CPP and the combination of ACP-CPP and fluoride on early enamel lesions. MATERIALS AND METHODS: Fifteen intact carious free human premolars were selected. The coronal part of each tooth was sectioned into four parts to make 4 enamel blocks. The baseline SMH (surface microhardness) was measured for all the enamel specimens using Vickers microhardness (VHN) testing machine. Artificial enamel carious lesions were created by inserting the specimens in demineralization solution for 3 consecutive days. The SMH of the demineralised specimens was evaluated. Then the four enamel sections of each tooth were subjected to various surface treatments, i.e. Group 1- Fluoride varnish, Group 2- ACP-CPP cream, Group 3- Fluoride + ACP-CPP & Group 4- Control (No surface treatment). A caries progression test (pH cycling) was carried out, which consisted of alternative demineralization (3hours) and remineralization with artificial saliva (21 hours) for five consecutive days. After pH cycling again SMH of each specimen was assessed to evaluate the remineralization potential of each surface treatment agent. Then, to asses the remineralization potential of various surface treatments at the subsurface level, each enamel specimen was longitudinally sectioned through the centre to expose the subsurface enamel area. Cross-sectional microhardness (CSMH) was evaluated to assess any subsurface remineralization RESULTS: Statistical analysis using one-way ANOVA followed by multiple comparisons test was applied to detect significant differences at P