Comparison of Radiographic and Clinical Status and Peri-implant Crevicular Fluid Prostaglandin E2 Levels Among Patients with Peri-implant Mucositis and Peri-implantitis.

The aim of this study was to compare radiographic and clinical status and peri-implant sulcular fluid (PISF) prostaglandin E2 (PGE2) levels among patients with and without peri-implant disease. Patients with peri-implant mucositis (PiM) (Group 1) and peri-implantitis (Group 2) and individuals without peri-implant disease (Group 3) were included. Demographic information was collected, and peri-implant modified plaque and bleeding indices (mPI and mBI), probing depth (PD), and crestal bone loss (CBL) were recorded. PISF samples were collected and PGE2 levels measured. Statistical significance was set at P < .01. A total of 22 patients with PiM, 22 with peri-implantitis, and 23 without peri-implant disease (controls) were included. Scores of mPI (P < .01), mBI (P < .01), and PD (P < .01) were higher in patients with PiM and peri-implantitis than the controls. The volumes of collected PISF were significantly higher in patients with peri-implantitis (P < .01) compared to patients with PiM and the controls. The PISF volume was significantly higher in PiM patients (P < .01) than in the controls. There was a significant correlation between peri-implant PD and PISF PGE2 levels in patients with peri-implantitis (P < .001). Raised PISF PGE2 levels indicate poor peri-implant health; therefore, PGE2 is a potential biomarker for the assessment of peri-implant health status.

Comparison of self-rated pain and salivary alpha-amylase and cortisol levels during early stages of fixed orthodontic and clear aligner therapy.

OBJECTIVES: To compare self-rated orthodontic pain (OP) and whole salivary alpha-amylase (αA) and cortisol levels (CL) during early stages of fixed orthodontic and clear aligner therapy (CAT). METHODS: In groups 1 and 2, malocclusions were treated using fixed orthodontic appliances and CAT, respectively. In Group-3, individuals had normal occlusion and had never undergone orthodontic therapy. Self-rated OP was assessed using the visual-analogue-scale at baseline (T0); after 24-hours (T1) of appliance activation; and after 30 days (T2). Unstimulated whole saliva was collected and αA and CL were measured using enzyme-linked immunosorbent assay. p < .01 was considered statistically significant. RESULTS: Twenty-four (Group-1), 24(Group-2) and 25 (Group-3) patients were included. In groups 1 and 2, participants had Class-I malocclusion with anterior-crowding in both arches. At baseline (T0) none of the participants reported pain on mastication. In groups 1 (p < .01) and 2 (p < .01), OP was higher at T1 than T2. In groups 1 and 2, αA and CL were higher at T1 (p < .01) than T0 and T2. At T1 and T2, salivary αA and CL were higher in groups 1 (p < .01) and 2 (p < .01) than Group-3. In groups 1 and 2, a significant correlation was recorded between OP and αA (p < .01) and CL (p < .01) at T1 interval. CONCLUSION: Self-rated OP and salivary αA and CL during the early stages of fixed OT and CAT are similar. Whole salivary αA and CL and OP and are high during the first 24 hours of fixed OT and CAT activation.

Peri-Implant Inflammation in Waterpipe Users and Cigarette Smokers: An Observational Study.

OBJECTIVE: The aim of this study was to compare peri-implant clinical and radiographic status and levels of advanced glycation endproducts (AGEs) in peri-implant sulcular fluid (PISF) in waterpipe users and cigarette smokers. METHODS: Waterpipe users, cigarette smokers, and never smokers were included. Demographic details were collected using a questionnaire. Characteristics of implants (dimensions, jaw location, depth of placement, insertion torque, and duration in function) were recorded. Peri-implant modified plaque and gingival indices (mPI and mGI), probing depth (PD), and crestal bone loss (CBL) were recorded in all groups. Volume of PISF and levels of AGEs were determined using standard techniques. Sample-size estimation was done on data from a pilot investigation, and correlation between clinicoradiographic and immunoinflammatory parameters was assessed using logistic regression models. Probability values <.05 were considered statistically significant. RESULTS: In all, 25, 25, and 24 cigarette smokers, never smokers, and waterpipe users, respectively, were examined. All participants were male and had comparable mean ages. Cigarette smokers and waterpipe users had a smoking history of 20.2 ± 3.5 years and 18.8 ± 0.6 years, respectively. The mPI (P < .01), CBL (P < .01), PD (P < 0.01), and mGI (P < .01) were significantly higher in cigarette smokers and waterpipe users than never smokers. There was no significant difference in clinicoradiographic status and AGE concentrations in waterpipe users and cigarette smokers. A statistically significant correlation was recorded between AGEs and PD in cigarette smokers (P < .01) and waterpipe users (P < .01). CONCLUSIONS: Waterpipe usage is not less hazardous to peri-implant tissue health than conventional cigarette smoking. It is imperative to caution patients with dental implants about the detrimental effects of tobacco products on oral health.

Levels of interleukin 1-beta and soluble urokinase plasminogen activation factor in peri-implant sulcular fluid of cement- and screw-retained dental implants.

OBJECTIVE: The present study compared interleukin 1-beta (IL-1ß) and soluble urokinase plasminogen activation factor receptor (suPAR) levels in peri-implant sulcular fluid of patients with cement-retained and screw-retained implants. METHOD AND MATERIALS: Patients with cement-retained and screw-retained implants were included. Demographic data were collected, and implant-related characteristics (geometry, insertion torque, loading and retention protocol, arch location, duration in function, and depth of insertion) were retrieved from records. Modified Plaque Index, crestal bone loss, probing depth, and modified Bleeding Index were measured. suPAR and IL-1ß levels were assessed in peri-implant sulcular fluid. Statistical comparisons were done and correlation between clinicoradiographic parameters and peri-implant sulcular fluid IL-1ß and suPAR were assessed. Statistical significance was judged at P < .05. RESULTS: Clinical and radiographic parameters showed no difference among screw-retained and cement-retained implants. There was no difference peri-implant sulcular fluid volume among patients with cement-retained (0.22 ± 0.00 µL) and screw-retained (0.19 ± 0.005 µL) implants. Levels of IL-1ß and suPAR in patients with cement-retained and screw-retained implants were 50.08 ± 0.6 ng/mL and 44.6 ± 0.08 ng/mL, and 0.28 ± 0.05 ng/mL and 0.22 ± 0.006 ng/mL, respectively. CONCLUSION: Implants with cement-retained or screw-retained restorations are comparable to one another in terms of clinicoradiographic status and demonstrate IL-1ß and suPAR levels within the normal range in the peri-implant sulcular fluid provided oral hygiene is stringently maintained.

Association of Peri-Implant Health Status With COVID-19.

OBJECTIVE: The aim of this research was to evaluate peri-implant health status in patients infected with COVID-19 and control patients (individuals without COVID-19). METHODS: This observational investigation was performed in adults with (test group) and without (control group) COVID-19 infection having at least 1 functional dental implant. Self-reported education status and daily frequency of toothbrushing and flossing was determined. A questionnaire was administered to record demographic data, brushing/flossing frequency, and education status. Periodontal examination comprised full-mouth assessment of clinical attachment loss (CAL), plaque index (PI), probing depth (PD), and gingival index (GI). Peri-implant PD, modified PI, and modified gingival index were recorded. Loss of marginal and crestal bone around teeth and implants was also measured. Significance level was established for P < .05. RESULTS: Seventy-three (41 males) and 71 (44 males) individuals were included in the test and control groups, respectively. Average ages of patients and controls were 44.6 ± 5.2 and 40.1 ± 3.1 years, respectively. University-level education was attained by 52 (75.3%) and 50 (70.4%) individuals in the test and control groups, respectively. Seventy (95.9%) and 68 (95.7%) patients and controls were brushing twice a day. Once-daily interproximal flossing was reported by 44 (60.3%) and 48 (67.6%) individuals in test and control groups. All participants had healthy periodontal and peri-implant tissues. CONCLUSIONS: The study indicated that there are no short-term adverse effects on the peri-implant tissues due to acute COVID-19 infection, and further well-controlled longitudinal studies are needed to evaluate the long-term effect of the infection on these tissues.

Photobiomodulation for Managing "Dry Socket": A Randomised Controlled Trial.

OBJECTIVE: There are no studies that have evaluated the effect of Alveogyl with and without adjunct photobiomodulation therapy (PBMT) in reducing self-rated post-operative pain (SPP) in patients with alveolar osteitis (AO; dry socket). The aim of the present randomised controlled trial was to assess the effectiveness of Alveogyl with and without PBMT for the management of SPP in patients with AO. METHODS: Adult nonsmokers with diagnosed AO were included. Patients were randomly divided into 4 groups. In Group 1, patients underwent mechanical curettage (MC) with copious normal saline irrigation. In Group 2, patients underwent MC + Alveogyl dressings in extraction sites which were changed every 48 hours until cessation of pain. In Group 3, patients underwent MC + Alveogyl followed by PBMT using a 660-nm indium-gallium-aluminum-phosphide diode laser. In Group 4, patients were treated solely with PBMT. The visual analogue scale was used up to 3 postoperative days to assess SPP up to 3 days at 6- (T0) and 12-hour (T1) intervals. Statistical analyses were performed using the analysis of variance and Bonferroni post hoc adjustment tests. Correlation between SPP scores and age, sex, and eruption status of teeth was assessed using logistic regression models. P values <.01 were nominated as being statistically significant. RESULTS: In all, 14, 13, 14, and 14 individuals with AO were included in groups 1, 2, 3 and 4, respectively. All patients had undergone extraction of mandibular third molars. At baseline and on day 1, there was no difference in SPP in all groups. On days 2 and 3, mean visual analogue scale (VAS) scores at T1 (P < .01) and T2 (P < .01) intervals were significantly high in Group 2 compared with Group 3. On days 2 and 3, mean VAS scores at T1 (P < .01) and T2 (P < .01) intervals were significantly high in Group 4 compared with Group 3. There was no difference in SPP in groups 3 and 4 on day 3 at T0 and T1 intervals. CONCLUSIONS: PBMT following MC and Alveogyl dressing is more efficient in reducing SPP compared with MC with or without Alveogyl dressing in patients with AO.

Comparison of periodontal status and salivary IL-15 and -18 levels in cigarette-smokers and individuals using electronic nicotine delivery systems.

BACKGROUND: It is hypothesized that periodontal status is compromised and whole salivary (WS) interleukin (IL)-15 and IL-18 levels are higher among cigarette-smokers and electronic-nicotine-delivery-systems (ENDS)-users than never-smokers. The aim of the present case-control study was to compare the periodontal status and WS IL-15 and -18 levels among cigarette-smokers, ENDS-users and controls (never-smokers). METHODS: Participants were divided into 4 groups as follows: Group-1:Current cigarette-smokers; Group-2:ENDS-users; Group-3:Never-smokers with periodontitis; and Group-4: Never-smokers without periodontitis. Demographic data was collected and plaque index (PI), gingival index (GI), probing-depth (PD), clinical attachment-loss (AL), and marginal bone loss (MBL) were measured. Number of missing teeth were recorded and WS IL-15 and IL-18 levels were determined. Group-comparisons were done and P < 0.01 was selected as an indicator of statistical analysis. RESULTS: Nineteen, 18, 19 and 19 individuals were enrolled in groups 1, 2, 3 and 4, respectively. Scores of PI, clinical AL, PD, and number of missing-teeth were elevated in groups 1(P < 0.001), 2 (P < 0.001) and 3 (P < 0.001) than -4. Scores of PI, clinical AL, PD, MBL and missing teeth were comparable among patients in groups 1, 2 and 3. Levels of IL-15 and IL-18 were elevated in groups 1 (P < 0.001) and 2 (P < 0.001) than groups 3 and 4. The levels of IL-15 and -18 were higher in Group-3 than in Group-4 (P < 0.001). CONCLUSION: Clinically, cigarette-smokers and never-smokers demonstrate similar periodontal statuses; however, WS immunoinflammatory biomarkers (IL-15 and -18) are elevated in these individuals than non-smokers.

Periodontal status and whole salivary adipokines after scaling and root planing with and without adjunct antimicrobial photodynamic therapy in obese patients with periodontitis.

OBJECTIVE: Whole-salivary (WS) adiponectin and leptin levels after scaling and root planing (SRP) with and without antimicrobial-photodynamic-therapy (aPDT) in obese and normal-weight individuals with periodontitis remain uninvestigated. This study compared the effect of SRP without and with adjuvant aPDT on periodontal status and WS leptin and adiponectin levels (LAL) in obese patients with periodontitis. METHODS: Groups 1 and 2 entailed obese patients without and with periodontitis. Groups 3 and 4 had normal weight individuals without and with periodontitis. Therapeutically, individuals with periodontitis were categorized into test- (SRP+aPDT) and control- (SRP alone) subgroups. All patients without periodontitis underwent routine dental prophylaxis. Clinical attachment loss (AL), gingival and plaque index (GI and PI), probing depth (PD), missing teeth (MT) and WS LAL were measured at baseline and at three months of follow-up. P<5% were graded statistically significant. RESULTS: At baseline, clinicoradiographic variables were significantly higher among patients in test- and control-groups in groups 1 (P<0.01) and 3 (P<0.01) versus 2 and 4. In group 2 and 3, LL were significantly high at baseline compared with follow-up (P<0.01). There was no difference in periodontal parameters and WS adiponectin and LL in the test and control-groups at of follow-up. No correlation existed between salivary LAL and clinical periodontal parameters (PI, GI, PD and clinical AL). No correlation existed between age, gender and BMI and WS LAL. CONCLUSION: In the short-term, SRP with or without aPDT is ineffective in the treatment of periodontitis in obese patients with periodontitis.

Assessment of salivary alpha amylase and mucin-4 before and after non-surgical treatment of peri-implant mucositis.

BACKGROUND: The present study was based on the null hypothesis that there is no difference in clinicoradiographic parameters and whole salivary alpha amylase (AA) and mucin-4 levels before and after non-surgical mechanical debridement (NSMD) of patients with peri-implant mucositis (PM). The aim was to assess whole salivary AA and mucin-4 levels before and after treatment of PM. METHODS: Patients with PM (Group-1) and individuals without peri-implant diseases (Group-2) were included. Demographic data was collected and peri-implant modified plaque and bleeding indices (mPI and mBI, respectively), probing depth (PD) and crestal bone loss were measured at baseline. Levels of AA and mucin-4 were assessed in unstimulated whole saliva samples. All patients underwent full-mouth non-surgical periodontal therapy (NSPT) and NSMD; and clinical parameters and salivary biomarkers were re-assessed after 3 months. Level of significance was set at P < 0.01. RESULTS: Twenty-six and 32 individuals were included in groups 1 and 2, respectively. None of the participants had periodontitis. At baseline clinical periodontal parameters (PI [P < 0.001], GI [P < 0.001], clinical AL [P < 0.001] and PD [P < 0.001]) were significantly high in Group-1 than Group-2. At 3-month follow-up, there was a statistically significant reduction in clinical periodontal and peri-implant parameters (PI [P < 0.01], GI [P < 0.01], and PD [P < 0.01]) in Group-1 compared with their baseline values. At baseline, salivary AA levels were significantly high in Group-1 than Group-2 (P < 0.01). At 3-month follow-up, there was no significant difference in whole salivary AA levels among patients in groups 1 and 2. CONCLUSIONS: The AA and mucin-4 levels are potential biomarkers for evaluation of peri-implant diseases including PM. Mechanical instrumentation continues to be the most predictable treatment option for the management of peri-implant diseases.

Increased expression of advanced glycation endproducts in the gingival crevicular fluid compromises periodontal status in cigarette-smokers and waterpipe users.

BACKGROUND: The aim was to assess the association between levels of advanced glycation endproducts (AGEs) in the gingival crevicular fluid (GCF) and periodontal parameters among cigarette-smokers and waterpipe-users. METHODS: Self-reported cigarette-smokers; waterpipe-users and never-smokers were included. Demographic data was recorded using a questionnaire. Periodontal parameters (plaque index [PI], gingival index [GI], clinical attachment loss [AL], probing depth [PD], and marginal bone loss [MBL]) were assessed in all groups. The GCF samples were collected using standard techniques and assessed for AGEs levels using enzyme-linked immunosorbent assay. Sample-size estimation was done and group-comparisons were done. Correlation between levels of GCF AGEs levels and periodontal parameters was assessed using a logistic regression model. Level of significance was set at P < 0.01. RESULTS: Eighty-two individuals (28 cigarette-smokers, 28 waterpipe-users and 26 never-smokers) were included. There was no difference in mean ages of all patients. Cigarette-smokers had a smoking history of 5.1 ± 0.2 pack years and waterpipe-users were using waterpipe for 4.4 ± 0.6 years. There was no statistically significant difference in PI, GI, clinical AL, PD and MBL in all groups. Levels of AGEs were significantly higher among cigarette-smokers (P < 0.001) and waterpipe-users (P < 0.001) than never-smokers. There was no significant correlation between levels of GCF AGEs levels and periodontal parameters in all groups. CONCLUSION: Clinical periodontal status of individuals with a short history of cigarette-smoking and waterpipe-usage may appear similar to never-smokers. On a molecular level, cigarette-smoking and waterpipe-users express raised levels of AGEs than never-smokers that sirens about the ongoing yet latent periodontal inflammatory process.

Cortisol Levels in the Peri-implant Sulcular Fluid of Type-2 Diabetic and Non-diabetic Patients with Peri-implantitis.

PURPOSE: Cortisol levels (CL) in peri-implant sulcular fluid (PISF) samples in relation to type-2 diabetes mellitus (T2DM) and peri-implantitis remain unaddressed. It is hypothesi?sed that PISF CL are higher in patients with type-2 diabetes and peri-implantitis than in healthy patients without and with peri-implantitis. The aim was to assess the PISF CL of peri-implantitis patients without and with T2DM. MATERIALS AND METHODS: Peri-implantitis patients with T2DM (group 1), T2DM patients without peri-implantitis (group 2), non-diabetic patients with peri-implantitis (group 3) and non-diabetic patients without peri-implantitis (group 4) were included. Demographics were recorded; and patients' medical and dental records were assessed. Peri-implant modified plaque-index (mPI), modified gingival index (mGI), and probing depth (PD) and crestal bone loss (CBL) were recorded. The PISF was collected and CL were determined. p < 0.01 was considered statistically significant. RESULTS: Each of the four groups included 16 subjects (n = 64) with no difference in mean age. In groups 1 and 2, the mean duration of T2DM was 10.5 ± 0.8 and 10.6 ± 0.4 years, respectively. Mean HbA1c levels (p < 0.01) were higher and clinicoradiographic parameters (p < 0.001) were worse in group 1 than in the other groups. The median PISF volume and mean CL were higher in groups 1 (p < 0.01) and 3 (p < 0.01) than groups 2 and 4. There was a statistically significant correlation between PD and CL in group 3 (p < 0.001). CONCLUSION: Cortisol levels in the PISF are higher in T2DM and non-diabetic patients with peri-implantitis than in healthy individuals with and without peri-implantitis. Hyperglycemia did not influence peri-implant clinicoradiographic parameters and CL in the present patient population.

Role of antimicrobial photodynamic therapy in reducing subgingival oral yeasts colonization in patients with peri-implant mucositis.

OBJECTIVE: The aim was to assess the role of antimicrobial photodynamic therapy (aPDT) in reducing subgingival oral yeasts colonization (OYC) in patients with peri-implant mucositis (PIM). METHODS: Patients diagnosed with PIM were included. Patient demographics were recorded and implant placement and prosthetic rehabilitation protocols were retrieved from patients' records. Peri-implant clinical parameters (modified plaque index [mPI], modified bleeding index [mBI] probing depth [PD]) and subgingival OYC and were assessed using standard techniques. All patients were randomly divided into test- and control-groups. In the test-group, patients underwent mechanical debridement (MD) of implant surfaces and supra and sub-gingival peri-implant sulci peri-implant immediately followed by a single session of aPDT. In the control-group, patients underwent MD alone. Peri-implant clinical parameters and OYC were re-assessed at 3-months' follow-up. Sample-size estimation was done on data from a pilot investigation and group-comparisons were done using the paired t- and Mann Whitney U-tests. Correlation between age, mPI, mBI, PD and OYC at baseline and 3-months' follow-up was assessed using regression analysis models. A statistically significant difference between the groups was recorded when P-values were less than 0.01. RESULTS: Thirty-four individuals (17 and 17 in the test- and control groups, respectively) were included. There was no significant difference in the mean age, scores of mPI, mBI, PD and OYC among patients in the test- and control-groups at baseline. At 3-months of follow-up, there was a statistically significant reduction in scores of mPI (P<0.001), mBI (P<0.001), PD (P<0.001) and OYC (P<0.001) among patients in the test- compared with the control-groups. There was no significant correlation between age, mPI, mBI, PD and OYC in both groups. CONCLUSION: In the short term, a single session of aPDT as an adjunct to MD is effective in reducing peri-implant soft tissue inflammation and OYC in patients with PIM.

Evidence-Based Bibliometric Analysis of Research on Silver Diamine Fluoride Use in Dentistry.

BACKGROUND: This bibliometric analysis is aimed at reviewing the research pattern on the use of silver diamine fluoride (SDF) in dentistry using various citation metrics. METHODS: A well-curated search was conducted on Elsevier's Scopus database for the relevant literature on SDF published between 1969 and 2021. Bibliographic information such as information related to citations, bibliographic data, abstracts, keywords, and other relevant information was extracted using different combinations of keywords ("silver diamine fluoride" OR "Silver Diamine Fluorides" OR "Diamine Fluoride" OR "Silver Fluoride"). Analysis and visualization of the selected documents and related data were performed using various tools and software including MS Excel, MS Access, Bibexcel, VOS viewer, Biblioshiny, and Gephi. VOS Viewer was utilized for the Graph Modeling Language (GML) to generate graphical representations of the data. Furthermore, network graphs were generated to assess the various associations between research themes, countries, organizations, authors, journals, and citations. RESULTS: The initial search yielded 662 documents, of which 410 were chosen for analysis. 252 records were deemed irrelevant. The chosen records consisted of journal articles (n = 351), conference papers (n = 14), book chapters (n = 1), and review articles (n = 44). The results showed that there was an upward trend in the research on SDF, and a substantial increase was observed in the citation index after 2014. Researchers from the United States of America, Hong Kong, and Japan were the top contributors, with organizations and authors from the Faculty of Dentistry, University of Hong Kong, leading the way in citations and productivity. CONCLUSION: The bibliometric analysis provides valuable information regarding the total number of publications on SDF and their citation details. It also identifies the leading countries and organizations involved in the research on SDF and provides a comprehensive analysis of the research trends related to SDF.

Periodontal Clinicoradiographic Status and Whole Saliva Soluble Urokinase Plasminogen Activation Receptor and Tumor Necrosis Factor Alpha Levels in Type-2 Diabetic and Non-diabetic Individuals.

PURPOSE: The authors hypothesise that whole saliva soluble-urokinase-type plasminogen-activator receptor (suPAR) and tumor necrosis factor-alpha (TNF-α) levels are higher in patients with poorly-controlled than well-controlled type-2 diabetes mellitus (DM) and non-diabetic controls. The aim was to assess the periodontal clinicoradiographic status and whole-salivary suPAR and TNF-α levels in type-2 diabetic and non-diabetic individuals. MATERIALS AND METHODS: Patients with and without type-2 DM were included. In all patients, hemoglobin A1c (HbA1c) levels were measured. Participants were divided into 4 groups. Group 1: patients with poorly controlled type-2 DM; group 2: patients with well-controlled type-2 DM; group 3: non-diabetic patients with periodontitis; group 4: non-diabetic patients without periodontitis. Clinicoradiographic periodontal parameters (plaque index [PI], gingival index [GI], clinical attachment loss [AL], probing depth [PD] and mesial and distal marginal bone loss [MBL]) were measured. The whole saliva total protein concentration (TPC) and suPAR as well as TNF-α levels were measured. The level of statistical significance was set at p < 0.01. RESULTS: One hundred patients (25 patients per group) were included. Scores of PI (p < 0.01), GI (p < 0.01), clinical AL (p < 0.01), PD (p < 0.01), number of missing teeth and mesial (p < 0.01) and distal (p < 0.01) MBL were statistically significantly higher in group 1 than in groups 2-4. Scores of PI, GI, clinical AL, PD, mesial and distal MBL, and numbers of missing teeth were higher in group 3 (p < 0.01) than in groups 2 and 4. The whole saliva TPC, suPAR and TNF-α levels were statistically significantly higher among patients in group 1 (p < 0.01) than in groups 2-4. CONCLUSION: Patients with poorly-controlled type-2 DM presented with poorer clinicoradiographic periodontal status and increased whole saliva levels of suPAR, TNF-α and TPC compared with patients with well-controlled type-2 DM and non-diabetic individuals.

Reasons for Extraction of Permanent Teeth in a University Dental Clinic Setting.

PURPOSE: This study aimed to explore the reasons for tooth extraction and investigated the potential correlations between tooth loss and several variables including age, gender, education level, and other risk factors, such as diabetes and smoking habit. PATIENTS AND METHODS: The study retrospectively analyzed 1811 dental records of patients who underwent extraction procedure of at least one tooth. Patients' variables included: age, gender, level of education, diabetes, and smoking habit. Reasons for extraction were recorded as follows: caries, periodontal disease, endodontic treatment complications, orthodontic treatment, impactions, trauma, pre-prosthetic, and others (esthetic reasons, tooth malposition, or unspecified reasons). STATISTICAL ANALYSIS: The significance of variables was analyzed by Chi square test, P < 0.05. The variances in the mean number of extracted teeth per patient were investigated using ANOVA. Pearson correlation test was used to test the strength of the association among the tested variables, P < 0.01. RESULTS: Out of 1811 reviewed patients' records, 2654 extracted teeth were identified. Males had a higher number of extracted teeth, 1447 (54.5%), than females, 1207 (45.5%). Males had more extractions due to periodontal disease, while females had more extractions for orthodontic and pre-prosthetic reasons. The highest mean of extracted teeth was identified among the 51-year-old and above age groups (3.73 ± 0.53 teeth) where periodontal disease was shown to have a significant association (P < 0.05). Diabetic patients showed a significant association with periodontal diseases, while smokers showed a significant association with caries. Both diabetics and smokers had moderate correlation (0.055 and 0.04, respectively). CONCLUSION: Caries, periodontal disease, and endodontic complications were the most common causes of tooth extraction. In addition, this study indicated that age, diabetes, and smoking habits were found to be suitable forecasters for permanent tooth loss as these variables displayed significant statistical association.

Risk factors of complications subsequent third molar extractions: A prospective cohort study / Fatores de risco de complicações subsequentes à extrações de terceiros molares: um estudo de coorte prospectivo

Objective: The aim of this study was to determine the complications that were associated with the surgical removal of third molars (M3s), and to assess the association of patient, anatomic, and surgical risk factors with the postoperative complications of surgically removed impacted M3s. Material and Methods: This study was a cohort prospective study conducted on patients, aged 17 and older, admitted to the oral and maxillofacial surgery clinic. All patients who needed 1 or more extractions were included and totalled 268 patients with 314 extracted teeth. Risk factors were divided into patient factors, anatomic factors and surgical factors. The postoperative complication variables mainly included: pain, alveolar osteitis, infection, bleeding, swelling, trismus. Statistical analysis used: Chi-square test was used for the bivariate analyses while Pearson correlation coefficient (1- tailed) test was used for the purpose of determining the association between the study variables. The significance of associations was considered statistically significant at p < 0.05. Results: Patients aged of 25 years and above experienced more complications, 39 (88.6%). With respect to gender, females experienced more complications, 29 (65.9%). Mandibular M3s had more complications than maxillary M3s, 34 (8.0%), followed by distoangular inclined M3s, 23 (52.3%), and last was full bony impaction, 13 (29.5%). Pain was the most frequent complication, 18 (40.9%), followed by alveolar osteitis 12 (27.3%). Conclusion: The results indicated that the most frequently complications were pain, infection, alveolar osteitis. These complications were associated with common risk factors such as age, gender, medical history, M3 angulation, impaction level, bone removal, tooth sectioning, and number of M3 removed per session. (AU)

Objetivo: O objetivo deste estudo foi determinar as complicações que estavam associadas à cirurgia de remoção dos terceiros molares (3Ms) e avaliar a associação dos fatores de risco do paciente, anatômicos e cirúrgicos com as complicações pós-operatórias dos 3Ms impactados removidos cirurgicamente. Material e Métodos: Esse estudo foi um estudo de coorte prospectivo realizado em pacientes com idade igual ou superior a 17 anos, admitidos na clínica de cirurgia oral e maxilofacial. Todos os pacientes que precisaram de uma ou mais extrações foram incluídos, totalizando 268 pacientes e 314 dentes extraídos. Os fatores de risco foram divididos em fatores do paciente, fatores anatômicos e fatores cirúrgicos. As variáveis de complicações pós-operatórias incluíram principalmente: dor, osteíte alveolar, infecção, sangramento, edema, trismo. Análise estatística utilizada: o teste de Qui-quadrado foi utilizado para as análises bivariadas enquanto o teste do coeficiente de correlação de Pearson (unicaudal) foi usado para determinar a associação entre as variáveis do estudo. A significância das associações foi considerada estatisticamente significativa para p < 0,05. Resultados: Pacientes com 25 anos ou mais apresentaram mais complicações (39; 88,6%). Com relação ao gênero, o sexo feminino apresentou mais complicações (29; 65,9%). 3Ms mandibulares tiveram mais complicações do que 3Ms maxilares (34; 8,0%), seguidos por 3Ms com inclinação distoangulada (23; 52,3%) e, por último, com impactação óssea total (13; 29,5%). Dor foi a complicação mais frequente (18; 40,9%), seguida de osteíte alveolar (12; 12,3%). Conclusão: Os resultados indicaram que as complicações mais frequentes foram dor, infecção, osteíte alveolar. Essas complicações foram associadas a fatores de risco comuns, como idade, sexo, histórico médico, angulação do 3M, nível de impactação, remoção de osso, secção dentária e número de 3Ms removidos por sessão. (AU)

In vivo antimicrobial activity of silver diammine fluoride on carious lesions in dentin.

Minimally invasive treatment protocols may leave a residual layer of carious dentin, which requires treatment for the inhibition of bacterial growth beneath restorations. We aimed to examine the in vivo effect of silver diammine fluoride (SDF) and SDF + potassium iodide (KI) application on bacteria present in deep carious lesions. We studied the in vivo efficacy in five patients, each of which had five carious lesions. Dentin samples taken before and after treatment were subjected to microbial analyses. Following treatment with SDF, the median colony-forming unit (CFU) counts per mg of dentin reduced from 9 × 105 to 1.6 × 102 (P < 0.05), and following that with SDF + KI, the counts decreased from 2.9 × 105 to 9.2 × 10 (P < 0.05). The use of chlorhexidine gluconate (CHX) reduced CFU counts from 1.1 × 105 to 4.8 × 102 (P < 0.05). In four of the five patients, no CFUs were found on mitis salivarius-bacitracin agar with respect to SDF or SDF + KI application. For CHX, the median CFU count before treatment was 1.6 × 103 and that after treatment was 1.1 × 102. SDF completely inhibited mutans streptococci growth in four of the five patients, while the growth of anaerobes was not completely inhibited.

Assessment of oral health attitudes and behavior among students of Kuwait University Health Sciences Center.

AIM: The aims of this study were to assess attitudes and behavior of oral health maintenance among students in four faculties (Medicine, Dentistry, Pharmacy, and Allied Health) and to compare oral health attitudes and behavior of all students at Kuwait University Health Sciences Center (KUHSC) based on their academic level. MATERIALS AND METHODS: Students enrolled in the Faculties of Dentistry, Medicine, Pharmacy, and Allied Health at KUHSC were evaluated regarding their oral health attitudes and behavior by an e-mail invitation with a link to the Hiroshima University Dental Behavior Inventory survey that was sent to all 1802 students with Kuwait University Health Sciences Center e-mail addresses. The data were analyzed for frequency distributions, and differences among the groups were assessed using the Mann-Whitney U test, Chi-square test, and Kruskal-Wallis test. P values less than 0.05 were considered to be statistically significant (P < 0.05). RESULTS: The results of this study indicated that dental students achieved better oral health attitudes and behavior than that of their nondental professional fellow students (P < 0.05). Students in advanced academic levels and female students demonstrated better oral health attitudes and behavior. CONCLUSION: Dental students and students who were in advanced levels of their training along with female students demonstrated better oral health practices and perceptions than students in lower academic levels and male students, respectively. Additional studies for investigating the effectiveness and identifying areas requiring modification within the dental curriculum at KUHSC may be warranted.

Patient satisfaction in Dental Healthcare Centers.

OBJECTIVES: This study aimed to (1) measure the degree of patient satisfaction among the clinical and nonclinical dental services offered at specialty dental centers and (2) investigate the factors associated with the degree of overall satisfaction. MATERIALS AND METHODS: Four hundred and ninety-seven participants from five dental centers were recruited for this study. Each participant completed a self-administered questionnaire to measure patient satisfaction with clinical and nonclinical dental services. Analysis of variance, t-tests, a general linear model, and stepwise regression analysis was applied. RESULTS: The respondents were generally satisfied, but internal differences were observed. The exhibited highest satisfaction with the dentists' performance, followed by the dental assistants' services, and the lowest satisfaction with the center's physical appearance and accessibility. Females, participants with less than a bachelor's degree, and younger individuals were more satisfied with the clinical and nonclinical dental services. The stepwise regression analysis revealed that the coefficient of determination (R (2)) was 40.4%. The patient satisfaction with the performance of the dentists explained 42.6% of the overall satisfaction, whereas their satisfaction with the clinical setting explained 31.5% of the overall satisfaction. CONCLUSION: Additional improvements with regard to the accessibility and physical appearance of the dental centers are needed. In addition, interventions regarding accessibility, particularly when booking an appointment, are required.

Knowledge of the Relationships between Oral Health, Diabetes, Body Mass Index and Lifestyle among Students at the Kuwait University Health Sciences Center, Kuwait.

OBJECTIVES: To evaluate the level of knowledge regarding the relationships between oral health, diabetes, body mass index (BMI; obesity) and lifestyle among students of the Health Sciences Center (HSC), Kuwait, and to explore any possible correlation between students' oral health knowledge, BMI and lifestyle choices. SUBJECTS AND METHODS: A stratified random sample was proportionally selected according to the size of each faculty from the 1,799 students. The questionnaire was divided into 3 sections (i.e. demographics, evaluation of oral health knowledge in relation to diabetes, and evaluation of diabetes knowledge in relation to lifestyle) and distributed to 532 students. Oral health knowledge was categorized as limited, reasonable or knowledgeable. Lifestyle was classified as healthy or nonhealthy. The BMI was calculated as weight (kg) divided by the square of the height (m). ANOVA and χ2 tests were used to test for differences between independent variables. A Pearson correlation coefficient test was used to assess correlations. p < 0.05 was considered statistically significant. RESULTS: Of the 532 questionnaires, 498 (93.6%) were completed. The mean knowledge score was 47.7 ± 25.2; of the 498 students, 235 (47.3%) had a BMI within the normal range, 184 (37.0%) were pre-obese and 67 (13.5%) were obese. Of the 498 students, 244 (49%) had a healthy lifestyle. There was no correlation between oral health knowledge and the other variables; however, there was a correlation between lifestyle and obesity. CONCLUSION: In this study, the majority of the students had limited knowledge of oral health in association with diabetes and lifestyle. More than half of the students fell in the pre-obese/obese range.