Knowledge of Dental Ethics and Jurisprudence Among Dental Practitioners in Pune: A Questionnaire Survey.

Objective Dental ethics is a moral obligation that solicits professional behaviour imposed by the members of the dental profession. In addition, a set of legal regulations by each state's legislature describing the legal limitations and regulations related to dentistry, dental hygiene, and dental assisting is a part of dental jurisprudence. The present study aims to evaluate the knowledge regarding ethics and medical law for the practice among private practitioners in Pune, India. Materials and methods This was a cross-sectional study. The snowball sampling method (a randomization method) was used to contact all the registered practitioners for the study. A total of 250 dentists agreed to provide written informed consent and participate in the study. The collected data were entered into Microsoft Excel 2013 sheet (Microsoft Corporation, Redmond, WA) and cleaned, and statistical analysis was carried out using Epi Info software (CDC, Atlanta, GA). All p-values below 0.05 were considered to be statistically significant. Results A total of 250 dentists participated in the present study. Female postgraduate dentists had lesser knowledge of abbreviations used on dental boards. Master of Dental Surgery (MDS) dentists had more knowledge regarding dental jurisprudence than Bachelor of Dental Surgery (BDS) practitioners. Conclusions The present study highlighted the lack of awareness regarding dental ethics and jurisprudence among dental practitioners. It underlines the need for more education programs and curriculum changes with a focus on ethics, jurisprudence, and legal matters pertaining to clinical practice.

The Evaluation of the Antibacterial and Antifungal Efficacy of Novel Kids Mineral Trioxide Aggregate (e-MTA) With ProRoot MTA and Glass Ionomer Cement.

Background Most pulpal and periapical problems could be treated nonsurgically. However, in cases of infections, certain operations must be performed that require using materials with good antibacterial and antifungal efficacy. ProRoot mineral trioxide aggregate (MTA) was marketed as gray- and white-colored preparations, composed of 75% Portland cement, 20% bismuth oxide, and 5% gypsum by weight. MTA, composed of powder and liquid as distilled water, formed a colloidal gel that further solidified and formed a hard cement within approximately four hours. The new endodontic material Kids e-MTA (Kids-e-dental, Mumbai, India) was introduced recently. It was also available as powder and liquid. It was a bioactive cement consisting of very fine hydrophilic particles of several mineral oxides. Aim This study compares the antimicrobial and antifungal efficacy of e-MTA (mineral trioxide aggregate) (Kids-e-dental, Mumbai, India), ProRoot MTA (Dentsply Sirona, Tulsa Dental, OK, USA), and glass ionomer cement (GIC) (GC Asia Dental Pte Ltd, Singapore). Materials and methods The agar diffusion method was used to test the materials. e-MTA, ProRoot MTA, and GIC were tested for their antibacterial efficacy against Enterococcus faecalis and antifungal efficacy against Candida albicans. The zone of inhibition was calculated and measured using a precision ruler. The collected data was put through Student's unpaired t-test. Results and conclusions On conducting the tests and comparing the results, it was found that e-MTA had a slightly better antibacterial efficacy and almost similar antifungal efficacy compared to ProRoot MTA but significantly superior properties compared to GIC.

Evaluation of Pre- and Post-loading Peri-implant Crestal Bone Levels Using Cone-beam Computed Tomography: An In Vivo Study.

AIM: To evaluate the buccal, lingual, mesial, and distal crestal bone around implant using CBCT analysis having buccal crestal bone width of 1 mm after placement of implant and after 3 months of loading. MATERIALS AND METHODS: Twenty-five patients between 18 and 60 years of age with adequate bone width and height were selected for this in-vivo study with single or multiple missing teeth. Surgical stent was fabricated for all of them by using self-cure acrylic resin for selection of implant according to the availability of bone, and gutta-percha was used as radio-opaque marker to locate the implant site. After proper analysis, in the first stage surgery, implants were placed. After 3 months to this, the second stage surgery was performed followed by elastomeric impression for porcelain fused to metal prosthesis fabrication. The buccal, lingual, mesial, and distal bone width and height were evaluated by using cone-beam computed tomography (CBCT). CBCT was standardized in terms of FOV (field of vision), slice thickness, and interval. After 3 months of loading, CBCT was taken to evaluate the alteration in the crestal bone around implants. Pre- and post-loading, crestal bone on four locations was measured by using CBCT software. RESULTS: There is significant bone loss at all the locations, buccal, lingual, mesial, and distal, at the time of placement and after 3 months of loading of implant (p <0.05). The mean difference of 0.840, 0.933, 0.840, and 0.380 at buccal, lingual, mesial, and distal locations, respectively, shows statistically significant difference in pre- and post-values of mean bone loss at buccal, lingual, mesial, and distal positions. Pre-loading bone loss was maximum in the distal surface, while post-loading bone loss was maximum in the buccal surface. CONCLUSION: From this study, it is concluded that although crestal bone loss was higher before implant placement, there was significant alteration in crestal bone even after loading of implant. CLINICAL SIGNIFICANCE: It is widely accepted that the bone loss around the implant crest module is multidisciplinary in nature. Long-term preservation of the crestal bone is a paramount for successfully functioning of dental implants. Preserving crestal bone will help in dissipating the functional load. With proper treatment planning by the practitioner, this technical contribution to the crestal bone loss can be minimized and long-term survival of dental implants can be achieved.

Oral Cancer in Young vs Old Individuals: A Systematic Review.

AIM: To compare various parameters associated with oral cancer in young and old patients and systematically compile the data on prognosis or outcome of oral cancer in young and old patients that include case series, matched-pair analyses, institutional series, and database reviews. BACKGROUND: Though oral cancer is considered a disease of old age, a recent clinical scenario witnesses its increasing incidence among young persons. When compared to old patients, young patients with oral cancer are exposed to the carcinogens for a very petite period of time suggesting underlying pathogenesis to be distinct from that in older individuals. Literature reports several studies about the occurrence of oral cancer in young patients; however, no unanimous opinion exists about its prognosis and treatment outcomes when compared to older patients. Keeping this in mind, we have extensively studied all the possible aspects (location, local and regional recurrence, nodal and distant metastasis, overall survival, etc.) from the English literature and systematically compiled the available data on prognosis or outcomes of oral cancer. REVIEW RESULTS: The overall outcome of the case series shows poorer prognosis in young patients, matched-pair analyses, and institutional series suggesting no significant differences whereas the databases favored a better prognosis in young patients. The mean overall survival rate was found to be better for young patients in the database and institutional review whereas worse in the matched-pair analyses. The mean 5-year survival rate was found to be more in young individuals in matched-pair analyses, database reviews, and institutional series as compared to older oral cancer patients. CONCLUSION: Though data extracted from various study designs are heterogeneous, the present review gives a scoping view of the papers published on oral cancer in young vs old patients. More prospective studies are suggested with a larger sample size in the future. CLINICAL SIGNIFICANCE: The present review will help to better understand the nature, course, and biologic behavior of oral cancer in young patients leading to the development of specific treatment strategies to manage the patients based on their age-groups.

Severe insulin resistance syndrome - A rare case report and review of literature.

Insulin Resistance syndromes (IR's), are a group of genetic disorders caused due a functional defect in chromosome 19p13. It is an autosomal recessive condition. Donohue Syndrome was initially described by Donohue and Uchida in 1948 and 1954, a case of sisters born to parents with a first-degree consanguineous marriage. Infants presented with typical facial features that resembled the Leprechaun elves of Irish fairy tales. The following is a report of a rare case of dental complications of Severe Insulin Resistance Syndrome. An eight year old female child, with characteristic features of severe insulin resistance syndrome, reported to the Department of Pediatric and Preventive Dentistry, Pravara Institute of Medical Sciences, Loni, presenting with cariously destructed molars and a previous history of dental treatment under local anaesthesia. Given her condition, it was decided to reduce the multiple appointments, to one appointment with all procedures done under general anaesthesia. The following case report discusses the advantages, disadvantages and post operative complications faced when forming a treatment strategy for Severe Insulin Resistance Syndrome.

Clinical Success of Platelet-rich Fibrin and Mineral Trioxide Aggregate (MTA) or MTA-like Agents in Healing of Periapical Lesion in Nonsurgically Treated Pulpless Immature Permanent Teeth: A Systematic Review.

BACKGROUND: The chances of extrusion of mineral trioxide aggregate (MTA) are quite high if apical barrier is not present in immature pulpless permanent teeth. Platelet-rich fibrin (PRF) enriched with platelets and growth factors serves to accelerate the wound healing of periapical lesion in immature pulpless permanent teeth and also serves as internal matrix to condense MTA. AIM: The aim of the present study was to comprehensively review the clinical success of MTA+PRF in healing of periapical lesions in immature pulpless permanent teeth. MATERIALS AND METHODS: An electronic search for systematic review was conducted in Pubmed/Medline (www.ncbi.nlm.nih.gov), Cochrane (www.cochrane.org), Scopus (www.scopus.com) databases upto 15th January 2020 related to the healing of periapical lesions in permanent teeth with immature apices when combination of MTA+PRF was used. A sample of 10 relevant studies and case reports were identified in our search out of 65. The sampling method was simple random technique. The studies and case reports with Randomised Controlled Trials(RCTs), Invitro studies, Case reports and animal studies in healing of periapical lesion were included in our comprehensive systematic review. RESULTS: The search showed that the combination of MTA+PRF showed faster and definite periapical lesion healing in immature permanent teeth. The follow-up period was also recorded in all the relevant studies and case reports. CONCLUSION: Acclerated bone filling was seen in healing of periapical leions when MTA+PRF was used.

Scaffolds--The Ground for Regeneration: A Narrative Review.

AIM: The aim of this study was to comprehensively review the various biomaterials used as scaffolds, rates of biodegradability of natural, artificial and composite hybrid scaffolds, and the role of controlled biodegradability in tissue engineering. MATERIALS AND METHODS: An electronic search for systematic review was conducted in PubMed/MEDLINE (www.ncbi.nlm.nih.gov), Cochrane (www.cochrane.org), Scopus (www.scopus.com) databases, and dental journals related to endodontics and pediatric dentistry to identify the research investigations associated with the degradation profiles, factors relating to degradation, rates of biodegradability and the role of controlled biodegradability of natural, artificial and composite scaffolds. A sample of 17 relevant studies and case reports were identified in our search of 100 using simple random sampling. RESULTS: Naturally derived scaffolds degrade at a much higher rate than artificial and composite scaffolds. The degradation profiles of composite scaffolds can be much better controlled than naturally derived scaffolds. CONCLUSION: Composite scaffolds are more favorable as compared to natural or artificial scaffolds, as it has superior mechanical properties, minimal immune response, and a controlled rate of degradation and consequent tissue regeneration.

A silent tumor of the gingiva: An unusual case report and surgical management with 1 year follow-up.

Neurofibroma is a benign tumor of the peripheral nerve sheath characterized by the proliferation of Schwann's cells, perineural cells, and endoneurial fibroblasts. Here, we present a case of unique variation in the observed characteristics of a neurofibroma, with no relation to neurofibromatosis (NF) type-1 or von Recklinghausen disease of the skin. A swelling was observed in the right maxillary gingiva in relation with 14-16 regions of a 25-year-old female patient. The lesion was smooth, with sessile base, painless, non-ulcerated, and with normal color. An excisional biopsy of the lesion was performed, and histologically the diagnosis was confirmed. The patient remains uneventful after 1 year of clinical follow-up. Oral cavity involvement by a solitary neurofibroma in patients with no other signs of NF is uncommon and the gingival involvement is very rare.

A comprehensive oral and dental management of an epileptic and intellectually deteriorated adolescent.

Epilepsy along with intellectual deterioration and other neurological disorders can have social, physical, and psychological consequences, especially, when they begin in childhood. Moreover, the seizure episode along with mental deterioration may compromise the oral and dental care resulting in numerous decayed teeth. This report presents the case history of an adolescent with poor oral hygiene and numerous decayed teeth. This report also presents the comprehensive endodontic, surgical, and prosthodontic management of epileptic mentally challenged patient in the dental office. Epilepsy along with intellectual deterioration and other neurological disorders can have social, physical, and psychological consequences, especially, when they begin in childhood. Moreover, the seizure episode along with mental deterioration may compromise the oral and dental care resulting in numerous decayed teeth. This report presents the case history of an adolescent with poor oral hygiene and numerous decayed teeth. This report also presents the comprehensive endodontic, surgical, and prosthodontic management of epileptic mentally challenged patient in the dental office.

Periodontitis, diabetes mellitus, and the lopsided redox balance: A unifying axis.

AIM: The aim of present study was to evaluate and compare the total antioxidant capacity in the saliva of type 2 diabetes mellitus (DM) patients and healthy subjects, with and without periodontal disease. MATERIALS AND METHODS: The study was designed as a case-control study, comprising of 120 male subjects, who were divided into four groups of 30 patients each. Group I: Thirty type 2 diabetic males with periodontal disease; Group II: Thirty type 2 diabetic males without periodontal disease; Group III: Thirty healthy males with periodontal disease; Group IV: Thirty healthy males without periodontal disease. After clinical measurement and sampling, the total antioxidant capacities in the saliva of type 2 diabetic and healthy men were determined, and the data were tested by non-parametric tests. The total antioxidant capacity of the clinical samples was determined spectrophotometrically. RESULTS: The total antioxidant capacity in the saliva was the lowest in type 2 diabetic males with periodontal disease. The results were statistically significant. CONCLUSION: The findings of our study finally conclude that the salivary total antioxidant capacity is affected in type 2 diabetic males, in addition to the impact of periodontal disease, and hence, can be used as a useful marker of periodontitis in healthy and diabetic patients.

Correlation of mast cells in periodontal diseases.

BACKGROUND: Among the cells involved in immune and inflammatory responses in periodontal disease, mast cells have been shown to be capable of generating a large number of biologically active substances. Mast cells are mobile, bone-marrow-derived, granule-containing immune cells that are found in all connective tissue and mucosal environments and in the peripheral and central nervous systems. Mast cells are able to phagocytose, process and present antigens as effectively as macrophages. The present study was undertaken to quantify the mast cells in health and disease, whether they correlate degree of inflammation and clinical features of periodontium. MATERIALS AND METHODS: Ten cases of localized chronic periodontitis (CP), 10 cases of dental plaque-induced gingivitis (DPIG) and 10 cases of clinically healthy gingival tissues were selected. Samples were obtained from patients undergoing for periodontal surgery in CP and DPIG. In health group third molar impacted and covered with operculum without any inflammation were selected. Sample fixed in 10% buffered formalin and stained with Toludine blue stain and observed under binocular microscope. CONCLUSION: In human periodontal disease there is an increase in the number of mast cells that may be participating either in the destructive events or in the defense mechanism of periodontal disease via secretion of cytokines.

Evaluation of Total Antioxidant Capacity of Saliva in Type 2 Diabetic Patients with and without Periodontal Disease: A Case-Control Study.

BACKGROUND: Diabetes mellitus (DM) has been linked with oxidative stress and decreased antioxidant defense. A connection has been established between diabetes and periodontal disease. AIM: The aim of present study was to compare salivary total antioxidant capacity of type 2 DM patients and healthy subjects with and without periodontal disease. MATERIALS AND METHODS: A total of 120 subjects consisting of 30 type 2 DM patients with periodontal disease; 30 type 2 DM patients without periodontal disease; 30 healthy subjects with periodontal disease; 30 healthy subjects without periodontal disease were included in the study. After clinical measurement and samplings, total antioxidant capacity in saliva of type 2 diabetic and healthy subjects were determined, and the data were tested by non-parametric tests. Total antioxidant capacity of the clinical samples was determined spectrophotometrically. RESULTS: The mean salivary total antioxidant capacity was lowest in diabetic patients with periodontitis. CONCLUSION: Total antioxidant capacity is inversely proportional to the severity of inflammation and can be used as an useful marker of periodontitis in healthy and diabetic patients.

Pattern and prevalence of maxillofacial fractures in rural children of central maharashtra, India. A retrospective study.

The aim of this study was to review the pattern and prevalence of maxillofacial fractures occurring in rural children, at Rural Dental College and Hospital, Loni, Central Maharashtra, India. A retrospective analysis of patient records and radiographs was conducted during the 5 year period between January 2005 and December 2010. Data were identified and analysed based on age group, gender and anatomic site. During the 5 year period, 156 patients with 163 maxillofacial fractures were reviewed, males formed 70 % and females formed 30 % of studied population with the peak incidence rate occurring in 10-12-year old age group. The most common fracture site in maxilla was dentoalveolar component (70 %) and in mandible common fracture site was condyle (40.9 %). Of the fractures, 43 % were from accidental fall, 24.3 % from assaults, 16 % from road traffic accidents, 13.5 % from sporting injuries and 3.2 % from other causes such as animal injuries. Our results exhibit that accidental falls were the leading cause of maxillofacial fractures, and males were three times more affected than females. There is variation of incidence and pattern of maxillofacial injuries from region to region.

Links demystified: Periodontitis and cancer.

Cancer is marked by the uncontrolled growth of cells, tissue invasion and metastasis to various organs via the circulatory and lymphatic systems. Recent data have expanded the concept that inflammation is a critical component of tumor progression. Many cancers arise from sites of infection, chronic irritation, and inflammation. The tumor microenvironment, which is largely orchestrated by inflammatory cells, is an indispensable participant in the neoplastic process, fostering proliferation, survival, and migration. Periodontal disease, a chronic inflammatory condition is characterized by an oral bacterial infection leading to inflammation within the supporting tissues of the teeth, which often leads to the destruction of the periodontal tissues and alveolar bone that support the teeth. This oral inflammation often has systemic effects leading to an increased concentration of circulating inflammatory markers with the severity of disease being correlated directly with levels of serum inflammatory markers. Periodontal infection has been linked to organ and systemic diseases. There is documented evidence of significant associations between cancer of the lung, kidney, pancreas, hematological and oral cancers, and periodontal disease. This articles reviews and summarizes the possible biological mechanisms involved between periodontal infection and cancer.

Mucocele of the glands of blandin-nuhn in children: a clinical, histopathologic, and retrospective study.

BACKGROUND: The anterior lingual salivary glands (glands of Blandin-Nuhn) are mixed mucous and serous glands that are embedded within the musculature of anterior tongue ventrum. AIM: The present study was designed to describe the clinical and histopathological features. MATERIAL AND METHODS: We investigated the clinical and histopathologic features of 30 cases of mucocele of glands of Blandin-Nuhn. All the cases were seen in the department of pedodontics. RESULTS: All the lesions were located on the ventral surface of the tongue. Lesions were situated at the midline in 24 patients and laterally in 6 patients. All the lesions were surgically treated. There was female predominance, and most patients were younger than 15 years. CONCLUSION: Histopathological examination showed extravasation type of mucocele, suggesting that trauma may be a frequent initiating factor. All the patients were younger than 15 years.

Oral lichen planus: a report and review of an autoimmune-mediated condition in gingiva.

Oral lichen planus (OLP) is a chronic autoimmune, mucocutaneous disease that affects the oral mucosa as well as the skin, genital mucosa, scalp, and nails. It is one of the most common dermatological diseases presenting in the oral cavity. An immune-mediated pathogenesis is recognized in lichen planus, although the exact etiology is unknown. The disease most commonly affects middle-aged females. It is infrequently found in children, with a prevalence of about 0.03%, and reports of this are scarce in the literature. The erosive and atrophic forms of OLP are less common, yet they are more likely to cause symptoms. OLP is the target of much controversy, especially in relation to its potential for malignancy. Thus, it is important for clinicians to maintain a high index of suspicion for all intraoral lichenoid lesions. Periodic follow-up of all patients with OLP is recommended. In view of the above, the authors highlight a case of gingival erosive lichen planus affecting a 17-year-old adolescent without concomitant cutaneous lesions, with special emphasis on clinical and microscopic characteristics of the condition and management with retinoids and steroid therapy.

Unilateral pathology associated with bilateral etiologies.

Hormonal fluctutaions affect not only a woman's reproductive system but surprisingly they have a strong influence on the oral cavity also. These changes are not necessarily the result of direct hormonal action on the tissue, but are perhaps best explained as the effects of the local factors (e.g. plaque on tissues exacerbated by hormonal activity). One such case of pubertal induced gingival enlargement associated with chronic generalized periodontitis caused by the combined influence of hormones and the habit of unilateral mastication is presented here. A 14-year-old girl reported with a complaint of swollen gums in the right maxillary and mandibular arches of the mouth since 2 years. The patient also had the habit of unilateral mastication (left side) since childhood which was revealed upon history. Amelioration of the gingival inflammation and the periodontal attachment loss was obtained through conventional periodontal therapy, including plaque control, scaling, root planing, and surgical removal of the soft tissue using Modified Widman Flap and bone grafting. Postoperative follow-up did not show any signs of recurrence. Pubertal induced gingival enlargement with unilateral masticatory habit needs early removal of enlargement to prevent further bone loss.

The challenge of antioxidants to free radicals in periodontitis.

Periodontal disease is a chronic adult condition. Bacteria implicated in the etiology of this disease causes destruction of connective tissue and bone. As a result of stimulation by bacterial antigen PMN produces free radicals via respiratory burst as a part of host response to infection. Patients with periodontal disease display increased PMN number and activity. This proliferation results in high degree of free radical release culminating in heightened oxidative damage to gingival tissues, periodontal ligament and alveolar bone. Damage mediated by free radicals can be mitigated by "ANTIOXIDANT DEFENSE SYSTEM ". Physiological alteration and pathological states produced by free radicals depend on disequilibrium between free radical production and antioxidant levels leading to oxidative stress.Hence this study has been designed to estimate the TOTAL ANTIOXIDANT CAPACITY in patients with PERIODONTITIS and healthy control subjects.