Knowledge of ocular infections among the dental practitioners across India: a cross sectional survey.

BACKGROUND: Ocular issues such as impaired vision, ophthalmia, orbital cellulitis, and blindness are not common with dental infections. However, there is absence of set guidelines in prevention and management of ocular issues arising from dental infections. Hence the knowledge and vantage point of the dentists with respect to ocular complications arising from dental infections was evaluated. OBJECTIVE: This study reviews the knowledge of dentists with association of eye infection due to dental contamination. METHOD: A cross sectional survey using standardized questionnaires were sent suing social media platform among the academicians and practicing dental clinicians. All the questionnaires were content validated by three ophthalmologists. Descriptive statistics was scrutinized and tabulated by employing the Statistical Package for Social Sciences (SPSS), version 17 (SPSS Inc., Chicago IL). Chi square tests was used. RESULTS: About 69.1%(65) and 30.9%( 29) of BDS and MDS grduates have experienced ocular complications because of dental contamination. This distribution showed no statistical significance (p = 0.25). 73.8% (183) and 28.2%( 65) had compliance with the eye protection, 77.7% (160) of BDS graduates and 22.3% (46) of MDS graduates preferred safety eye wear. This distribution showed statistical significance (p = 0.00). About 76.2% (279) of BDS graduates and 23.8%( 67) of MDS graduates faced ocular infections because of different types of splashes which included water, blood and saliva. (p = 0.23) CONCLUSION: This study puts an emphasis on the knowledge assessment among the dental practitioners on the importance of preventive barriers, and how special protective gear is required for doing cases undergoing dental treatment.

COVID-19 and Personal Protective Equipment-Related Challenges Faced by Pediatric Dentists during patient care: A Qualitative Study

Abstract Objective: To describe the challenges pediatric dentists face while caring for their patients during the pandemic. Material and Methods: A descriptive qualitative study was conducted with purposefully sampled pediatric dentists. Data were collected through in-depth, semi-structured interviews until the content of the collected data reached theoretical saturation. Data were transcribed verbatim, coded, and analyzed using content analyses. Results: Seven participants (four females and three males) between 29 and 50 years participated in the study. Three themes emerged from the analyses: Anxiety and fear; PPE (Personal Protective Equipment) and its impact on care delivery; and 3) Behavior management. Conclusion: Dental care delivery was challenging for pediatric dentists. They experienced high anxiety levels and modified their services according to the recommended guidelines while making accommodations to lessen patients' COVID-19-related anxiety. The additional mandated PPE use affected the communication between the dentists and their patients, affecting their dentist-patient bonding.

A scoping review exploring oral health inequalities in India: a call for action to reform policy, practice and research.

INTRODUCTION: Reduction in health inequalities and providing universal access to health care have been identified as two important global milestones by the World Health Organization for countries to achieve by 2030. Therefore, recognizing the magnitude of oral health inequalities in India has become a pressing priority to improve access to dental care within the country. This scoping review was conducted with the aim of reviewing, collating and analysing the current knowledge base on oral health inequalities in India. METHODOLOGY: The scoping review followed Arksey and O'Malley's approach, and reporting was performed in accordance with the PRISMA-ScR guidelines. A systematic search was conducted on Scopus, PubMed, Web of Science, and EMBASE to identify literature addressing one or more dimensions of oral health inequalities in India, published in English between January 2002 and April 2022. The data were charted, and qualitative analysis was performed to derive themes, highlighting the key concepts emerging from this review. RESULTS: In accordance with the eligibility criteria, a total of 71 articles retrieved through database search and backward citation search were included in this scoping review. The major themes ranged from individual to diverse sociodemographic factors acting as barriers to and facilitators of access to dental care. Deficiencies in human resources for oral health, along with a wide diversity in dental service provision and dental education were other major themes contributing to inequality. Subsequently, this has resulted in recommendations on restructuring the dental workforce and their development and modifications in oral health care policies and practices. The qualitative synthesis demonstrates the intertwined nature of the multiple factors that influence the goal of achieving an affordable, accessible, extensive and inclusive oral healthcare system in India. CONCLUSIONS: This comprehensive review provides a broad perspective on oral health inequalities in India, providing valuable insights for both researchers and policymakers in this area and guiding their efforts towards achieving universal oral health coverage in the Indian context.

Effect of educational intervention in reducing exposure to second hand tobacco smoke among 12-year-old children as determined by their salivary cotinine levels and knowledge, attitude and behavior - a randomized controlled trial.

Background: Tobacco use is one of the most important public health concerns, with approximately 8.7 million tobacco-related deaths each year, primarily in low- and middle-income countries. Even more concerning is the fact that 1.3 million of these deaths are seen in nonsmokers, including babies and children. This study was performed to determine whether a school-based "tobacco-free" educational intervention program among 12-year-old children would be effective in reducing their exposure to second-hand tobacco smoke (SHS) by improving their knowledge, attitude and behavior post intervention and estimating salivary cotinine levels as markers of SHS exposure. Materials and method: A randomized controlled trial was performed by a cluster random sampling technique, with 30 participants each in the experimental and control arms. A knowledge, attitude, avoidance behavior and self-efficacy of avoidance questionnaire was administered, followed by estimation of salivary cotinine levels. The experimental arm received the "tobacco-free" intervention, which comprised a 40-min health education session, with the first follow-up at 15 days and the second at 30 days after the intervention. After the intervention, the questionnaire was readministered, followed by re-estimation of salivary cotinine levels. Results: One month after the intervention, the number of participants who had a smoker who lived with them and the number of people who smoked inside the house were reduced in the experimental group compared to the control group. In the knowledge domain and the attitude domain, 80% and 60% of the items showed a statistically significant improvement in the experimental group compared to the control group. In the avoidance behavior domain and the Self-Efficacy of Avoidance Domain, all the items showed improvement in the experimental group compared to the control group. When the mean salivary cotinine levels were compared pre- and postintervention, it was found that although the mean postintervention salivary cotinine levels increased in both the experimental and control groups, the increase was less in the experimental group than in the control group. Conclusion: The present study has been shown to be effective in improving the knowledge, attitude and avoidance behavior of adolescents toward exposure to secondhand smoke.

Effect of ethylenediaminetetraacetic acid, maleic acid, and fumaric acid on postendodontic treatment root fracture toughness - An in vitro study.

Aim: The aim of this study was to evaluate the effectiveness of ultrasonic activation of ethylenediaminetetraacetic acid (EDTA), maleic acid (MA), and fumaric acid (FA) in combination with sodium hypochlorite (NaOCl) on postendodontic treatment root fracture toughness. Materials and Methods: Forty single-rooted mandibular premolars were sectioned below the cementoenamel junction and were kept on average 14 mm long. With the exception of eight randomly selected teeth acting as a negative control group (Group I/nonprepared), the rest were prepared till F3. Thirty-two specimens were randomly placed into four groups equally and then irrigated using the final irrigation protocols. Saline and NaOCl were used to irrigate Group II, 17% EDTA and NaOCl were used to irrigate Group III, 7% MA and NaOCl were used to irrigate Group IV, and 0.7% FA and NaOCl were used to irrigate Group V. The irrigants were ultrasonically activated in every group. The root canals were obturated with gutta-percha and AH Plus sealer. The roots were embedded along the long axis in the self-curing acrylic blocks along with polyvinyl siloxane, leaving the coronal 2 mm of the root exposed. The specimens were tested using a universal testing machine. Statistical Analysis: The Post hoc Tamhane's and one-way ANOVA tests were applied to examine the data. Results: The result of the study revealed that 0.7% FA (598.09 N) provided better root fracture resistance than EDTA (428.07 N) and MA (511.87 N). Conclusion: The conclusion derived from the study was that 0.7% FA provided better fracture resistance of endodontically treated teeth when compared to 17% EDTA and 7% MA.

Validation of ageism scale for dental students in India: (Ageism Scale for Dental Students- India) - a cross sectional study.

Background: Ageism persists in many different societies as it is innate and subconscious in nature. Negative effects such as loneliness, mistreatment, and occupational discrimination are frequently present due to ageism. The dental students in our study were wary of the possible benefits of expensive dental care because ageism is rife in their field. There is no validated and reliable ageism scale to assess how dental students perceive ageism in India. The current study was carried out to validate the ageism scale for dental students in the Indian context. METHODS: This was a cross sectional analytical study carried out among both males and females in Manipal College of Dental Sciences, Mangalore in which the instrument was 27-item Ageism scale for dental students. Content validity was done by six subject experts. The final version was administered to 213 students/Residents of dental school. The factorability of data was confirmed with KMO = 0.61 and Bartlett's Test of Sphericity resulting in p < 0.001. RESULTS: Final PCA model resulted in 15 items and six components that together accounted for 70.37% of overall variance. The six components had reliability ranging from marginal 0.51 (Component 6) to a high of 0.81 (Component 3). As per the gender differences by component females showed less ageism than men in "non-compliance" (-0.9(-1.66-0.14), p<0.05) and "practitioner perspective" (1.43 (0.84, 2.03), p<0.01). Statistical significance was seen in Barriers/concerns in dental treatment of elderly where residents showed reversed (1.4 (0.41, 2.38), p<0.01). Urban group showed more ageism for component 'time restraint' (-0.79 (-1.57, -0.02), p<0.05. CONCLUSION: Preliminary validation resulted in 15 item scale with six components with acceptable validity of the ageism scale and could be further tested in large samples. This scale will help recognize ageism in Indian context and provide necessary information to make changes in the curriculum as required.

Evaluation of Anxiety Levels in Children While Using Rubber Dam and OptraDam Isolation Techniques.

Aim: The aim of the study was to evaluate the anxiety levels in children while using rubber dam and OptraDam isolation techniques. Materials and methods: This study was a crossover trial conducted on 27 selected 6-12-year-old children. The procedure of placement of either of the isolation techniques was told and demonstrated using audiovisual aid. The sequence of the proceedings on each child (rubber dam or OptraDam) was determined randomly using toss of coin. Second demonstration was carried out 7 days after the first demonstration. The anxiety experienced was recorded using Venham's anxiety scale at two time points-after verbal explanation and after the audiovisual demonstration. The study also objectively assessed the anxiety by measuring the salivary malondialdehyde (MDA) levels of two patients. Results: When mean values of Venham's anxiety scores after verbal explanation and after audiovisual demonstration were compared for each of the two techniques using paired Student's t test, there was statistically significant decrease in the anxiety score following audiovisual demonstration in both the techniques. When the scores between two groups after verbal explanation and after audiovisual demonstration were compared using repeated measures of analysis of variance (ANOVA), the reported anxiety scores were significantly lesser for the OptraDam technique (p = 0.000). Conclusion: Audiovisual demonstration reduced the anxiety of children when compared to verbal explanation for both isolation techniques. OptraDam isolation was found to be less anxiety generating in children compared to rubber dam isolation. Clinical significance: When using modern adhesive techniques, a good isolation of the working field is an important requirement for better prognosis. OptraDam being the latest addition to the rubber dam family, if found to be more children friendly can solve majority of the problems related to isolation in pediatric dentistry. How to cite this article: S Mahima, YM Karuna, Shenoy R, et al. Evaluation of Anxiety Levels in Children while using Rubber Dam and OptraDam Isolation Techniques. Int J Clin Pediatr Dent 2023;16(2):287-291.

Role of nutritional supplements on oral health in adults - A systematic review.

Purpose: The word 'diet' usually encompasses the consumption of food that includes all the necessary nutrients required for the optimal functioning of the body. Nutritional supplements hold a supreme position due to the demanding lifestyles or medical conditions in this current era. Although medical literature has sufficient evidence exploring the effect of nutrients on general health, this systematic review aimed at specifically evaluating the role of nutritional supplements on oral health in adults. Methods: PRISMA guidelines were followed in conducting this systematic review where four electronic databases including Scopus, PubMed, EMBASE, and Web of Science were reviewed. Based on the inclusion criteria, four studies exploring the effect of oral nutritional supplements on oral health among the adult population were included in this systematic review. Results: This review generated evidence suggesting a positive effect of nutritional supplements on oral health. These findings were depicted in the form of a reduction in plaque scores, probing depths, gingival inflammation, and greater improvement in periodontal healing among individuals with higher intakes of nutritional supplements within recommended doses. Conclusions: The systematic review outlines the positive impact of consuming nutritional supplements in the recommended dosage on oral health. Additionally, this review stresses the necessity for interventional studies to further investigate the effects of nutritional supplements on oral health, particularly in regard to periodontal healing. PROSPERO registration: CRD42021287797 (27/11/2021).

Evaluation of Dental Interns' Perception and Self-Confidence Levels Regarding Endodontic Treatment"- A Questionnaire Study

ABSTRACT Objective: To evaluate the perception and self-confidence of Dental interns regarding endodontic treatment performed on patients. Material and Methods: A total of 111 dental interns from 5 different educational institutes of a state in South India participated in a questionnaire-based survey. The questionnaire consisted of 12 questions related to root canal procedures performed on patients. Analysis was done using SPSS version 17.0. Results: Sixty-five interns (59%) performed less than 10 root canal treatments on patients during the course of the internship. Twenty-eight interns (25% of the intern population) took up more than 10 root canal treatment cases, whereas only 18 interns (16%) did not perform the treatment on patients and answered the questionnaire based on their experience with extracted teeth model work. Only five interns out of 111 were 'Very confident' and 22 were 'Confident' in performing the root canal treatment. Conclusion: The present study indicates that the self-perceived confidence level among dental interns can affect their clinical performance. It also recommends additional hands-on workshops, problem-based learning and clinical guidance for the dental interns to become more confident with the root canal procedure.

Evaluation of the quality of life of patients with maxillofacial defects after prosthodontic rehabilitation: A cross-sectional study.

Context: Oral cancer surgery leads to hard- and soft-tissue loss which can affect the quality of life of the individuals. Maxillofacial prosthodontics focuses on optimizing the disrupted oral function of individuals whose rehabilitation will serve as a psychosocial therapy. Aim: The aim of this study was to assess the oral health-related quality of life (OHRQoL) after the maxillofacial prosthetic rehabilitation following cancer resection surgery. Settings and Design: The sample comprised 15 oral cancer patients who agreed to maxillofacial prosthesis (MFP) after surgery. Materials and Methods: Oral function and OHRQoL were evaluated pre- and postmaxillofacial prosthetic rehabilitation. The masticatory function, swallowing function, and articulatory function were evaluated. The OHRQoL was evaluated by OHIPJ-14 questionnaire. Descriptive methods such as frequency, percentage, mean, and standard deviation were calculated. Statistical Analysis: Descriptive statistics was used to analyze the results. Results: A statistically significant difference was observed between prescores and postscores of dysphagia score (P = 0.05) and OHIP-J14 score (P = 0.00). No statistically significant differences were evident in perceived chewing ability (P = 0.29) and intelligibility score (P = 0.43). A statistically significant difference was evident in the prescore and postscore of OHIP-J14 subscales: functional limitations (P < 0.05), physical pain (P < 0.05), psychological discomfort (P < 0.05), physical disability (P < 0.05), psychological disability (P < 0.05), and handicap (P < 0.05), before and after maxillofacial prosthetic treatment except for social disability (P > 0.05). Conclusion: OHRQoL significantly improved with maxillofacial prosthetic rehabilitation.

Influence of presence or absence of posts on the failure rates of post endodontic restorations: A systematic review and meta-analysis.

Aim: The study was designed to evaluate the existing evidence on the failure rates of post-endodontic restorations retained with and without post in endodontically treated teeth (ETT). Settings and Design: Preferred Reporting Items for Systematic Reviews and Meta-Analyses- Protocol (PRISMA-P) guidelines were used to formulate the review. Materials and Methods: Randomized controlled trials (RCT's) and prospective clinical studies comparing post endodontic restorations retained with and without post were included. PubMed/Medline, Embase, Cochrane Library and Scopus databases were searched to recognize relevant full-text articles in English language. The quality of the RCT's were evaluated using the Cochrane collaboration tool to assess the risk of bias and reported as having high, low or unclear risk. Random-effects model at a 95% confidence interval was used for the meta-analysis. Statistical Analysis Used: Meta-analyses was performed using the Mantel -Haenszel method31 and risk ratio, with a 95% confidence interval (CI), was estimated for dichotomous data. Random effects model32 was used as the pooling method and 95% confident interval (α = .05 for RR values) in Review Manager (RevMan) [Computer program]. Version 5.4. The Cochrane Collaboration, 2020). Results: Four studies comparing post retained and post free restorations in ETT with a total of 916 restorations were included in the analysis. The total risk ratio was 2.16, (95% CI:1.25 to 3.72). Conclusion: ETT with post retained restorations exhibited significantly lower failure rates compared to restorations without post. Well-designed RCT's are warranted to develop a clinical protocol with respect to post-retained restorations.

Dentists' perceptions on present and future dental practice during the COVID-19 pandemic: An embedded study.

BACKGROUND: The emergence of the COVID-19 pandemic has placed a significant burden on everyone. Although dental professionals are at an increased risk of COVID-19 infection, currently, very little is known about how oral health professionals and their professions could be affected by the pandemic. This study aims to investigate dentists' perceptions on present and future dental practice in light of the COVID-19 pandemic.  Methods: We conducted an embedded mixed-methods study at Manipal College of Dental Sciences, Mangalore, with Indian dentists registered with the Dental Council of India.   Results: Of the 976 participating dentists, 61% were females, 32% were 40 years of age or younger. Nearly half of the respondents (54%) acknowledged that the lockdown measures caused them a severe financial burden, and 56% were seriously concerned about being a source of infection to their family, friends, and community. Although 79% felt very comfortable or somewhat comfortable going back to work, they were all worried that Personal Protective Equipment (PPE) use would increase their financial burden and impact the number of patients seeking care. Even though a vast majority received the necessary information regarding returning to practice from their concerned dental regulatory bodies, some were unsure about the reuse of the PPEs because of the conflicting information they received.  Conclusion: The COVID-19 pandemic affected participants' professional lives negatively. Their major concerns were being a source of infection to their families and community. Providing information to dental professionals in a timely manner may prepare dentists to provide safe care to their patients while protecting themselves, their staff, and their families.

Teledentistry: a new oral care delivery tool among Indian dental professionals - a questionnaire study.

Background: The sudden massive spread of coronavirus disease 2019 (COVID-19) has led to a major public health emergency and changed the scene of the health care globally. During the COVID-19 pandemic, most dental treatment procedures were considered as major sources of infection transmission. Thus, the current survey aimed at evaluating knowledge, awareness and attitude of dental professional of India towards teledentistry. Methods: A pre structured questionnaire was framed and distributed among 600 dental professionals of India using email, WhatsApp and other social media modes.  SPSS version 17 was used for data analysis. The Chi-Square, student t test and one way ANOVA test were applied to assess the association between qualification, type of practice and participant response.  Logistic regression analysis was also carried out. Results: In total, 431 dental professionals completed the survey. Overall, 94.7% of dental professionals were aware about teledentistry and agreed it is useful in fulfilling needs of the community at great amount. A statistically significant difference was found for questions related to the application of teledentistry for all branches, whether it is a good tool to assess oral hygiene in remote areas and its usefulness in training in primary health care centre when comparison was done among dental professionals and specialist in different branches of dentistry. Conclusions: Within the limits of the study, findings show that study participants exhibited good knowledge and awareness regarding teledentistry. The participants exhibited positive attitude towards teledentistry but at the same time expressed the uncertainty in challenges which they may face in teledentistry. Lack of training, advanced infrastructure, good connectivity and network are main issues they were concerned about. The other important point of concern is many participants felt teledentistry cannot be applied for all branches of dentistry. Future research should focus on this aspect of teledentistry.

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.

Comparing the disinfecting efficacy of pomegranate peel extract oil, Garlic oil, Tulsi leaf oil, and Clove leaf oil with standard autoclaving on dental round burs tested against Enterococcus faecalis: An in vitro study.

Background: The study was conducted to compare and evaluate the disinfecting efficacy of four different herbal oils with standard autoclaving against Enterococcus faecalis (E. faecalis). Fifty round burs were infected with E. faecalis and dipped into the chemical test solution for 10 min. The disinfecting efficacy for each test chemical was checked using culture method on blood agar plate and peptone water test to check for turbidity. Clove leaf oil and Tulsi leaf oil have very good antimicrobial efficacy against E. faecalis which are similar and comparable to that of autoclaving. Aim: This stusy aimed to compare the efficacy of pomegranate peel extract (PPE) oil, Garlic oil, Tulsi leaf oil, and Clove leaf oil with standard autoclaving on dental round burs tested against E. faecalis. Settings and Design: The disinfecting capability of four different experimental oils against autoclave was evaluated on 50 round burs exposed to E faecalis in an In-vitro study. Materials and Methods: A total of 50 round dental burs were exposed to E. faecalis and the disinfecting capability of four different experimental oils against autoclave was evaluated by counting colony-forming units (CFUs) and turbidity test. Statistical Analysis: Statistical analysis was performed using SPSS version 20.0 (IBM), Chicago. The CFUs between the five groups (I, II, III, IV, V) were compared using the Chi-square test. The level of significance was kept at 5%. Results: Clove leaf oil showed the best disinfection efficacy comparable to autoclaving, followed by Tulsi leaf oil with no statistically significant difference between them, whereas garlic oil and PPE oil were significantly less effective against E. faecalis. Conclusion: Clove leaf oil and Tulsi leaf oil can be used for disinfecting dental burs, infected with E. faecalis, as alternatives to autoclaving.

Comparison of clinical effectiveness of conventional and self-etch sealant: a split mouth randomized controlled trial.

Background: Self-etching has been shown to be beneficial compared to the other resin sealants especially in pediatric practice. The present in-vivo study was designed to clinically evaluate the sealing ability and retention of the self-etching sealant compared to the conventional resin sealant. The aim was to evaluate and compare the retention and marginal integrity of the self-etch and acid etch sealant materials at three, six and twelve-month follow up. Methods: The study was designed as a double blinded, split mouth randomized controlled trial, . In total, 35 children (70 teeth) between 7 and 10 years of age formed part of the study. Group 1 received acid-etch sealant and Group 2 received self-etch sealants. The study participants and the investigator who performed the statistical analysis were blinded to the treatment allocation. All the samples were evaluated at 3, 6, and 12 months. The inter-group and intragroup comparison were carried out using the Chi-Square test and Friedman test with level of significance set at 5% and the P value less than 0.05. Results: Complete retention of sealants was observed in 34.5% of conventional acid etch (group 1) and 22.9% of self-etch samples (group 2) whereas complete loss of sealants were seen in 11.4% of group 1 and 20% of the group 2 samples and intergroup comparison of retention failure was non-significant (p=0.135). In total, 85.7% of the group 1 and 82.9% of the group 2 samples exhibited good marginal integrity with no clinical changes in the enamel around the margins but this was not statistically significant (p=0.5). Conclusions: Sealants with fewer procedural steps and those which provide adequate retention would be ideal for use in children. Thus, self-etch sealants have been found to be effective and efficient as a sealant in the present in-vivo study. Clinical Trials Registry, India registration: CTRI/2019/03/018343 (29/03/2019).

Evaluation of the efficacy of diode laser in bleaching of the tooth at different time intervals using spectrophotometer: An in vitro study.

Aim: This study aimed at comparative evaluation of the efficacy of tooth bleaching using different concentrations of carbamide peroxide (CP) with and without diode laser at 980 nm for 2.5 and 5 min time duration. Materials and Methods: Hundred intact human incisors were selected. Teeth were artificially stained using black tea solution. Samples were randomly allocated into four groups: Group I: distilled water, Group II: 15%, 20%, and 35% CP without laser, Group III: 15%, 20%, and 35% CP using diode laser for 2.5 min, and Group IV: 15%, 20%, and 35% CP using diode laser for 5 min. Color measurements were made using spectrophotometer. Data were statistically analyzed by ANOVA, repeated measures of ANOVA, and Tukey post hoc test. Results: 35% concentration of CP gave similar mean shade (ΔE) value at T2, as 15% CP at T3. At T3, 15% concentration of CP using diode laser for 2.5 min gave similar mean shade (ΔE) value, as 35% concentration of CP using diode laser for 2.5 min. Conclusion: 35% CP causes change in chroma and whitens the tooth at a faster rate with a significantly more lightening effect. Bleaching twice weekly produces a similar effect when using high or low concentrations of CP. Laser-assisted bleaching decreases the time of whitening process.

Effect of whitening toothpaste on surface roughness and microhardness of human teeth: a systematic review and meta-analysis.

Background: Whitening toothpastes exert a whitening effect on teeth through higher surface cleaning effectiveness resulting from the abrasive properties of the paste or specific chemical components. This systematic review and meta-analysis was conceptualized to examine the relationship between whitening toothpastes and surface roughness as well as microhardness of human teeth and to clarify the evidence base available around this relationship by conducting a systematic review and meta-analysis of studies in this topic area, looking at in vitro randomized control trials. Methods: Criteria for including studies in the review were done based on population, intervention, comparison, outcomes and study and studies were identified from electronic databases. Covidence® was used for data screening and data extraction. The CONSORT tool was used for checking relevant content and methodology used in each of the papers reviewed. Systematic review was done followed by meta-analysis, using Review Manager. Results: A total of 125 articles were obtained on key word search. After duplicate removal and title screening, 17 articles were eligible for full text review. Finally, 7 studies were included for systematic review and meta-analysis was conducted on 4 studies. The forest plot for surface roughness showed that that the meta-analytic effect was statistically significant with surface roughness value being higher in the intervention group. The forest plot for microhardness showed that the meta-analytic effect was statistically significant with the microhardness value being lesser in the intervention group. Conclusions: Although whitening toothpastes typically can lighten tooth color by about one or two shades, there is some evidence to show that these toothpastes also affect the mineral content of teeth by increasing surface roughness and reducing microhardness. More evidence and further research are needed to identify the type of whitening agent which will whiten the tooth effectively while maintaining the integrity of the tooth structure.

To evaluate and compare the effect of 17% EDTA, 10% citric acid, 7% maleic acid on the dentinal tubule penetration depth of bio ceramic root canal sealer using confocal laser scanning microscopy: an in vitro study.

Background: The main factors that affect the success of an endodontic infection are effective cleaning and shaping of the root canal system including complete disinfection by using chemical irrigating solutions and obturation with an endodontic sealer to provide a fluid-tight seal. Using rotary and hand instruments for shaping and cleaning the root canal along with irrigants produces a smear layer on the surface of root dentin affecting the penetration of the endodontic sealer into the dentinal tubules. This smear is difficult to remove with the use of only endodontic irrigants, hence, chelating agents were introduced in adjunct with irrigating solutions for irrigation protocol for effective removal of smear layer which effect the penetration of endodontic sealers into the dentinal tubules. Methods: 32 mandibular premolar teeth were used. The biomechanical preparation was done till Protaper F3 size. Irrigation was done with 2.5 mL sodium hypochlorite (NaOCl) solution after each instrumentation change for 1 min. Samples were then divided into 4 groups according to the irrigating solution used as the final rinse used with passive ultrasonic agitation. The groups were: Group I: 5 ml of saline, Group II: 5ml of 17% ethylenediaminetetraacetic acid, Group III: 5 ml of 10% citric acid, Group IV: 5 ml of 7% maleic acid each for one minute. All the canals were obturated with BioRoot tmRCS with gutta-percha using the ultrasonic condensation technique. For staining the samples for Confocal LASER microscopy, BioRoot tmRCS was mixed with Rhodamine B dye. Results: The maximum penetration of bio-ceramic sealer was observed in the coronal region. At the apical third, the maximum sealer penetration was seen with 7% maleic acid. Conclusions: Maximum sealer penetration was seen in the coronal section followed by the middle and apical section. Maximum sealer penetration was seen with 7 % maleic acid at the apical third.

Comparative Evaluation of Surface Roughness and Wettability of an Alkasite with Nano Bulk-Fill and Nanofilled Resin Composite Restorative Materials: In vitro Study.

Context: Surface characteristics of resin-based composites (RBCs) can change with polishing and over time. Aim: The aim of the study was to compare the surface roughness and wettability of three different posterior RBCs after polishing and the change in these surface characteristics over time, after aqueous aging. Settings and Design: Experimental in vitro study. Materials and Methods: Eleven disc-shaped RBC specimens were fabricated. The RBCs used were, alkasite composite, bulk-fill nanocomposite, conventional nanofilled composite. All the specimens underwent polishing with Soflex Diamond Polishing System and then analyzed for roughness and wettability at baseline and after aqueous aging for 3 months with the help of an atomic force microscope and a contact angle goniometer respectively. Statistical Analysis: One-way ANOVA and Tamhane test were used for the multiple comparisons. Results: Alkasite composite showed significantly higher surface roughness (P = 0.028 and P < 0.001, respectively) and lower wettability (P = 0.023 and P = 0.020, respectively) than conventional nanofilled composite at baseline and 3 months. Surface roughness of alkasite composite was also significantly higher than bulk-fill nanocomposite (P = 0.009 and P < 0.001, respectively) at both the time points. Conclusions: Alkasite has higher surface roughness in comparison to conventional nanocomposite and bulk-fill nanocomposite and lower wettability than conventional nanocomposite after polishing and aqueous aging over a 3-month period. In terms of surface characteristics, alkasite composite may be advantageous in preventing initial plaque adhesion to the material surface, but the lower surface roughness of nano-filled composites may be more advantageous in terms of plaque retention prevention.