Background: The anterior loop is an important structure in the interforaminal area of the mandible. The aim of the present study was to assess the prevalence and length of the anterior loop of mental nerve using cone beam computed tomography (CBCT) scan and to compare the differences between age, gender, and side. Materials and Methods: A total of 180 projections were analyzed in different sectional planes. The inferior alveolar nerve was determined. To measure the length of anterior loop in tangential plane, two parallel lines from the anterior point of mental foramen and anterior point of anterior loop were drawn. The distance between these two lines was measured by drawing a perpendicular line on them. The data were analyzed by SPSS (version 22). McNemar's test, Chi-square test, and t-test were performed to compare the significance of findings regarding side, age, and gender. P < 0.05 was considered statistically significant. Results: The results showed that 32.8% of images had anterior loop. The mean lengths of anterior loop in the right and left sides were 2.69 mm (standard deviation [SD] = 1.56) and 2.36 mm (SD = 1.16), respectively. There were no statistically significant differences between the mean lengths of the anterior loop in both sides (P = 0.18). Conclusion: Great care is required when placing implants in proximity to mental foramen to avoid anterior loop injury. Because of the variations of anterior loop length in each patient, a fixed distance anterior to the mental foramen is not safe, and the anterior loop length should be determined for each individual. The use of CBCT provides accurate measurements of the length of anterior loop.

Background: During sliding mechanics, the frictional force (FF) is an important counterforce to orthodontic tooth movement. The purpose of this in vitro study was to investigate the static and kinetic FFs of S silica-insert ceramic (SIC) brackets with Teflon-coated (TC) and conventional S stainless steel (SS) archwires. Materials and Methods: The target group of this study included 80 maxillary canine 0.022 inch slot SIC brackets. Forty SS brackets were used as the control. TC and conventional uncoated SS archwires of different dimensions (0.016, 0.018, 0.016 × 0.022, and 0.018 × 0.025 inch) were examined. All tests were carried out under artificial saliva injected condition. Scanning Electron Micrographs were prepared for two samples of coated and uncoated archwires. Analysis of variance and Tukey post hoc tests were used for statistical purposes (level of significance P < 0.05). Results: SIC brackets showed significantly lower levels of FFs than SS brackets. TC archwires had greater frictional values than conventional uncoated ones. They also exhibited an unusual behavior of increasing kinetic FFs with time. Indentation and delamination of coating were obvious under scanning electron microscopy observations. Conclusion: From the standpoint of friction, SIC brackets may serve well, even better than SS brackets, in sliding mechanics. The coating layer of the archwires may delaminate and lost, causing an impediment to tooth movement.

Background: Adequate Vitamin D is essential for dental and skeletal health in children and adult. The purpose of this study was to assess the correlation of serum Vitamin D level with external-induced apical root resorption (EARR) following fixed orthodontic treatment. Materials and Methods: In this cross-sectional study, the prevalence of Vitamin D deficiency (defined by25-hydroxyvitamin-D) was determined in 34 patients (23.5% male; age range 12–23 years; mean age 16.63 ± 2.84) treated with fixed orthodontic treatment. Root resorption of four maxillary incisors was measured using before and after periapical radiographs (136 measured teeth) by means of a design-to-purpose software to optimize data collection. Teeth with a maximum percentage of root resorption (%EARR) were indicated as representative root resorption for each patient. A multiple linear regression model and Pearson correlation coefficient were used to assess the association of Vitamin D status and observed EARR. P < 0.05 was considered statistically significant. Results: The Pearson coefficient between these two variables was determined about 0.15 (P = 0.38). Regression analysis revealed that Vitamin D status of the patients demonstrated no significant statistical correlation with EARR, after adjustment of confounding variables using linear regression model (P > 0.05). Conclusion: This study suggests that Vitamin D level is not among the clinical variables that are potential contributors for EARR. The prevalence of Vitamin D deficiency does not differ in patients with higher EARR. These data suggest the possibility that Vitamin D insufficiency may not contribute to the development of more apical root resorption although this remains to be confirmed by further longitudinal cohort studies.

Background: Macrophage migration inhibitory factor (MIF) is a key proinflammatory mediator. It plays a vital role in immune response against the oral disease. MIF is a regulator of innate immunity, and bacterial antigens can stimulate serum level of this protein. In experimental gingivitis, the expression level of MIF increases and this increment positively correlates with oral plaque index. The single nucleotide polymorphisms in the gene encoding the MIF protein can control the function of MIF. The aim of the present study was a clarification of the associations between MIF-173 G/C, MIF 95 bp, and 189 bp insertion/deletion (I/D) polymorphisms and chronic periodontitis (CP) compared with healthy controls. Materials and Methods: This case–control study was carried out on 210 CP patients and 100 normal subjects. MIF-173 G/C and MIF 95 bp and 189 bp I/D polymorphisms were genotyped, using polymerase chain reaction–restriction fragment-length polymorphism (PCR-RFLP) and PCR, respectively. Allele and genotype frequencies of the variants were compared between patients and controls using Chi-square. test. The value of P < 0.05 was considered statistically significant. Results: The study findings showed that MIF-173 G/C polymorphism, especially the C allele increased the risk of CP. The 95-bp I/D polymorphism was not associated with CP and the 185-bp I/D variant was not polymorphic in our population. Conclusion: Therefore, MIF-137 G/C variant increased the risk of CP in the South East of the Iranian population. In other words, polymorphisms in MIF gene influence clinical outcome of CP infection and influence the susceptibility to disease. Further studies with larger sample sizes and different ethnicities are required to validate our findings.

Background: Masking ability of a restorative material plays an important role to cover discolored tooth structure; however, this ability has not yet been well understood in zirconia-based restorations. This study assessed the masking ability of a zirconia ceramic on composite resin substrates with different shades. Materials and Methods: Ten zirconia disc specimens, with 0.5 mm thickness and 10 mm diameter, were fabricated by a computer-aided design/computer-aided manufacturing system. A white substrate (control) and six composite resin substrates with different shades including A1, A2, A3, B2, C2, and D3 were prepared. The substrates had a cylindrical shape with 10 mm diameter and height. The specimens were placed onto the substrates for spectrophotometric evaluation. A spectrophotometer measured the L*, a*, and b* values for the specimens. ΔE values were calculated to determine the color differences between the groups and the control and then were compared with a perceptional threshold (ΔE = 2.6). Repeated measures ANOVA and Bonferroni tests were used for data analysis (P < 0.05). Results: The mean and standard deviation of ΔE values for A1, A2, A3, B2, C2, and D3 groups were 6.78 ± 1.59, 8.13 ± 1.66, 9.81 ± 2.64, 9.61 ± 1.38, 9.59 ± 2.63, and 8.13 ± 1.89, respectively. A significant difference was found among the groups in the ΔE values (P = 0.006). The ΔE values were more than the perceptional threshold in all the groups (P < 0.0001). Conclusion: Within the limitations of this study, it can be concluded that the tested zirconia ceramic could not thoroughly mask different shades of the composite resin substrates. Moreover, color masking of zirconia depends on the shade of substrate.

Background: The aim of this study was to compare the in vitro effects of four different root canal sealers on the fracture resistance of endodontically treated teeth. Materials and Methods: Seventy-five freshly extracted human mandibular premolars were used for the study. Teeth were divided into five groups based on type of root canal sealers used. Gutta-percha was used for all the samples: Group I: AH Plus root canal sealer, Group II: MTA Fillapex root canal sealer, Group III: Apexit root canal sealer, Group IV: Conventional zinc oxide-eugenol (ZOE) sealer, Group V: Control (unobturated teeth). The teeth were embedded in acrylic resin blocks and fracture force was measured using a universal testing machine (Asian Test Equipments). Data obtained were statistically evaluated using one-way ANOVA and post hoc test (Tukey's test). All groups showed statistically significant result (P < 0.05). Results: Group I and Group II showed higher resistance to fracture than other three groups. There was comparable difference in fracture force between Group I and Group II. Moreover, there was no statistically significant difference between Group III and Group IV and between Group IV and Group V. Conclusion: Based on this in vitro study, resin-based sealer was more effective as compared to other sealers and the control group. However, no significant differences were observed between ZOE and control group.

Background: Allergic rhinitis (AR) may be overdocumented in cases of dental caries because of controversies in the literature This study was conducted to investigate the potential relationship between AR and dental caries in children. Materials and Methods: A total of 296 children were included in this cross-sectional study. Participants were evaluated using the decay-missing-filled (DMF) index, and their AR status was evaluated by physical examination and through a standard questionnaire. Baseline demographics and clinical characteristics were compared among groups using Student's t-test or the Mann–Whitney U-test, the Chi-square test, and/or Fisher's exact test as appropriate. A level of P < 0.05 was regarded as statistically significant. Results: Evidence of AR was found in 77 (35.1%) participants. There was no significant difference in the rate of tooth decay or DMF between participants with or without AR (P = 0.07), but a significant difference was observed in the number of missing and filled teeth between those with and without AR (P < 0.05). There were no significant differences in educational level, family income, milk intake, use of pacifier, use of a toothbrush, saliva secretion, or body mass index (P > 0.05 in all cases) between AR-positive and AR-negative patients. Fluoride therapy and oral breathing were identified as confounding factors and controlled using log-linear analysis. The mean rate of DMF in patients who also had AR was 20% greater than in the AR-negative group (odds ratio [OR] = 1.21, confidence interval [CI]: 1.05–1.35) and 15% greater in among children who breathed orally than those who did not (OR = 1.15 CI: 1.02–1.31). Conclusion: AR and oral breathing may have an effect on oral health and dental condition, leading to an increased rate of tooth loss, oral fillings, and development of dental caries.

Background: The functional and esthetic rehabilitation of patients with atrophic maxilla or posterior maxillary defect is often challenging. The aim of this study was to determine patient demographics, indications, success rate, and complications following the use of zygoma implants. Materials and Methods: All patients who had zygoma implant placement in our clinic between 1998 and 2013 were retrospectively assessed for implant outcome. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 16 and Microsoft Excel 2007 test for significance (ρ) using Pearson's Chi-square (χ²) set at 0.05. Results: A total of 28 patients consisting of 22 females (78.6%) and 6 males (21.4%) were treated, and their age ranged from 41 years to 83 years with a mean age of 60.3 ± 10.6 years. The main indication for zygoma implant placement was atrophic maxilla 12 (42.9%). In the prosthetic rehabilitation of the patients, 2 had epithetic prostheses, and 2 had obturators while 18 patients had conventional removable dental prostheses. Four patients (14.3%) had perimplantitis and one implant was accidentally placed into the maxillary sinus. A cumulative success rate of 88.1% was obtained from this retrospective analysis. Conclusion: A cumulative success rate of 88.1% reported in this study is lower than the reports from other studies. The difference in success rates may be related to different criteria for assessment of zygoma implant success and to the difference in inclusion criteria and follow-up period.

Background: The aim of this cross-sectional study was to evaluate the association between stress, salivary cortisol, and periodontitis among the inmates of the central prison. Materials and Methods: Seventy inmates were grouped depending on their pocket depth into Group A (pocket depth >4 mm and <6 mm), Group B (at least four sites with pocket depth ≥6 mm), and Group C (pocket depth ≤3 mm). The clinical parameters such as the oral hygiene index-simplified, gingival index, pocket depth, and the clinical attachment levels (CALs) were recorded. Stress was measured using the Depression, Anxiety, and Stress Scale along with prison time served. Saliva samples were collected, and cortisol levels were determined using electrochemiluminescence assay. Chi-square test was used for finding the association between the clinical parameters. The correlation between clinical parameters, stress, salivary cortisol levels, and time served was done using Pearson's rank correlation coefficient. Results: The CALs, the stress score and the salivary cortisol levels were significantly higher in Group B (P < 0.001). Pearson's correlation showed a positive correlation between stress, cortisol level, and pocket depth. A positive correlation which was statistically significant was obtained between salivary cortisol level and prison time served by the inmates. Conclusion: Within the limits of this study, it can be concluded that there is a positive relation between stress and periodontal disease. The study suggests that salivary cortisol level can be used as a marker to assess stress.

Background: This study was conducted to assess the hardness of orthodontic brackets produced by metal injection molding (MIM) and conventional methods and different orthodontic wires (stainless steel, nickel-titanium [Ni-Ti], and beta-titanium alloys) for better clinical results. Materials and Methods: A total of 15 specimens from each brand of orthodontic brackets and wires were examined. The brackets (Elite Opti-Mim which is produced by MIM process and Ultratrimm which is produced by conventional brazing method) and the wires (stainless steel, Ni-Ti, and beta-titanium) were embedded in epoxy resin, followed by grinding, polishing, and coating. Then, X-ray energy dispersive spectroscopy (EDS) microanalysis was applied to assess their elemental composition. The same specimen surfaces were repolished and used for Vickers microhardness assessment. Hardness was statistically analyzed with Kruskal–Wallis test, followed by Mann–Whitney test at the 0.05 level of significance. Results: The X-ray EDS analysis revealed different ferrous or co-based alloys in each bracket. The maximum mean hardness values of the wires were achieved for stainless steel (SS) (529.85 Vickers hardness [VHN]) versus the minimum values for beta-titanium (334.65 VHN). Among the brackets, Elite Opti-Mim exhibited significantly higher VHN values (262.66 VHN) compared to Ultratrimm (206.59 VHN). VHN values of wire alloys were significantly higher than those of the brackets. Conclusion: MIM orthodontic brackets exhibited hardness values much lower than those of SS orthodontic archwires and were more compatible with NiTi and beta-titanium archwires. A wide range of microhardness values has been reported for conventional orthodontic brackets and it should be considered that the manufacturing method might be only one of the factors affecting the mechanical properties of orthodontic brackets including hardness.

Background: Oral cancer has one of the highest mortality rate among other malignancies. An attempt has been made to assess the genetic expression of a cell surface glycoprotein component - sialic acid released by the malignant cells which will reflect on the oral squamous cell carcinoma (OSCC). The aim of this study was to estimate and correlate the salivary and serum sialic acid levels in OSCC. Materials and Methods: In our case–control study, saliva and blood samples were obtained from Group 1 - 10 healthy controls, Group 2 - 12 well-differentiated OSCC, Group 3 - 7 moderately differentiated and 2 poorly differentiated OSCC. Serum and salivary total sialic acid levels were analyzed by Warren's thiobarbituric acid method and acidic ninhydrin method, respectively. The results were analyzed statistically by Student's t-test and Pearson's correlation coefficient (P ≤ 0.05). Results: A significant difference in the serum and salivary sialic acid levels was observed between Group 1 and Group 3 (P = 0.01 and < 0.0001) and in salivary sialic acid between Group 2 and Group 3 (P = 0.02). A significant positive correlation was observed between salivary and serum sialic acid in Groups 2 and 3 together (P = 0.015). Conclusion: As the histopathological grade progresses, there is a marked increase in level of sialic acid. There is a significant positive correlation between serum and salivary sialic acid levels in OSCC. Further research with larger sample size along with grading and staging system may highlight its significance in OSCC.

Background: The aim of the study was to assess the oral health status and treatment needs and correlation between dental caries susceptibility and salivary pH, buffering capacity and total antioxidant capacity among students attending special schools of Mangalore city. Materials and Methods: In this study 361 subjects in the age range of 12–18 years were divided into normal (n = 84), physically challenged (n = 68), and mentally challenged (n = 209) groups. Their oral health status and treatment needs were recorded using the modified WHO oral health assessment proforma. Saliva was collected to estimate the salivary parameters. Statistical analysis was done using Statistical Package for Social Sciences version 17. Chicago. Results: On examining, the dentition status of the study subjects, the mean number of decayed teeth was 1.57 for the normal, 2.54 for the physically challenged and 4.41 for the mentally challenged study subjects. These results were highly statistically significant (P < 0.001). The treatment needs of the study subjects revealed that the mean number of teeth requiring pulp care and restoration were 1 for the normal, 0.12 for the physically challenged, and 1.21 for the mentally challenged study subjects. These results were highly statistically significant (P < 0.001). The mean salivary pH and buffering capacity were found to be lowest among the mentally challenged subjects. Physically challenged group had the lowest mean total antioxidant capacity among the study subjects. Among the study subjects, normal students had the highest mean salivary pH, buffering capacity, and total antioxidant capacity. These results were highly statistically significant (P < 0.001). Conclusion: This better dentition status of the normal compared to the physically and mentally challenged study subjects could be due to their improved quality of oral health practices. The difference in the treatment needs could be due to the higher prevalence of untreated dental caries and also due to the neglected oral health care among the mentally challenged study subjects. The salivary pH and buffering capacity were comparatively lower among the physically and mentally challenged study subjects which could contribute to their increased caries experience compared to the normal study subjects. However, further studies are needed to establish a more conclusive result on the total anti-oxidant capacity of the saliva and dental caries.

Background: The aim of this study was to evaluate and compare the changes in the mechanical properties and surface morphology of different orthodontic wires after immersion in three mouthwash solutions. Materials and Methods: In this in vitro study, five specimens of each of 0.016 inch nickel titanium (NiTi), coated NiTi, and stainless steel orthodontic wires were selected. The specimens were immersed in 0.05% sodium fluoride (NaF), 0.2% chlorhexidine, Zataria multiflora extract, and distilled water (control) for 1.5 h at 37°C. After immersion, loading and unloading forces at 0.5 mm intervals and the elastic modulus (E) of the wires were measured using a three-point bending test. Surface changes were observed with a scanning electron microscope (SEM). Two-way analysis of variance and Bonferroni tests were used to compare the properties of the wires. The level of significance was set at 0.05. Results: Statistically significant changes in loading and unloading forces and E of the orthodontic wires were observed after immersion in different mouthwash solutions (P < 0.05). A pairwise comparison showed a nonsignificant difference between the effect of different mouthwashes on the E of different types of wires (P > 0.05). SEM images showed surface changes in some types ofthe orthodontic wires. Conclusion: The mouthwashes used in this study seemed to change the mechanical properties and surface quality of the orthodontic wires.

Background: The purpose of this study was to evaluate the microbial reduction in deciduous molars using Morinda citrifolia juice (MCJ) as irrigating solution. Materials and Methods: This was a randomized comparative study including 60 deciduous molars chosen among the patients belonging to the age group of 6–9 years based on the inclusion or exclusion criteria. The selected teeth were divided randomly into two groups based on irrigation solution used, that was, Group I (1% NaOCl) and Group II (MCJ). The microbial samples were collected both pre- and post-irrigation and were transferred for microbial assay. Paired t-test was used for intragroup analysis of pre- and post-operative mean reduction of bacterial colony forming unit (CFU)/ml, whereas Independent t-test was used to assess the intergroup, pre- and post-operative mean reduction of bacterial CFU/ml. Results: In the intragroup comparison, both of the groups showed statistically significant (P < 0.001) reduction in the mean CFU/ml; however, it did not show statistically significant reduction when intergroup comparison was carried out between the two groups. Both the study materials had clinically revealed decrease in the microbial count postirrigation. Conclusion: Both the irrigants, 1% NaOCl and MCJ, were significantly effective in the reduction of mean CFUs/ml postoperatively. The results of this study have confirmed the antibacterial effectiveness of MCJ in the root canals of deciduous teeth. Considering the low toxicity and antibacterial effectiveness of MCJ, it can be advocated as a root canal irrigant in endodontic treatment of primary teeth.

Background: Halitosis is the presence of unpleasant or foul smelling breath. The origin of halitosis may be related to both systemic and oral conditions, but a large percentage of cases, about 90%, is generally related to an oral cause. The aim of this study was to compare the concentration of urea and uric acid in patients with halitosis and people without halitosis. Materials and Methods: In this case–control study, concentration of urea and uric acid was compared between two groups: (1) persons suffering halitosis (2) control group without halitosis. Each group includes fifty patients. Unstimulated saliva was collected in both groups. Then, concentration of urea, uric acid, and creatinine was determined. The results were statistically analyzed with SPSS software version 14 (SPSS Inc., Chicago, Illinois, USA) by t-test (α = 0.05). Results: Results showed that salivary urea and uric acid concentration in halitosis group were significantly greater than control group (P < 0.05). Salivary creatinine concentration in halitosis group was significantly lower compared to control group (P < 0.05). Salivary urea and uric acid concentration to creatinine ratios were higher in halitosis group than control group, and significant differences between them were existed (P < 0.05). Conclusion: According to the results, urea and uric acid concentration show increase in patient suffering halitosis, and this increase may result in oral malodor.

Background: This study aimed to assess the salivary levels of interleukin-8 (IL-8) in oral lichen planus (OLP) and diabetes mellitus (DM) patients, and OLP + DM patients in comparison with healthy individuals. Materials and Methods: This descriptive cross-sectional study was conducted on 75 patients (30 with OLP, 5 with both OLP and DM, 20 with DM and 20 healthy controls). The salivary levels of IL-8 and fasting blood sugar and 2-h postprandial blood glucose levels were measured in all the subjects. Data were analyzed with one-way ANOVA and post hoc least significant difference tests. Results: The mean salivary level of IL-8 was the highest in OLP + DM patients, followed by DM, OLP and control groups, respectively. Pair-wise comparisons of the groups revealed significant differences in the salivary levels of IL-8 between OLP and control, DM and control, also OLP + DM patients and control (P < 0.05). Conclusion: The increasing salivary level of IL-8 in the control, OLP, DM, OLP + DM groups, respectively, indicates the role of this inflammatory cytokine in the pathogenesis of OLP and diabetes.

Background: The use of jargon has become very common in the healthcare field, especially in medical/dental records. Although the use of standard medical jargon can be seen as professional, efficient shorthand, a lack of awareness regarding the standard medical abbreviations and incessant and overzealous use of slang among the healthcare professionals can act as a barrier to effective communication and understanding among patients and peers. The aim of this study was to assess the acceptance and use of jargon in case history taking among clinical dental students and dental teaching faculty members of dental colleges in Ernakulam and Idukki districts of Kerala. Materials and Methods: A cross-sectional questionnaire-based survey was carried out, consisting of 15 questions, to assess the objectives of the study. The study was conducted among clinical dental undergraduate students, house surgeons, postgraduate students and teaching faculty members of five dental colleges in Ernakulam and Idukki districts, Kerala. The results were expressed as a number and percentage of response for each question and Chi-squared test was used for inferential statistical analysis. Results: All the 549 respondents used jargon in case history taking. Approximately 22.4% of the respondents admitted that they always used jargon and 55.8% admitted of using jargon only when there was a lack of time. The majority of the respondents (71.4%) learned the jargon from their colleagues. Approximately 50% of the respondents admitted use of jargon in a history section and about 32% of the respondents in all the sections of case history taking. Approximately 74% were of the opinion that abbreviations should be permitted in case history taking. Conclusion: This study showed widespread use of jargon/abbreviations in case history taking among the respondents. There is a lack of knowledge regarding standard medical abbreviations. Although the majority of the respondents were comfortable with the use of jargon, the majority of the postgraduates and faculty members felt the use of jargon should be stopped.

Background: This study investigated the impact of different surface treatments, including fractional carbon dioxide (CO₂) laser on shear bond strength (SBS) of resin cement to lithium disilicate ceramic. Materials and Methods: In this in vitro study, 72 blocks of IPS e.max CAD ceramic were randomly divided into six groups in terms of treatment (n = 12). Group 1 underwent etching with 9.6% hydrofluoric (HF) acid, whereas group 2 was subjected to air abrasion with aluminum oxide particles. Groups 3 and 4 were treated with a fractional CO₂laser for 10 s using 10 W/14 mJ (group 3) or 20 W/10 mJ (group 4). In groups 5 and 6, the CO₂laser was applied similar to that in groups 3 and 4, respectively; then, the specimens were etched by HF acid. After silane application, luting cement was bonded to the specimens. The SBS was assessed with a universal testing machine, and the type of bond failure was determined. Data were analyzed by ANOVA, Duncan, and Fisher's exact tests. Results: Surface conditioning with fractional CO₂laser alone resulted in significantly lower SBS than HF acid treatment (P < 0.05). Bond strengths of the specimens treated with a combination of laser irradiation and acid etching were significantly greater than all the other groups (P < 0.05). No significant difference was found in the distribution of failure modes among the groups (P = 0.337). Conclusion: The combination of fractional CO₂laser irradiation and HF acid etching could be recommended when extra retention is required for lithium disilicate-based restorations, whereas laser treatment alone cannot produce sufficient SBS.

Background: The aim of this cross-sectional descriptive study was to determine children's preferences in a dental clinic so as to reduce anxiety during dental procedures. In this study survey methodology was used. Materials and Methods: A questionnaire was designed to evaluate the child's preference in a dental hospital so as to remove anxiety during a dental procedure. This study was carried out on 50 children aged 6–10 years. The children were randomly selected based on their first dental visit in a private dental college. Results: A large number of children preferred listening to rhymes and watching cartoons while undergoing dental treatment. They also preferred the walls painted with cartoons, the dental chair full of toys, a scented environment, and the presence of their parents during the treatment. Conclusion: The results of this study will help the dental team decide on the appropriate design of the pediatric dental operatory room in order to provide a comfortable dental environment which will reduce anxiety in children and improve the quality of health care.

Background: The aim of this study was to evaluate the effectiveness of audiovisual (AV) distraction in behavior modification during dental caries assessment and sealant placement in children with autism spectrum disorder. Materials and Methods: This study was conducted on 28 children diagnosed with autism spectrum disorder, aged 6.5−9.8 years. Children underwent one introductory (desensitization) appointment and three treatment sessions. During the introductory session, children had the procedures explained to them, they watched a movie projected on a screen while oral screening and assessment of cooperation level were carried out. In treatment session I, oral examination, charting, and dental x-rays were undertaken, whereas the children watched movies with or without video eyewear. During treatment sessions II/III, dental prophylaxis was carried out on upper and lower jaws in addition to the application of dental sealants on the right upper and lower and the left upper and lower permanent molars, respectively, while the children were distracted by cartoon movies using video eyewear. Changes in pulse oximeter and heart rate were recorded every 5 min. Independent samples t-test was used to assess the significance of changes in pulse and O₂ saturation levels during each visit. Results: International Caries Detection and Assessment System-code 2 was found to be the most prevalent (n = 58; 52%). A significant difference (P < 0.02) was observed in mean heart rate during dental screening of the upper and lower jaws with and without video eyewear. A decrease was observed in the mean heart rate during subsequent treatment sessions. Conclusion: Initial desensitization appointment and “tell-show-do” approach, followed by short and positive treatment sessions, assisted in gaining cooperation and improving behavior in the subjects. Video eyewear distraction proved an effective tool in managing children with autism spectrum disorder during noninvasive preventive dental procedures.

Background: This study aimed to evaluate and compare the efficacy of three desensitizing dentifrices on dentinal hypersensitivity (DH) and salivary biochemical characteristics. Materials and Methods: A randomized, parallel arm, triple-blinded, clinical trial was conducted over a period of 12 weeks, with a total of three visits: baseline, 6 weeks, and 12 weeks. Calcium sodium phosphosilicate, potassium nitrate and amine fluoride dentifrices were compared. A total of 68 subjects who satisfied the inclusion criteria were included and randomly divided into four groups. Visual analog scale scores for controlled air stimulus were used to assess dentinal sensitivity and salivary pH and buffering capacity were recorded at baseline, 6 and 12 weeks. Results: All groups showed a reduction in sensitivity scores at 6 and 12 weeks. The calcium sodium phosphosilicate group showed a higher degree of effectiveness in reducing DH than potassium nitrate, amine fluoride dentifrices, and placebo for sensitivity measures. Salivary pH of calcium sodium phosphosilicate group was more toward neutral, and the buffering capacity of the same group showed significant changes from baseline to 6 and 12 weeks compared to the other groups. Conclusion: The desensitizing toothpaste containing calcium sodium phosphosilicate was found to be more effective in reducing DH and showed improvement in salivary biochemical characteristics over a period of 12 weeks compared to others.

Background: Caries in second molar is common and prophylactic removal of the impacted teeth may be considered appropriate. Caries detection and restoration can be difficult and a restored second molar can undergo recurrent caries if the third molar is not removed prophylactically. In this study, the clinical findings related to impaction and its association with angular position and depth of impacted third molar were evaluated. Materials and Methods: A retrospective descriptive study was carried out among the patients visiting the outpatient, department of Dentistry, RIMS, Ranchi. The clinical examination, periapical radiographs and Pre-op OPG were taken. Teeth positions were analyzed by Pell and Gregory and Winter classification. The angulation and depth of mandibular third molar impaction and caries in the second molar with the eruption status of the mandibular third molar was determined. Results: A total of 200 patients were included in the study between age group 17-45 years. Majority of the Patients reported to the hospital with complaints of decayed tooth (66%) and pain (59%). The most common third molar impaction was mesioangular followed by distoangular. A statistically highly significant difference (P = 0.001) was obtained with the presence of caries in second molar adjacent to mesioangular third molar in class I and level B. Conclusion: According to this study, pattern of mandibular third molar impaction is in association to caries in mandibular second molar. More future studies are needed. In addition, the results of the present study can be used to screen and inform the patients about the possibility of caries in relation to third molar mandibular impaction.

Background: Poor denture hygiene can be a potential source of pathogens. The aim of this study was to compare the efficacy of microwave radiation with that of chemical and mechanical techniques in disinfecting complete dentures contaminated with Staphylococcus aureus and Pseudomonas aeruginosa. Materials and Methods: Seventy-two sterilized mandibular dentures were separately contaminated with S. aureus (n = 32) and P. aeruginosa (n = 32) and then incubated at 37°C for 48 h. The contaminated dentures were disinfected as follows: chemical disinfection with Corega tablets; chemical disinfection with 2% glutaraldehyde; mechanical disinfection by brushing the denture; and physical disinfection by 650-W microwaves irradiation for 3 min with six samples in each subgroup. Six dentures served as negative control group, and six contaminated dentures with no disinfection served as the positive control group. 10^-3–10^-6 dilutions were cultured in the nutrient agar, and the colonies were counted after incubation at 37°C for 48 h. To evaluate the lasting time of disinfection, the containers with nutrient agar and dentures were stored for 7 days at 37°C to evaluate turbidity. Data were analyzed using Kruskal–Wallis and Mann–Whitney U-test (α = 0.05). Results: There was no evidence of bacterial growth in 48 h and turbidity after 7 days of incubation of dentures disinfected by microwaves, glutaraldehyde, and Corega tablets, which was statistically significant compared to the positive controls (P < 0.001). In mechanically disinfected dentures (brushing), bacterial growth was detected after 48 h which was statistically significant compared to the positive controls (P < 0.001) and turbidity was seen in all the nutrient agar plates. Conclusion: Microwave iradiation, 2% glutaraldehyde, and Corega tablets disinfected complete dentures contaminated with S. aureus and P. aeruginosa which lasted for a long and a short terms.

Background: The aim of the study was to assess the correlation between salivary cotinine level and psychological dependence measured through Fagerstrom test for nicotine dependence (FTND) questionnaire among tobacco users. Materials and Methods: This was a cross-sectional study, conducted on tobacco users. Participants with the present habit of tobacco chewing and smoking above the age of 16 years were included in the study. A standard questionnaire form of FTND revised version for smoking and smokeless form of tobacco were given to each participant. Each participant was asked to answer the questions as per their experience of tobacco consumption and calculate the total point score or FTND score. Salivary cotinine level assessment was done using commercial available NicAlert kit. Results: When salivary cotinine level was correlated with different variables of both groups, it was observed that weak correlation between salivary cotinine level and FTND scoring in smokers group (r = 0.083) and also in smokeless group (r = 0.081). When two groups were compared for salivary cotinine level, statistically significant difference (P = 0.021) was observed, with smokeless group showing high level of salivary cotinine level as compared to smokers group. Conclusion: Salivary cotinine and psychological dependence through FTND scoring are not strongly correlating with each other. This indicates that dependence over tobacco is a separate phenomenon and cannot be assessed by salivary cotinine level. It is well accepted that salivary cotinine level is influenced by age of individual, duration of habit, and type of tobacco consumption.

Background: One of the most effective ways for distal movement of molars to treat Class II malocclusion is using extraoral force through a headgear device. The purpose of this study was the comparison of stress distribution in maxillary first molar periodontium using straight pull headgear in vertical and horizontal tubes through finite element method. Materials and Methods: Based on the real geometry model, a basic model of the first molar and maxillary bone was obtained using three-dimensional imaging of the skull. After the geometric modeling of periodontium components through CATIA software and the definition of mechanical properties and element classification, a force of 150 g for each headgear was defined in ABAQUS software. Consequently, Von Mises and Principal stresses were evaluated. The statistical analysis was performed using T-paired and Wilcoxon nonparametric tests. Results: Extension of areas with Von Mises and Principal stresses utilizing straight pull headgear with a vertical tube was not different from that of using a horizontal tube, but the numerical value of the Von Mises stress in the vertical tube was significantly reduced (P < 0/05). On the other hand, the difference of the principal stress between both tubes was not significant (P > 0/05). Conclusion: Based on the results, when force applied to the straight pull headgear with a vertical tube, Von Mises stress was reduced significantly in comparison with the horizontal tube. Therefore, to correct the mesiolingual movement of the maxillary first molar, vertical headgear tube is recommended.

Background: In dental histology, the assimilation of histological features of different dental hard and soft tissues is done by conventional microscopy. This traditional method of learning prevents the students from screening the entire slide and change of magnification. To address these drawbacks, modification in conventional microscopy has evolved and become motivation for changing the learning tool. Virtual microscopy is the technique in which there is complete digitization of the microscopic glass slide, which can be analyzed on a computer. This research is designed to evaluate the effectiveness of virtual microscopy with conventional microscopy on student learning in dental histology. Materials and Methods: A cohort of 105 students were included and randomized into three groups: A, B, and C. Group A students studied the microscopic features of oral histologic lesions by conventional microscopy, Group B by virtual microscopy, and Group C by both conventional and virtual microscopy. The students' understanding of the subject was evaluated by a prepared questionnaire. Results: The effectiveness of the study designs on knowledge gains and satisfaction levels was assessed by statistical assessment of differences in mean test scores. The difference in score between Groups A, B, and C at pre- and post-test was highly significant. This enhanced understanding of the subject may be due to benefits of using virtual microscopy in teaching histology. Conclusion: The augmentation of conventional microscopy with virtual microscopy shows enhancement of the understanding of the subject as compared to the use of conventional microscopy and virtual microscopy alone.

Background: Total antioxidant capacity (TAC) and malondialdehyde (MDA) levels have not been reported in oral lichen planus (OLP) patients treated with a topical corticosteroid. This study evaluates TAC and MDA levels in unstimulated saliva of OLP patients. Such measurements may need to be supported by clinical observation. Materials and Methods: Twenty patients with OLP participated in a study conducted at the Department of Oral Medicine, Tehran University of Medical Sciences. Salivary TAC and MDA were determined by biochemical analyses before and after 5-week triamcinolone acetonide (0.2%) mouthrinse treatment. Subjective symptoms as well as lesion status pre- and post-treatment were measured using visual analog scale (VAS) and clinical scoring system, respectively. Wilcoxon signed rank test was used for the evaluation of MDA and TAC parameters, VASs, and rates of clinical scores. Spearman's rank correlation was used to determine the relationship between different variables. Results: A statistically significant increase in salivary TAC was found after treatment. There was no significant difference in the reduction of salivary MDA levels in OLP patients after treatment. Conclusion: Posttreatment analyses revealed a significant degree of recovery and pain relief of OLP lesions. Hence, triamcinolon mouthrinse by reducing oxidative stress is an appropriate treatment in OLP patients.

Background: Following loss of teeth, atrophy of alveolar ridge of the jaws is a substantial problem and unintended outcome that compels clinicians to perform bone reconstruction ahead of implant placement. Although autogenous bone is recommended as the gold standard in bone reconstruction, aninvasive second surgery harvestinga limited volume of bone (from intraoral source) has led a significant approachingthe use of synthetic bone substitute materials. The aim of this study was to evaluate the histologic and histomorphometric properties of porous titanium granules (Natix^®) used in horizontal reconstruction of alveolar ridge before implant placement. Materials and Methods: In the present quasi-experimental clinical trial, four patients (three females and one male) needed horizontal bone augmentation on ten areas of edentulous mandibular ridge before implant treatment. During surgery, the buccal aspect of edentulous ridge was augmented by Natix^®, covered by resorbable membrane (Cytoplast^®). After 8 months, 10 core biopsies were obtained. Results: In histological study, no foreign body reaction at the site of the newly formed bone or around the biomaterial residue was observed. Newly formed bone was fully vital with large lacunae containing osteocytes. In 60% of cases, connective tissue was observed at the biomaterial – new bone interface. In histomorphometric study, mean percentage of bone formation was 40.56% ± 19.83% and mean bone trabecular thickness was 39.98 ± 17.54 μ. Conclusion: Despite acceptable histological and histomorphometric bone formation findings, in clinical terms, no increase was created in the horizontal dimension. Thus, it seems that application of this biomaterial in horizontal reconstruction of alveolar ridges with noncontained defects is inappropriate.

Background: Latex elastics are still in common use due to their low cost and high flexibility to improve sagittal discrepancies or interdigitation of teeth. Mechanical properties of elastics are influenced by several environmental factors such as pH changes. This study evaluated similar latex elastics to define the influence of synergic effect of intermittent low pH and various baselines pH of saliva. Materials and Methods: Four groups of latex elastics (3-M Unitek, 3/16 inch) were tested (n = 15 in each group). Two groups of elastics were immersed in two tanks of artificial saliva with different pH levels of 7 and 5, and two groups were immersed in two tanks of artificial saliva with intermittent drop of pH to 4. The force was measured when the elastics were stretched to 25 mm. These measurements were taken in 0, 4, 8, 12, 24, 36, and 48 h for each group. Repeated measures analysis of variance (RMANOVA) and post-hoc Tukey's test were used to assess the findings. The level of significance was 0.05%. Results: The interaction between pH and time analyzed with RMANOVA showed no significant differences (P > 0.05) except in 36 h (P = 0.014). The Tukey's analysis showed that each comparison between any two groups did not indicate significant differences (P > 0.05) except between Groups 1 and 3 and between Groups 2 and 3 (P < 0.05). Conclusion: No significant correlation was seen between fluctuation of pH and force degradation in latex elastic band except in 36 h.

Background: Antibacterial activity is one of the important characteristics of an ideal root canal sealer. The aim of this study was to investigate the antibacterial activity of five different sealers against Enterococcus faecalis using two different methods. Materials and Methods: The mineral trioxide aggregate (MTA) Fillapex, Tg-sealer, Endomethasone, AH-26, and RoekoSeal sealers were placed into the brain heart infusion (BHI) culture medium containing E. faecalis (PTCC1393). The diameter of the bacterial zone of inhibition was measured. In the direct contact test, a suspension containing grinded set sealers and E. faecalis bacteria was cultured in BHI after 6, 15, and 60 min. The number of colonies in milliliter was calculated. Data were subjected to one-way ANOVA and Tukey's multiple comparisons test (P < 0.05). Results: In the agar diffusion test, Endomethasone had the highest antibacterial activity against E. faecalis compared to other sealers (P < 0.001). In the direct test, the antibacterial effect of MTA Fillapex was significantly higher than that of all other sealers (P < 0.001). Conclusion: The technique and components of the tested sealers affect the antibacterial activity results. This study showed that all of sealers had antimicrobial effect.

Background: It is shown that neuropeptides can be transported from pulp chamber to periodontal ligament through apical foramen and accessory canals. Therefore, clinical pulpal pain leads to expression of preinflammatory neuropeptides such as substance P (SP) and neurokinin A (NKA) in gingival crevicular fluid (GCF). This study aimed to evaluate levels of SP and NKA in GCF of carious and healthy permanent teeth, comparatively. Materials and Methods: This cross-sectional study was performed on twenty children referred to Department of Pediatric Dentistry, Tehran University of Medical Sciences, who had a painful permanent first molar. Sampling was done by sterile paper cone from GCF of the mentioned teeth and the intact tooth of the other side of the jaw in the same patient. Values of SP and NKA were measured by ELISA test. Results: The mean concentration of SP in GCF of painful carious and healthy teeth was 2.65 ± 0.56 and 1.83 ± 0.65 pcgr/ml, respectively. This value was 2.29 ± 0.29 and 1.61 ± 0.35 pcgr/ml for NKA concentration in carious and healthy teeth as well. Conclusion: Significant higher levels of both SP and NKA in GCF of painful carious teeth were observed, which is in line with previous studies' findings.

Background: Toothbrushing is an important aspect of children's oral health self-care. This study aimed to explore toothbrushing frequency among 4–6-year-old Iranian children and associated maternal attitude and sociobehavioral factors. Materials and Methods: This cross-sectional study was conducted on 407 mother–child (aged 4–6 years) pairs through stratified random sampling in Tabriz, Iran. Data were collected using self-reported questionnaires including demographic characteristic, maternal attitude, and toothbrushing frequency of both mothers and children. Logistic regression was used to determine the predicators of children's toothbrushing. Statistical significance was set at P < 0.05 for all tests. Results: The mean ages were 32.6 ± 4.8 and 5.3 ± 1.1 years for mothers and children respectively. Twice-daily toothbrushing was observed at a relative frequency of 12.8% in children and 18.4% in mothers. About 43.7% of children brushed their teeth once daily. Nearly 38.7% of children started toothbrushing behavior regularly at 4 years of age, and 41% had dental visits. Multiple logistic regression analysis indicated that children's toothbrushing (once daily or more) was associated with maternal brushing frequency (odds ratio [OR] =2.0, 95% confidence interval [CI] =1.53–2.86), maternal attitude toward oral health (OR = 1.15, CI = 1.08–1.22), and children's age (OR = 1.21, 95% CI = 1.02–1.77). Conclusion: The descriptive results indicated that maternal and children toothbrushing behaviors are unfavorable. Furthermore, maternal toothbrushing behavior is a strong predicator of children's brushing behavior. Health promotional activities seem necessary for mothers to enhance oral health behavior of their children.

Background: To assess the prevalence of dental diseases among 9–15-year-old visually impaired children and find out its impact on their daily activities using the Child-Oral Impact on Daily Performance (C-OIDP) questionnaire in districts of Uttarakhand, India. Materials and Methods: A total of 423 visually impaired institutionalized children between the age group of 9–15 years were included in the study. Stratified random sampling technique was used to obtain the study population. Dental caries was recorded using dmft for primary dentition and DMFT for permanent dentition, traumatic dental injuries were assessed using traumatic dental injury index, and dentofacial anomalies were recorded using Angle's classification of malocclusion. The Hindi braille version of C-OIDP questionnaire was used to gather information regarding oral health-related quality of life (OHRQoL). Results: There was a high dental caries prevalence of 57.7% in visually impaired children. The prevalence of traumatic dental injuries was 50.6%. Crowding (61.5%) was the most commonly seen dentofacial anomaly and the most commonly perceived oral health problem was toothache. There was less favorable OHRQoL in males as compared to females. Conclusion: There was a high prevalence of dental diseases in this group and higher C-OIDP scores suggestive of unfavorable OHRQoL.

Background: To determine patient orthodontic treatment need, appropriate self-perceived indices are required. The aim of this study was to assess the sensitivity and specificity of esthetic component (AC) of the index of orthodontic treatment need (IOTN), oral esthetic subjective index scale (OASIS), and visual analog scale (VAS) through dental health component (DHC) IOTN as a normative index to determine the more appropriate self-perceived index among young adults. Materials and Methods: In this cross-sectional study, a sample of 993 was randomly selected from freshman students of Isfahan University. Those with a history of orthodontic treatment or current treatment were excluded. DHC was evaluated by two inter- and intra-calibrated examiners. Data for AC, OASIS, and VAS were collected through a questionnaire completed by students. Descriptive statistics, Mann–Whitney U-test, and Spearman correlation test, were used for data analyses. Sensitivity, specificity, positive and negative predictive values of self-perceived indices were calculated through DHC. Results: Sensitivity of AC, OASIS, and VAS for evaluating definite orthodontic treatment need was calculated at 15.4%, 22.3%, and 44.6%, respectively. Specificity of these indices for evaluating definite orthodontic treatment need was calculated at 92.7%, 90.5%, and 76.2% percent, respectively. All self-perceived indices had a significant correlation with together and with DHC (P < 0.01). Among demographic factors, there was weak but significant correlation only between mother's educational level and VAS (P < 0.01). Conclusion: Due to the sensitivity and specificity of the three self-perceived indices, these indices are not recommended for population screening and should be used as adjuncts to a normative index for decision-making in orthodontic treatment planning.

Background: Radiotherapy is one of the oral and pharyngeal cancer treatment methods that can cause damage to the tissues in the radiation area; the purpose of this study is to evaluate the effects of radiotherapy on dental pulp tissue in rats. Materials and Methods: In this interventional, experimental double-blind study, 30 rats were studied in three groups (n = 10 each). The first group received 12 gray (Gy), the second group received 18 Gy in one session, and the third group was not exposed to radiation (control group). The 5 μm sections of mandibular molar tooth were prepared and stained with hematoxylin and eosin. Samples were studied under optical microscope to evaluate and score inflammation, necrosis, hyalinization, and vascular congestion. The data were coded and analyzed by statistical tests of χ² and Fisher's exact tests. The significant level of P = 0.05. Results: In Group 1, necrosis in two cases, inflammation in one case, hyalinization in one case, and vascular congestion in four cases were observed. In Group 2, inflammation in four cases, hyalinization in two cases, and vascular congestion in five cases were observed. In Group 3, inflammation was observed only in one case. In comparison between the groups, no significant differences were observed in inflammation (P > 0.05), necrosis (P > 0.05), and hyalinization (P > 0.05). However, the difference was significant for vascular congestion (P < 0.05). Conclusion: Radiotherapy with doses of 12 and 18 Gy had no significant effect on inflammation, necrosis, and hyalinization in all groups; however, the difference was significant for vascular congestion.

Background: The prevalence of chronic renal failure is increasing because of increase in chronic debilitating diseases and progressing age of population. These patients experience accumulation of metabolic byproducts and electrolyte imbalance, which has harmful effects on their health. Timely hemodialysis at regular intervals is a life-saving procedure for these patients. Salivary diagnostics is increasingly used as an alternative to the traditional methods. Thus, the aim of the present study was to determine the diagnostic efficacy of saliva in chronic renal failure patients. Materials and Methods: This case–control study included 82 individuals, of which 41 were chronic renal failure patients and 41 were age- and sex-matched controls. Blood and saliva were collected and centrifuged. Serum and supernatant saliva were used for biochemical analysis. Serum and salivary urea, creatinine, sodium, potassium, calcium, and phosphorus were evaluated and correlated in chronic renal failure patients using unpaired t-test, Pearson's correlation coefficient, diagnostic validity tests, and receiver operative curve. Results: When compared to serum; salivary urea, creatinine, sodium, and potassium showed diagnostic accuracy of 93%, 91%, 73%, and 89%, respectively, based on the findings of study. Conclusion: It can be concluded that salivary investigation is a dependable, noninvasive, noninfectious, simple, and quick method for screening the mineral and metabolite values of high-risk patients and monitoring the renal failure patients.

Background: Tooth extraction causes an open wound in the soft and hard tissues. During the inflammatory phase of the healing process, a large amount of free radicals are produced and cause oxidative stress, which leads to tissue damage and delayed wound healing. Thus, in this study, we evaluated the effect of tert-butylhydroquinone (TBHQ), as an antioxidant, on the healing process of tooth sockets in rats. Materials and Methods: To conduct this experimental study, male Wistar rats (n = 42) were divided into two groups. In each case, one upper second molar was extracted under general anesthesia. After the extraction, the tooth sockets of the experimental group were treated with a 0.02% TBHQ solution (0.1 ml) while the same volume of distilled water placed in the sockets of the control group. On days 3, 7, and 21 postoperatively, 7 rats from each group were euthanized, and histological slides were prepared from their tooth sockets. The prepared slides were examined histopathologically using a light microscope and compared using an independent two-sample t-test. The significance level was set at 0.05. Results: In the experimental group, a statistically significant (P = 0.003) increase in granulation tissue was observed on day 3, in comparison to the control group. The extent of bony trabeculation was also significantly higher in the TBHQ-treated group than in the control group on day 21 (P < 0.001). Conclusion: Considering the limitations of an experimental study, it can be concluded that TBHQ may enhance the healing of the hard tissue in the tooth sockets.