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   2019| October-December  | Volume 17 | Issue 4  
    Online since December 12, 2019

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Age and reasons for first dental visit: A cross-sectional study of children in Bengaluru, India
Priya Subramaniam, Jyothirmai Reghuvaran
October-December 2019, 17(4):293-300
Background: An early first dental visit lays down the foundation of preventive dental care in order to ensure optimal oral health during childhood. The timing of a child's first dental visit varies in different countries. Aim: The aim of this study was to find the age at which parents first seek dental care for their children in Bengaluru, India, and reasons for the first dental visit. Materials and Methods: A cross-sectional study was conducted across randomly selected dental colleges, private dental clinics, and dental department of hospitals in Bengaluru city, India. Sociodemographic details and reasons for the first dental visit were recorded using a pro forma. Data obtained were subjected to statistical analysis using SPSS software V.22, IBM, Corp., USA. The Chi-square test was used, and the level of significance was set at P < 0.05. Results: The mean age of the first dental visit was 8.18 ± 3.2 years. The maximum number of children reported for their first dental visit at age 6 years. Ninety-six percent of children visited only when there was a problem. Dental pain, dental caries, irregularly placed teeth, deposits, and trauma were found to be significant reasons (P ≤ 0.001). Conclusion: Age 6 years was the most common age for the first dental visit. Pain and dental caries were the most common reasons for the first dental visit.
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Association between dental caries, periodontal status, and personality traits of 35–44-year-old adults in Bareilly City, Uttar Pradesh, India
Anushka Gupta, Nagesh Laxminarayan Shetty
October-December 2019, 17(4):301-305
Background: A majority of human diseases are said to have psychosomatic origin. Certain pathologic entities have already been accepted to have a psychological basis. Personality of an individual is one such psychological entity, but the research on relationship between personality traits and oral diseases is scarce. Aim: To find an association between the personality traits of the participants and their dental caries and periodontal status. Materials and Methods: A descriptive survey (questionnaire + clinical examination) using consecutive sampling technique was conducted. The study population consisted of 450 adults, aged 35–44 years. Sociodemographic details, oral hygiene practices, dental health seeking behavior, dietary practices, decayed–missing–filled teeth (DMFT) index, and community periodontal index were recorded. Eysenck Personality Questionnaire Revised-Short Form (Hindi version) was used to measure personality traits. The data were analyzed using SPSS version 19. Kruskal–Wallis ANOVA followed by Mann–Whitney U-test (post hoc), linear regression analysis using enter method, and logistic regression analysis were done. Results: As per the lie scale, 72 individuals were excluded, of which only 375 were further analyzed. There were 282 (62.7%) extroverts, 76 (16.9%) neurotics, 17 (3.8%) were a combination of extroversion and neuroticism, and 3 (0.7%) were a combination of extraversion and psychoticism. Dental caries (P = 0.002) and periodontal disease (P = 0.005) were significantly less in extroverts in comparison to other personality traits. Conclusions: Among different personality traits, extroverts were found to have lesser dental caries and better periodontal status. Thus, personality traits as one of the determinants of oral health may throw more light on the psychosomatic link of oral diseases, hence on the importance of behavior management.
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Association between healthy eating index, body mass index, and early childhood caries in schoolchildren of Sakaka, KSA: A case–control study
Sudhakar Vundavalli, Anil Kumar Nagarajappa, Radhika Doppalapudi, Adel Saleh Alhabarti, Ahmed Saad Assaf Aleiadah, Mazen Nafa H. Alruwili
October-December 2019, 17(4):306-312
Background: Early childhood caries (ECC) was observed in children worldwide, and it adversely affects the oral health-related quality of life. ECC is multifactorial, and the concepts of poor nutrition and inappropriate feeding bottle habits as its risk factors could not provide sufficient evidence. Aim: The study aimed to assess the relation between Healthy Eating Index (HEI), body mass index (BMI), and ECC in the age group of 5–6 years children. Materials and Methods: A case–control study was carried out among 350 schoolchildren of Sakaka, KSA. Caries experience was recorded using decayed, missing, and filled teeth (dmft) index (WHO criteria 1997); various anthropometric measures such as weight, BMI, and height were recorded as per the standard guidelines. The Pearson's correlation coefficient and unpaired t-tests were used as bivariate tests; ANOVA with Tukey's post hoc for multivariate analysis. Results: A total of 350 male participants participated in the study, with the age range of 5–6 years and the mean age being 5.4 ± 0.7. The prevalence of ECC in the study population was 87%. The mean dmft values for each BMI category among the underweight, normal, overweight, and obese children were 4.73, 7.8, 9.4, and 10.8, respectively. The mean intake of grains was 1.9, vegetables 0.61, fruits 1.31; milk 1.78, meat/dal 4.8, total fat 9.9, saturated fat 9.9, cholesterol 10 refined carbohydrates 10, and variety 0.17 in children with severe ECC (S-ECC). Overall mean HEI score was significantly higher in children with S-ECC compared to simple ECC low (43.25 ± 3.44 vs. 57.46 ± 4.12), and HEI and dmft values were negatively correlated (−0.932). Conclusion: There is a negative relationship between ECC and HEI scores and positive correlation between BMI scores and ECC. Diet is again proved as a common risk factor for dental caries and obesity. Hence, the Nutritional Education Program is the need of an hour for these children and parents.
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Efficacy of dental floss as an adjunct to toothbrushing in dental plaque and gingivitis: An open-labeled clinical nonexperimental study
Shrikanth Muralidharan, Arunkumar Acharya, Pramila Mallaiah, Shanthi Margabandhu, Sakharam Garale, Mayur Giri
October-December 2019, 17(4):279-282
Background: Periodontitis presents itself in the form of gingivitis or periodontal pockets/periodontitis. Gingivitis always precedes the later, but the reverse may not be true. Dental plaque is the primary etiology for chronic gingivitis. Hence, a regular cleaning is necessary especially in the interdental areas for the removal of plaque and to prevent gingivitis and periodontitis by means apart from the regular brushing. The most common and affordable ways of achieving this are through the use of dental floss. Aim: The present study was carried out to evaluate the effect of flossing with a waxed dental floss apart from toothbrushing as an effective means to reduce gingival inflammation. Materials and Methods: The study was an open-labeled nonexperimental clinical study. A total of 60 adult patients between 20 and 50 years were selected and randomly assigned to 2 groups – one Group A with only manual toothbrushing (Oral B) and the Group B with manual toothbrushing (Oral B) and flossing with an unwaxed dental floss (Colgate). Both the groups were evaluated at baseline, after 14 days and after 28 days. Gingival index was recorded using the Loe and Sillness index while the gingival bleeding was scored using the Carter and Barnes Bleeding Index. The data collected were subjected to statistical analysis using SPSS 20.0 (Chicago, IL, USA). Student's “t”-test was carried out. All P < 0.05 were considered to be statistically significant. Results: There was a statistically significant reduction in the gingivitis, bleeding, and plaque accumulation in the Group B compared to Group A, at baseline and after 28 days of evaluation (P < 0.001). There was no significant reduction in the bleeding index for the lingual surfaces between the two groups. The results thus showed that there was a significant reduction in the plaque accumulation and gingival bleeding for Group B compared to Group A. Conclusion: Regular toothbrushing helped to improve the gingival health and reduce the amount of plaque accumulation. Toothbrushing and flossing served better in achieving interdental plaque control and in reducing gingival bleeding.
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Prevalence of traumatic dental injuries among 5–16-year-old children and knowledge of teachers in the management of traumatic dental injuries
Mayank Das, L Vamsi Krishna Reddy, Sanjay Singh
October-December 2019, 17(4):328-332
Background: Dental injuries may occur throughout life. Traumatic dental injuries (TDIs) are a very significant problem among children. The main etiology was fall, fight, and sports activities. They were associated with biological, socioeconomic, and psychological factors. Aim: The aim of the study was to investigate the prevalence of TDI among 5–16-year-old schoolgoing children and knowledge in emergency management of dental injury among teachers. Materials and Methods: A cross-sectional study was carried out among 5–16-year-old schoolgoing children. A cluster random sampling method was used among 500 schoolchildren from different schools, and 100 schoolteachers were selected. Data were collected using the questionnaire form, and clinical dental examination was performed using the WHO Oral Health Assessment Form 2013. Statistical analysis was performed using the Statistical Package for the Social Sciences version 20.0. The Chi-square test was used to compare the results. All values were considered statistically significant at P < 0.05. Results: The prevalence of traumatic injury in male and female was 59.2% and 40.8%, respectively. Male teachers 78.8% and females 89.6% did not know in which medium tooth should be kept, whereas only (7.7%) male and none of female thought that medium should be saliva, and this value was statistically significant (P = 0.035). Conclusion: The prevalence in male was slightly higher than female. We suggest that educational programs should be organized for the schoolteachers, children, and parents to improve their knowledge and timely management of dental trauma.
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Universal oral health coverage: An Indian perspective
Nandita Venkatesh, Venkitachalam Ramanarayanan
October-December 2019, 17(4):266-268
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From the editor's desk
KR Sowmya
October-December 2019, 17(4):265-265
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Honorary secretary's message
Sabyasachi Saha
October-December 2019, 17(4):264-264
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IAPHD news

October-December 2019, 17(4):341-343
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Awareness and approaches in treating patients with special needs among dental practitioners of Chennai City: A pilot study
Menaka Satish, Kiran Iyer, Krishnan Lakshmi, S Neha, Elizabeth Ann Bina Biju, Madan Kumar Parangimalai Diwakar
October-December 2019, 17(4):333-336
Background: Special children are among the underserved dental patient groups around the globe, and their oral health care still remains an unmet challenge among the dental practitioners. One out of two persons with a disability cannot find an oral health professional resource to provide appropriate dental care. The identification of barriers can be the first step in addressing the deficiencies in dental care for such patients. Aim: The aim of the study is to assess the knowledge, attitude, and practices toward treating patients with special care need among private dental practitioners employed at a private dental teaching institution. Materials and Methods: A cross-sectional pilot study was conducted among a conveniently sampled 45 dental professionals from the same institution who were both private dental practitioners as well as academicians. The study was conducted between November 2017 and December 2017. Participants were interviewed through a validated questionnaire, which consisted of 14 items. The questionnaire comprised demographic details of the participants, their years of dental experience, disabled patients they had encountered so far in their practice, and questions related to their attitude, perception, and practice to provide oral health care for patients with special needs. Informed consent was obtained from the participants prior to the study. The data obtained were entered into Microsoft Excel 2010 and descriptive statistics was computed using the SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. Results: A response of 71% was obtained. Majority of the dentists (65%) were unaware of the Right to Disability Act. Half of the dentists (50%) felt teledentistry would do more good to people with special needs. About (31.8%) of them felt inadequate training to handle patients with special needs as major barrier faced while treating them. Conclusion: Majority of the study participants felt inadequate training among the dental practitioners as barrier to treat special needs patients and hence suggested incorporation of special care dentistry into the dental curriculum.
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Relationship between hemoglobin levels and oral hygiene status in different trimesters of pregnancy – A cross-sectional study
Venkat Baghirath Pacha, Madhuri Mukhe, Hari Vinay Balisetty, P Parameswar Naishadham, Vijay Kumar Jogishetty, Bhargavi Krishna Ayinampudi
October-December 2019, 17(4):337-340
Background: Pregnancy is a phase which has gained much attention due to the physiological changes taking place, of which the oral health is of utmost importance as it may pose difficulties in birth outcomes. Aim: This study aims to evaluate the oral hygiene status with hemoglobin (Hb) concentration in each trimester and in each age group and to correlate between them. Materials and Methods: A randomized cross-sectional study was conducted on 1008 pregnant women of the age group 18–40 years who attended at the Government Maternity Hospital in Hyderabad. The individuals were screened for the oral health status, which includes oral hygiene index-simplified (OHI-S) and periodontal index (PI) by Russell. The blood sample was collected to evaluate hematological profile. The correlation between Hb levels and oral health status was evaluated by Chi-square and one-way ANOVA test using SPSS version software. The P < 0.05 was considered statistically significant. Results: The mean of OHI-S was 2.11 ± 0.514, PI was 2.61 ± 0.818, and Hb levels were 1.49 ± 0.500. There was a statistical significance between OHI-S (P < 0.025), PI (P < 0.014), and Hb levels (P < 0.710), respectively with the trimesters but not with the age groups. Therefore, the values for OHI-S and PI were higher in 3rd trimester when compared to other trimesters. Conclusion: The study suggests that there was a significant correlation between OHI-S, PI, and Hb levels within the trimesters of pregnancy irrespective of the age groups and Hb levels. The oral hygiene of examined women was satisfactory but is more at risk of periodontal diseases.
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Home remedies for interdental cleaning: A descriptive study
PT Kaviya, R Anusha, Parangimalai Diwakar Madan Kumar
October-December 2019, 17(4):283-287
Background: The ignorance toward oral hygiene practices in the Indian society remains a major reason for poor oral hygiene. This has led to food impaction in the interproximal regions of the tooth surface, one of the most commonly faced oral problems. Till date, no evidence exists to have assessed the use of these home-based alternative aids for removing impacted food in the interdental regions of oral cavity. Objective: The objective was to assess the attitudes and practices regarding the removal of impacted food between the teeth among adult population in Chennai city. Materials and Methods: A convenience sample of 183 individuals were assessed. This cross-sectional study was conducted with a self-constructed 10-item questionnaire on individuals reporting to the outpatient department of our dental institution during March and April 2018. The questionnaire included close-ended questions related to demographic details, type of diet, oral hygiene practice, use of interdental aids or any household materials that are available at home, duration of usage, and symptoms (if any). Data were compiled, and frequency distribution was obtained using SPSS software version 20 (IBM Corp.). As the study sample was very small and analysis was not the primary objective, simple description of the data obtained was considered sufficient. Results: Among the study participants, 69.9% (n = 128) reported that they use household material as an interdental aid. Among those 128 participants, 35.2% (n = 45) used combination of materials (including broomstick, toothpick, safety pin, and fingernail) and 32.8% (n = 42) used broomstick, whereas 7.8% (n = 10) used safety pin and 4.7% (n = 6) used fingernail alone to remove the impacted food. About 25% (n = 32) reported pain and 22.7% (n = 29) reported bleeding while using these objects. Nearly 73.4% (n = 94) of the participants reported that they use it for more than 3 years. Conclusion: Our study showed that there is reduced practice of recommended interdental aids compared to the household materials that are easily available at hand. This indicates the lack of basic knowledge about interdental aids and the method of using them. Thus, oral health promotion through health education should identify these illicit oral hygiene practices and provide targeted interventions to alleviate the same.
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Assessing the legal nature of informed consent and attitude of patients attending outpatient departments of a dental hospital in Bengaluru City: A cross-sectional study
Yashashwini N Simha, N Vanishree, Deepa Bullappa, Keerthi Prasad, L Ramesh
October-December 2019, 17(4):288-292
Background: Informed consent is an ethical and legal requirement for research involving human participants. Aim: This study aimed to assess the patients' awareness of legal nature and attitude regarding the importance of the consent process. Materials and Methods: A descriptive, cross-sectional questionnaire survey was undertaken. Data were collected from the patients who seek care in the Outpatient Department of the Dental College, Bengaluru, for 3 months from June 2014 to August 2014. The data analysis was done using the statistical software SPSS version 14 to generate descriptive statistics. Results: Out of 376 (100%) participants, majority (103 [27.4%]) belonged to the age group of 21–30 years. With regard to the scores, 163 (74.4%) males had a score range of 7–12 as compared to females (117 [74.4%]). Conclusion: Informed consent process is intended to protect patients and to promote an enlightened ethics in patient–dentist relationship. Our study showed that many patients had limited knowledge of the legal implications of signing or not signing consent forms and did not recognize written consent as primarily serving their interest.
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Comparative evaluation of green tea and chlorhexidine mouthwashes on gingivitis: A randomized controlled trial
Omveer Singh, Vamsi Krishna Reddy, Devina Pradhan, Lokesh Sharma
October-December 2019, 17(4):269-274
Background: Green tea (Camellia sinensis) is one of the most popularly consumed beverages worldwide containing a number of bioactive chemicals, and it is particularly rich in flavonoids which include catechin. It is linked to a lower incidence of some pathological conditions including oral cancer, dental caries, stroke, cardiovascular diseases, and obesity. Aim: The aim of the study was to compare and evaluate the effects of commercially available green tea mouthwash with chlorhexidine mouthwash on gingivitis. Materials and Methods: A 3-week, double-blinded study was conducted on thirty nursing students aged between 18 and 25 years. Plaque status was assessed by plaque index (Silness and Loe 1964) and gingival status was assessed by gingival index (Loe and Silness 1963) at the 14th day and at the 21st day. Statistical analysis was done using the Statistical Package for the Social Sciences version 21. The test used was one-way analysis of variance and repeated measures. The level of significance was kept as P < 0.05. Results: There was a reduction in the gingivitis scores of the participants using green tea mouthwash as compared to chlorhexidine mouthwash and distilled water. Statistically significant differences were observed between distilled water and green tea groups (P = 0.04). Conclusion: The present study showed that green tea mouthwash was found to be more effective than the chlorhexidine mouthwash in reducing extensive levels of gingivitis.
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A study to compare the efficacy of three different chemical agents as toothbrush disinfectant: A triple blind study
Insha Nissar, Bhuvandeep Gupta, Rahul Gupta, Abhinav Sharma, Kirti Raina, Priyanka Kotia
October-December 2019, 17(4):275-278
Background: Toothbrushes are used as an adjunct for mechanical plaque control to improve the oral health and hygiene. However, toothbrushes are an easy source of contamination by the microorganisms. Rinsing with plain tap water may reduce this microbial load, but complete elimination is not possible. Aim: The study aimed to compare the efficacy of three different chemical agents as toothbrush disinfectant. Materials and Methods: A triple-blind randomized controlled trial was conducted in a dental institute. Forty volunteers were divided into three experimental groups and one control group (n = 10). (Group A: 0.2% chlorhexidine; Group B: distilled water; Group C: Listerine; and Group D: 2% sodium hypochlorite). The participants were instructed to brush their teeth using toothbrushes with standard bristles and then disinfect their toothbrushes according to instructed methods. Bacterial decontamination of toothbrushes was measured by calculating colony-forming units (CFUs) of Streptococcus mutans, Staphylococcus, Lactobacillus rhamnosus, and Escherichia coli. Data were statistically analyzed using the SPSS software package for Windows (version 15.0, SPSS Inc., Chicago, IL, USA). Means, standard deviations, and for data of each microorganism after disinfection with different methods were calculated with descriptive statistics. The Bonferroni test was performed for post hoc analysis. A P value of 0.05 was considered as the level of statistical significance. Results: Means were calculated for the CFU in all the groups; Group D (2% sodium hypochlorite) was found to have highest mean reduction for all the microorganisms followed by Group C (Listerine), Group A (0.12% chlorhexidine), and Group B (distilled water) (control group). Conclusion: All the methods tested were effective in reducing the bacterial count of S. mutans, Staphylococcus, L. rhamnosus, and E. coli. However, the most effective method was NaOCl (2%) followed by Listerine, chlorhexidine, and water.
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Assessment of oral health status and treatment needs among institutionalized elderly population of four major Cities of Madhya Pradesh
Upendra Singh Bhadauria, Pralhad L Dasar, N Sandesh, Prashant Mishra, Shaijal Godha
October-December 2019, 17(4):313-321
Background: The world is undergoing a demographic transition, and the proportion of elderly people is growing faster than any other age group. According to census 2011, older people comprise 8.14% of the total population. The literature on assessment of oral health status of the institutionalized elderly particularly for the state of Madhya Pradesh (MP) remains to be sparse and scant. Aim: The present study aimed to assess the oral health status and treatment needs of institutionalized elderly population of four major cities of MP. Materials and Methods: A descriptive cross-sectional study was conducted to assess the oral health status and treatment needs among the institutionalized elderly residing in old-age homes of four major cities of MP, India. The study was conducted among 487 inmates of 12 old-age homes of Indore, Bhopal, Jabalpur, and Gwalior cities. Statistical analysis was done using SPSS 20 software. The Chi-square test was used to compare the categorical variables. ANOVA test was performed for quantitative variables. P ≤0.05 was considered statistically significant. Results: About 5.6% of the inmates with 6 different types of oral-mucosal condition were reported. The prevalence of periodontal diseases in accordance with Community Periodontal Index scores was found to be 96.8%. Only 41.02% of the population had sound teeth, 4.48% were affected by caries, 6.34% were missing due to caries, and 43.12% required no treatment needs. The mean decayed, missing, and filled teeth score of 15.57 ± 10.08 was seen in the age group of 60–75 years, 18.95 ± 9.79 in the age group of 76–90 years, and 19.18 ± 9.97 in the elderly aged 91 years and above. Conclusion: Based on the results of the present study, it can be concluded that oral health status of institutionalized inmates was found to be poor with higher prevalence of dental caries and periodontal diseases, poor prosthetic status, and higher prosthetic needs.
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Dental caries experience using the international caries detection and assessment system among adults, Nellore District, Andhra Pradesh, India: An epidemiological survey
N Sarah Sheela Emerald, V Chandrasekhar Reddy, KM Sudhir, R V. S Krishna Kumar
October-December 2019, 17(4):322-327
Objectives: The International Caries Detection and Assessment System (ICDAS-II) is a newly developed system for determining dental caries at both cavitation and noncavitation levels. The present study was conducted to assess the prevalence, severity, and risk indicators of dental caries using ICDAS-II. Methods: Multistage cluster sampling methodology was followed. Data were collected using a questionnaire, and dentition status was recorded according to the ICDAS-II. Multiple linear regression analysis was done to determine the risk factors for caries. The significance level is taken as P < 0.05. Results: In a total sample of 1500 participants, the prevalence of dental caries according to ICDAS-II was highest at the cutoff point 1 in both males (98.2%) and females (99.4%) and was the least at the cutoff point 4 (males [44.8%], females [32.1%]). The risk factors for dental caries in the present study population are age, sex, employment status, socioeconomic status, level of education, systemic diseases, smoking, sugar consumption, last dental visit, self-perception of oral health, pain, and type of material used to clean teeth according to the ICDAS-II. Conclusions: This cross-sectional epidemiological study provides the prevalence, severity, and risk indicators of dental caries in 35–44-year-old adults of Nellore district, Andhra Pradesh, India.
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President's message
V Gopikrishna
October-December 2019, 17(4):263-263
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