Deepak Kumar Singhal

Microbiological analysis after complete or partial removal of carious dentin using two different techniques in primary teeth: A randomized clinical trial.

Background: The management of deep carious lesions can be done by various techniques but residual caries dilemma still persists and bacterial reduction in cavities treated by either partial or complete caries removal techniques is debatable. So the objective of the present randomized clinical trial was to compare microbial counts in cavities submitted to complete caries removal and partial caries removal using either hand instruments or burs before and after 3 weeks of restoration. Materials and Methods: Primary molars with acute carious lesions in inner half of dentine and vital pulp were randomly divided into three groups of 14 each: Group A: Partial caries removal using hand instruments atraumatic restorative treatment (ART) only; Group B: Partial caries removal using bur; Group C: Complete caries removal using bur and caries detector dye. Dentine sample obtained after caries removal and 3 weeks after restoration, were subjected to microbial culture and counting (colony-forming units [CFU]/mg of dentine) for total viable bacterial count, Streptococcus spp., mutans streptococci, Lactobacillus spp. Results: Three techniques of caries removal showed significant (P < 0.05) reduction in all microorganisms studied after 3 weeks of evaluation, but there was no statistically significant difference in percentage reduction of microbial count among three groups. Conclusion: Results suggest the use of partial caries removal in a single session as compared to complete caries removal as a part of treatment of deep lesions in deciduous teeth in order to reduce the risk of pulp exposure. Partial caries removal using ART can be preferred for community settings as public health procedure for caries management.

Development and Validation of a Socio-Dental Impact Locus of Control (SILOC) Scale

Purpose: To develop a Socio-Dental Impact Locus of Control Scale (SILOC) and to study its relationship with oral health status as well as dental attendance. Materials and methods: In the pilot study, 100 students returned completed forms containing the Multi Dimensional Health Locus of Control (MHLC) and the (SILOC) scale. In the main study, 509 adolescent school children from three schools returned completed forms containing the SILOC scale and were examined for oral health status and dental attendance. Results: The SILOC scores highly correlated with the MHLC scores. A Cronbach’s alpha of 0.75 showed its internal consistency. Those with higher SILOC scores had greater levels of caries, plaque, gingivitis, and a history of postponing needed dental visits. Multiple logistic regression analysis after adjusting for potential confounders showed that those with high SILOC scores were more likely to be having caries (OR=3.32, p<0.001), plaque (OR=1.83, p=0.026), gingivitis (OR=1.80, p=0.012) and a history of ‘Postponement of needed dental treatment’ (OR=4.5, p<0.001) as compared to the others. Conclusion: The SILOC scale showed satisfactory reliability and validity in measuring Locus of Control orientation in relation to socio-dental impacts in an Indian adolescent population.

The impact of lifestyles on the periodontal health of adults in Udupi district: A cross sectional study

Objectives: (1) To assess the impact of different lifestyle factors on periodontal health of adults. (2) To assess the impact of overall/combined lifestyle variable (calculated by health practice index [HPI]) on periodontal health of adults. Materials and Methods: A cross-sectional study consisting of a structured questionnaire on HPI, oral health-related behavior, and personal habits as well as sociodemographic variables was conducted on 800 subjects aged 20–50 years attending dental outreach set-ups of Manipal College of Dental Sciences, Manipal. Clinical examination for periodontal status was done by recording loss of attachment scores using community periodontal index (FDI/WHO-1982). Statistical analysis was done by bivariate analysis using Chi-square followed by multivariate analysis to obtain adjusted odds ratio with 95% confidence interval. Results: After adjusting for all the confounding variables in multivariate logistic regression analysis, the variables that showed an independent association with periodontitis were age, location, marital status, smoking, hours of sleep per night, physical activity, and overall poor lifestyles. Conclusion: Our results support studying a combined approach using various lifestyle behaviors for controlling chronic periodontitis. Necessary public health action on conditions which determine unhealthy lifestyle behaviors across population is needed which is possible by patients involvement in self-care by promoting healthy lifestyles.

A Comparison of the Bleaching Effectiveness of Chlorine Dioxide and Hydrogen Peroxide on Dental Composite

This study was carried out to verify if composites could be bleached using chlorine dioxide as compared with hydrogen peroxide. 3M ESPE Filtek Z350 Universal Restorative discs were prepared (n=40), with dimensions 5 mm diameter x 2 mm thickness. The discs were divided into 4 groups of 10 discs each. Color assessment was performed by CIEDE2000. The discs were stained with coffee, tea, wine and distilled water (control) solutions for 14 days, 5 hours daily. Color assessment was repeated on stained discs and followed by bleaching of 5 discs from each group using chlorine dioxide and hydrogen peroxide in-office systems. Finally, a last color assessment was performed and compared statistically. DE2000 after bleaching was very close to baseline for both the bleaching agents, although chlorine dioxide showed better results than hydrogen peroxide. After staining, there was a clinically significant discoloration (∆E2000≥3.43) for the tea, coffee and wine groups, and discoloration (∆E2000) was seen more in the wine group as compared to tea and coffee. Overall, the control group (distilled water) had the least color change in the three intervals. After bleaching, the color in all specimens returned close to the baseline. The color differences between bleaching and baseline were less than 3.43 for all groups. The obtained results show that chlorine dioxide is slightly superior to hydrogen peroxide in the bleaching of composites, while maintaining the shade of the composite close to the baseline.

Preparedness of dental students to manage medical emergencies in clinical dental set-up: a cross-sectional questionnaire survey

Background: Medical emergencies are inevitable in clinical dental set-up. They put the well-being of patients at risk. If addressed properly, severity of such episodes can be brought down significantly. So the aim of this study was to assess the preparedness of dental students to manage medical emergencies in dental clinics. Materials and method: This cross-sectional survey was done among 147 graduate and postgraduate students of a dental college in South India. The participants filled self-administered questionnaire consisting of 23 close-ended questions. Descriptive analysis using Chi-square test was done to compare two groups. P-value of <0.05 was considered as statistically significant. Result: Amongst 147 participants, around three-fourth of study participants have encountered medical emergency during clinics. Around three-fourth of students has received theoretical training but still majority of participants feel they are incompetent to handle medical emergencies. Most of them are willing to undergo proper training to handle medical emergencies and also support the addition of separate ALS and BLS course. Majority of PGs and three-fourth graduates knew how to perform BLS, CPR but administration of IM, IV and SC injections were known to less than one-third of students. Conclusion: Dental professionals should be confident and prepared to deal with medical emergencies arising during their practice. Reforms in dental curriculum and thorough training of dental students at an initial stage will help to increase their confidence and competence to deal with medical emergencies.

The effect of 6 months or longer duration of chronic obstructive respiratory disease medication on the oral health parameters of adults: COPD MEDICATIONS AND ORAL HEALTH

The objectives of this study were to study the effect of COPD medication of 6 months or more duration on oral health parameters of adult patients. A cross-sectional study was conducted to assess and compare the decayed, missing, and filled teeth (DMFT), oral hygiene index-simplified (OHI-S), periodontal disease index (PDI) scores, and presence of candida (colony-forming units [CFU]) among adult patients aged 20-45 years who had a history of 6 months or longer duration usage of chronic respiratory disease medications, with controls. A total of 170 participants each were taken in both the groups. Oral health parameters like DMFT scores (p ≤ 0.002), OHI-S (p ≤ 0.001), calculus scores (p ≤ 0.001), plaque scores (p ≤ 0.001), and CFU/ml of candida species (p ≤ 0.001) were higher among cases than controls. DMFT scores and candida presence were significantly higher among those whose treatment duration was greater than 5 years as compared to those with lesser duration. Gingival-periodontal component scores of PDI were lower among cases than controls (p ≤ 0.001). Our findings suggest the need for regular oral health maintenance for those under COPD treatment and for greater research into the possible protective role of inhaled corticosteroids in limiting periodontal disease among patients.

Measurement of the Entire Spectrum of Dental Caries Using an Innovative Tool:CAST Index for Children Aged 11 to 14 Years of Udupi Taluk, India

Introduction: One of the most prevalent known chronic diseases worldwide is dental caries. The caries assessment spectrum and treatment (CAST) index–Frencken JE et al. (2011) records all the clinical stages of caries spectrum under nine codes. Materials and methods: The prevalence of the entire spectrum of caries was assessed among children aged 11 to 14 years, of Udupi Taluk, via a cross-sectional study. 800 children were examined under natural light, with sterilized plane mouth mirrors and periodontal probe of 0.5 mm ball tip. The most severe condition was considered for each participant and was recorded. Results: Thirty-five percent had permanent teeth that were caries free. No children had preventive fillings in permanent teeth, and only 9% had restorations. Thirty percent of children had dental caries (codes 3–5) whereas 18% were suffering from after effects of severe untreated dental caries of permanent teeth (CAST code 6 or 7). Eight percent had at least one tooth removed due to caries. Discussion: The reported findings were higher than studies done on adults in an Asian population using CAST index. Conclusion: CAST index as a measurement tool, gives an accurate picture of the hidden iceberg of disease (dental caries) prevalent in Indian children.

Determining relationship of dental utilization with optimism, life satisfaction, and self-reported oral health among adult population in Udupi Taluk, India

Background: Dental care utilization has been documented over the years and shown association with many factors. So aim of this study is to determine the relationship of dental utilization with optimism, life satisfaction, and self-reported oral health. Materials and Method: A cross-sectional survey consisting of structured questionnaire on demographic characteristics, dental utilization, self-reported oral health, optimism and life satisfaction was done on Udupi population. Result: Out of 390 patients, 317 returned the completed questionnaire (response rate-81%). Bivariate logistic regression analysis shows gender, marital status, location, SES, those satisfied with their life, self-reported decay, and self-reported missing teeth were significantly associated with dental utilization. Multivariate logistic regression analysis shows gender, location, upper SES, self-reported decay, and self-reported missing teeth were significantly associated with dental utilization. Marital status and life satisfaction and optimism were not significantly associated with dental utilization. Conclusion: Socioeconomic factors along with psychological aspects and self-reported oral health have an influence on dental utilization of the individual.

Oral health status and oral health behaviors of 12-year-old urban and rural school children in Udupi, Karnataka, India: A cross-sectional study

Objectives: The objective of this study is to assess the oral health status and oral health behavior among 12-year-old urban and rural school children and to evaluate the relative effect of sociobehavioral risk factors on caries experience. Materials and Methods: A cross-sectional study was conducted which included urban and rural subgroups of 12-year-old school children. The final study population covered two groups: 12 years rural (n = 261) and urban school children (n = 264). Data were collected and compared using Chi-square test. Logistic regression analysis was done to assess the importance of variables associated with dental caries. Results: Highly significant differences (P < 0.001) were observed between rural and urban school children for the use of oral hygiene aids, frequency of tooth brushing, and dental services utilization. Dental caries level was significantly higher (P < 0.03) for rural children. Decayed teeth (DT) component constituted majority of decayed, missing, and filled teeth (FT) in both population. 55.6% of the rural school children required treatment compared to 42.4% of urban school children. Mean Oral Hygiene Index-Simplified values, mean DT, and FT were statistically significant for urban and rural school children. Logistic regression analysis showed that government or private school, dental care utilization, socioeconomic status, and malocclusion status were significantly associated with dental caries. Conclusion: Poor oral health and high treatment needs of children belonging to low socioeconomic background is an alarming situation. Strengthening of oral health care in the rural and underprivileged section should be priority of the policymakers.

Evaluation of the efficacy of g32 (commercially available ayurvedic preparation) in reducing halitosis – A randomized controlled trial

Introduction Oral malodour is a social malady affecting people of all the age groups. Effective management of oral malodour is the key to improve the quality of life of such people. Aim To evaluate the effectiveness of ayurvedic medication, G32 in controlling oral malodour and comparing the effects with Chlorhexidine (CHX). Materials and Methods This was a single blind randomized controlled trial with parallel study design conducted at a hospital in the city of Udupi in Southern India. A total of 40 patients suffering with oral malodour, aged 17-35 years, were included in this trial. After inclusion into the study, the subjects were examined twice, with a one-week interval between both examinations. Volatile Sulphur Compounds (VSCs), gingival, plaque and tongue coating scores were assessed at both examinations. Subjects were randomly allocated to G32 group - ayurvedic formulation (intervention group) and CHX group (control group), and were provided with the respective formulations enough to be used twice daily for a period of one week. The difference between the mean scores of VSCs, plaque, and gingivitis and tongue coating were compared within the intervention and control groups, respectively, using paired t-test. Results Both test and control groups showed a significant reduction in VSCs, plaque and gingivitis levels. The percentage reductions in VSCs, plaque and gingivitis were found to be similar among the two groups. There was no significant difference between the preintervention and postintervention scores in both the groups. Conclusion G32, an ayurvedic medication, can be an effective tool to deal with oral malodour.