Gururaghavendran Rajesh

The validity and reliability of the Sense of Coherence scale among Indian university students.

Background: The importance of salutogenesis, with the focus of what creates health rather than what causes diseases, has been highlighted for a long time. This has been operationalized by Aaron Antonovsky as the Sense of Coherence (SOC-13) scale. The aim of this study was to further examine the psychometric properties of the SOC-13 in India. Methods: The present study was carried out among second-year degree students at three randomly chosen institutions at Mangalore University. Investigators assessed the appropriateness, relevance, comprehensiveness and understandability of the scale. Further, the scale was assessed by five subject experts. The SOC-13 was then pretested by administering it to peers, individuals and a few of the study subjects. Internal consistency was assessed by Cronbach’s alpha and split-half reliability. Test-retest reliability was assessed by administering the instrument to the same study participants after two weeks. Confirmatory factor analysis employing varimax rotation was employed. Results: The SOC-13 revealed a Cronbach’s alpha value of 0.76. Split-half reliability and Guttman split-half reliability were found to be 0.71 and 0.70, respectively. Test-retest reliability was found to be 0.71 (p < 0.01). Factor analysis revealed a three-factor solution explaining 40.53% of the variation in SOC. Conclusions: SOC-13 was found to be a reliable and valid instrument for measuring SOC in an Indian context. The present study contributes to health promotion in an Indian context, and could be useful even in other developing countries and for further research in India.

Antimicrobial efficacy of Tulsi leaf (Ocimum sanctum) extract on periodontal pathogens: An in vitro study.

Background: Periodontitis is an infection of the periodontal complex with severe forms of disease associated with specific bacteria colonizing the subgingival area. Widespread use of drugs has resulted in the emergence of side effects, uncommon infections, and resistance. Plant medicine like Tulsi has been used in many clinical conditions, and it appears to be a suitable alternative to manage conditions affecting the oral cavity. Hence, the objective was to assess the in vitro antimicrobial activity of Tulsi leaves extract (Ocimum sanctum) on periodontal pathogens with doxycycline as standard, as doxycycline has been used as an adjunct to nonsurgical therapy in periodontitis patients. Materials and Methods: Ethanolic extract of Tulsi was prepared by cold extraction method. Extract was diluted with an inert solvent, dimethyl formamide, to obtain five different concentrations (0.5%, 1%, 2%, 5%, and 10%). Doxycycline was used as a positive control and dimethyl formamide, as a negative control. The extract and controls were subjected to the microbiological investigation against Aggregatibacter actinomycetemcomitans, Prevotella intermedia, and Porphyromonas gingivalis. Agar well diffusion method was employed to determine the concentration at which Tulsi gave an inhibition zone, similar to doxycycline. Data were analyzed using one-way analysis of variance and Tukey post-hoc test was used for inter- and intra-group comparisons. Results: At 5% and 10% concentrations, Tulsi extracts demonstrated antimicrobial activity against A. actinomycetemcomitans, similar to doxycycline with similar inhibition zones (P > 0.05). P. gingivalis and P. intermedia, however, exhibited resistance to Tulsi extract that showed significantly smaller inhibition zones (P < 0.05). Conclusions: Tulsi demonstrated effective antimicrobial property against A. actinomycetemcomitans, suggesting its possible use as an effective and affordable “adjunct” along with the standard care in the management of periodontal conditions. However, further research assessing the toxicity, durability, and other assessments followed by clinical trials is necessary to explore the potential of Tulsi in combating oral conditions.

Insights into smoking and its cessation among current smokers in India.

BACKGROUND Initiation, perpetuation and cessation of smoking are all multifactorial. It is essential to explore interactions among various parameters influencing smoking and its cessation for effective smoking cessation interventions. OBJECTIVES To obtain insights into smoking and its cessation among current smokers in India. MATERIALS AND METHODS The present study was conducted among current smokers visiting the Department of Oral Medicine and Radiology, Manipal College of Dental Sciences (MCODS), Manipal University, Mangalore. Knowledge, attitudes, behavior, worksite practices towards smoking and its cessation, barriers to smoking cessation and socio-demographic variables were explored using a structured, pretested, self-administered questionnaire. RESULTS A total of 175 current smokers participated in the study. Mean knowledge, attitude, worksite practice and barrier scores were 15.2±5.67 (66.1%), 57.5±7.67(82.1%), 4.18±2.02 (41.8%) and 57.4±12.37 (63.7%) respectively. Correlation analysis revealed: association of knowledge with education, occupation and religion; attitude with education and occupation; worksite practices with occupation; knowledge with attitude; and barriers negatively with worksite practices. The majority (85.7%) of respondents intended to quit smoking and this was associated with higher attitude scores, whereas actual quit attempts were associated with high knowledge, attitudes, worksite practices and low barrier scores. CONCLUSIONS Various socio-demographic factors associated with smoking and its cessation were identified. The present study highlights the importance of identifying and targeting these interactions while framing guidelines and interventions for effective tobacco cessation in a developing country like India.

Insights into the state of radiation protection among a subpopulation of Indian dental practitioners

Purpose Radiographs is an integral part of patient management in dentistry, despite their detrimental effects. As the literature pertaining to radiation protection among Indian dental practitioners is sparse, exploring such protection is needed. Materials and Methods All private dental practitioners in Mangalore, India were included in the study. A structured, pre-tested, self-administered questionnaire was employed to assess the knowledge, attitudes, practices, previous training, perceptions towards the need to spread awareness, and willingness to gain and implement knowledge about radiation hazards and protection. Information regarding each respondents age, gender, education, and type and duration of practice was collected. Results Overall, 87 out of 120 practitioners participated in the study. The mean knowledge, attitude, and practice scores were 9.54±2.54, 59.39±7.01, and 5.80±3.19, respectively. Overall, 25.3% of the respondents had undergone training in radiation protection, 98.9% perceived a need to spread awareness, and 94.3% were willing to improve their knowledge. Previous training showed a significant correlation with age, sex, and duration of practice; attitude was significantly correlated with education and type of practice; and knowledge scores showed a significant correlation with type of practice. Conclusion Although the knowledge and practices of respondents were poor, they had a positive attitude and were willing to improve their knowledge. Age, sex, and duration of practice were associated with previous training; education and type of practice with attitude scores; and type of practice with knowledge scores. The findings of this study suggest a policy is needed to ensure the adherence of dental practitioners to radiation protection guidelines.

Impact of occlusal support and perceived chewing ability on oral health-related quality of life among patients attending a private dental institution in India

Purpose: Presence of functional tooth units is essential for preserving masticatory function among individuals. Representing the essence of health promotion practice, demand to measure varied evaluation outcomes is highlighted. Aim and Objectives:(1) To assess the influence of occlusal support and perceived chewing ability on oral health-related quality of life (OHRQoL) among adults attending a private dental institution in Mangalore. (2) To evaluate occlusal support using Eichner index (EI), perceived chewing ability using a self-administered questionnaire and OHRQoL using Oral Health Impact Profile-14 (OHIP-14). Materials and Methods: Overall, 300 adults attending a private dental institution in Mangalore were included. EI was used to group participants into three groups. The chewing ability was assessed using a questionnaire on perceived difficulty while chewing eight common foods. OHRQoL was measured employing OHIP-14. Perceived general and oral health status and demographic information were collected. Results: The mean perceived chewing ability score was 12.98 ± 6.2 and the mean total OHIP score was 9.23 ± 8.9. EI showed a significant relation with perceived chewing ability, OHIP, and perceived general health status (P < 0.05). Perceived chewing ability and OHIP demonstrated a significant correlation (r = 0.31, P< 0.001). Age, gender, education, occupation, monthly income, family income, and number of family members demonstrated a significant association with EI (P < 0.05). Binary logistic regression analysis revealed that EI, perceived chewing ability, and perceived oral health emerged as significant predictors of OHRQoL (P < 0.05). Conclusions: Occlusal support was significantly associated with perceived chewing ability, OHRQoL, and perceived general health status.

Work-Associated Stress and Nicotine Dependence among Law Enforcement Personnel in Mangalore, India.

PURPOSE To investigate the work associated stress and nicotine dependence among law enforcement personnel in Mangalore, India. MATERIALS AND METHODS A cross-sectional questionnaire survey was conducted among law enforcement personnel in Mangalore, India. Demographic details, stress factors experienced at work and nicotine dependency were the variables studied. The extent of stress factors experienced at work was assessed using the Effort-Reward Imbalance scale (ERI). Nicotine dependence was measured using the Fagerstrom Test for Nicotine Dependence (FTND) and the Fagerstrom Test for Nicotine Dependence-Smokeless Tobacco (FTND-ST). Logistic regression was used for the statistical analysis. RESULTS Three hundred and four law enforcement personnel participated in the study, among whom 68 had the presence of one or more habits like tobacco smoking, tobacco chewing and alcohol use. The mean effort score was 15.8±4.10 and the mean reward and mean overcommitment scores were 36.4±7.09 and 17.8±5.32 respectively. Effort/Reward ratio for the total participants was 1.0073 and for those with nicotine habit was 1.0850. Results of our study demonstrated no significant association between domains of ERI scale and presence of habits but work associated stress was associated with the presence of one or more habits. Compared to constables, head constables had 1.12 times higher risk of having a nicotine habit. CONCLUSIONS Our study implies job designation is associated with nicotine habits. However, there was no association between work associated stress and nicotine dependence among law enforcement personnel in Mangalore.

Trends in self-medication for dental conditions among patients attending oral health outreach programs in coastal Karnataka, India.

Objectives: To determine the prevalence, pattern, and awareness of self-medication practices among patients presenting at oral health outreach programs in coastal Karnataka, India. Materials and Methods: The cross-sectional study, based on an interview conducted in randomly selected 400 study subjects from the patients presenting at these oral health outreach programs. Data were collected regarding demographic information and the interview schedule consisting of 14 questions was administered. Results: Prevalence of self-medication was 30%. Respondents’ gender (χ2 = 5.095, P < 0.05), occupation (χ2 = 10.215, P < 0.05), the time from the last dental visit (χ2 = 8.108, P < 0.05), recommendation of drug(s) to family members or friends (χ2 = 75.565, P < 0.001), and the likelihood of self-medication in the next 6 months (χ2 = 80.999, P < 0.001) were significantly associated with self-medication. Male respondents were less likely to have undertaken self-medication (odds ratio = 0.581 [0.361, 0.933]). The frequently self-medicated drug was analgesics (42.5%) for toothache (69.2%). The regression model explained 39.4% (Nagelkerke R2) of the variance in self-medication practices. Conclusions: Prevalence of self-medication was 30% with demographic influence. Hence, this study highlights the policy implications for drug control by government agencies and stresses on the need for dental health education to discourage irrational drug use.

Oral health care availability in health centers of Mangalore taluk, India

Background: Community-oriented oral health programs are seldom found in India. When primary health care systems were in the 1980s, dentistry was not adequately included. This has left oral health far behind other health services. Objectives: To find the availability of dental professionals, infrastructure, equipment, and treatments provided in health centers of Mangalore taluk. Materials and Methods: A cross-sectional study was conducted among medical officers and dentists working in all the health centers of Mangalore taluk, using an interview schedule, the oral health care availability inventory (ORAI). Results: Among 23 health centers of Mangalore taluk, dental services were available at six health centers (26%) [two community health centers (CHCs) and four primary health centers (PHCs)]. Mouth mirrors, dental explorers, and extraction instruments were available at six health centers [two CHCs (100%) and four PHCs (19%)]. No health centers provided orthodontic tooth corrections, removal of impacted teeth, oral biopsies, and fabrication of removable dentures. Conclusions: Availability of dental services was limited in the health centers, and a vast majority of the rural population in Mangalore taluk did not have access to dental care.

Research design hierarchy: Strength of evidence in evidence-based dentistry

As practitioners, thinking critically about how we make clinical decisions is important. As educators, we should evaluate how to teach students to make clinical decisions. To make clinical decisions, and to practice modern dentistry and to educate the dental care professionals, the evidence-based dentistry forms an important asset. The cornerstone of evidence-based healthcare and health technology assessment is critical appraisal of the evidence underpinning a finding. The hierarchy of evidence includes several types of studies used to evaluate treatment effects, starting from case reports, observational studies, and randomized controlled trials (RCTs), the tip of which are systematic reviews, which constitute the highest level of evidence because they attempt to collect, combine, and report the best available evidence using systematic, transparent, and reproducible methodology. Clinicians are interested in the highest quality research report available to determine the best therapy for their patients. This article will assist in framing the questions and categorizing the best available evidence. A search was initiated to locate original research articles, review articles, and case reports pertaining to the key words: Evidence-based dentistry, hierarchy of evidence, ladder of evidence, research design hierarchy, strength of evidence. Electronic database was retrieved from PubMed , Google and Google Scholar to search and select keywords related to evidence-based medicine and dentistry. The keywords used were evidence based dentistry, research design hierarchy, evidence based practice, and strength of evidence. This article is the result of a literature study on evidence-based research design hierarchy. Clinical Relevance to Interdisciplinary Dentistry Evidence-based practice (EBP) is an interdisciplinary approach gaining ground after 1992; hence, its usefulness in any discipline is worth the attention. This article explores links between the state of academic and clinical training regarding interdisciplinary EBP and describes strategies to accelerate the translation of evidence across disciplines. This paper examines the concept of hierarchy of research design, barriers and challenges and applying evidence based dentistry in practice.

Perceptions towards evidence based practice among oral health professionalsin Mangalore, India

AshwiniRao Background:-Evidence based practice (EBP) is a way to transfer evidence obtained from research into everyday provision of health care services. A dentist should not only know about the sources to obtain evidence, but also be able to critically assess the mountain of research studies available. This study was aimed to determine EBP knowledge, attitudes, confidence in critical appraisal skills and methods for accessing evidence among oral health professionals in Mangalore, India. Material and method:-We used a standardized and validated 36 item EBP KACE (Knowledge, Attitudes, Confidence and Evidence) questionnaire which consisted of 4 domains, Knowledge of Critical Appraisal, Attitudes about Evidence-Based Practice, Confidence in Critical Appraisal Skills and Accessing Evidence. Statistical analysis was performed using student’s t test, binary logistic regression and bivariate correlation tests. Results:-A total of 133 males and 231 females took part in the study (n=364). Participants were divided into interns, postgraduate students and specialists. Mean knowledge of postgraduates (2.45; SD 1.2) was highest. Attitudes levels were similar for postgraduates (4.4; SD 2.5) and undergraduates (4.7; SD 2.6). Postgraduate students were more aware of newer methods of accessing evidence (4.1; SD 2.0) (p < 0.01) compared to others. Conclusions:-Postgraduates had greater knowledge of EBP and better ideas of ways to access evidence. The undergraduates showed a positive attitude and interest towards evidence based practice. Hence, making evidence based practice a formalized part of dental curriculum would enable young dentists to make optimal treatment decisions essential in the interest of the patient as well as the community.