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   Table of Contents - Current issue
Coverpage
January-April 2022
Volume 9 | Issue 1
Page Nos. 1-77

Online since Friday, April 29, 2022

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EDITORIAL  

The role of teledentistry in improving access to care for patients with special health-care needs p. 1
Sharat Chandra Pani
DOI:10.4103/sjoralsci.sjoralsci_16_22  
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REVIEW ARTICLES Top

Efficacy of oral brush biopsy in the early detection of oral cancer and oral potentially malignant disorders - a systematic review Highly accessed article p. 3
Mahesh Shenoy
DOI:10.4103/sjoralsci.sjoralsci_9_21  
Introduction: Oral cancer is one of the most prevalent cancers in South East Asian countries due to increased consumption of tobacco products and alcohol and ranks sixth among the malignancies worldwide. Several screening modalities such as toluidine blue, Lugol's iodine staining, exfoliative cytology, and biopsy are being used to detect suspicious oral potentially malignant disorders (PMDs) at an early stage. Oral brush biopsy is a painless and less invasive technique that uses variations of a small brush to collect cells from all three layers of epithelium. The technique is non-invasive and promises to be an adjunct to the gold-standard histopathological examination and diagnosis of oral PMD. Aim: The aim of this systematic review was to compile studies pertaining to diagnostic utility of oral brush biopsy with or without computer-assisted cytological analysis in the screening of innocuous oral PMDs for early detection of cancerous changes. Materials and Methods: Computerized literature search was performed to select eligible articles from the following databases: PubMed (MEDLINE), GOOGLE SCHOLAR, and SCIENCE DIRECT using specific keywords. The search was limited to articles published as full text in English, which were screened by two reviewers for eligibility. Results and Discussion: Six studies satisfied our inclusion criteria and found oral brush biopsy as a moderately reliable screening tool for early detection of dysplastic changes in oral PMDs. For oral brush biopsy, sensitivity and specificity obtained were 97.7% and 84.5%, respectively, in the detection of high-grade dysplasia. Conclusion: Brush cytology using a cytobrush is a reliable adjunct to histopathology in detecting oral premalignant and malignant oral lesions. Specificity and sensitivity of the technique requires further investigative clinical studies.
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Mucormycosis, COVID-19, and immunosuppression – The three sides of similar triangle: Narrative review p. 10
Amit Kumar Sharma, Akshat Gupta, Vijayata Jayprakash Singh, Chetna Kishor Gabhane, Mahek Modi
DOI:10.4103/sjoralsci.sjoralsci_56_21  
Introduction: More than two years into the COVID 19 pandemic, medical fraternity each day is facing renewed challenges. Mucormycosis has historically been prevalent in the various parts of world but did not had any diagnostic opportunity before the turn of 20th century. Immunosuppression in any form was always and will forever be the most important ingredients in this disease recipe. Minimally invasive diagnoses with aggressive antimicrobials in addition to the removal of immunosuppression factor are the golden standard of treatment, as oral and maxillofacial surgeons we acknowledge that surgical debridement and various other relatively newer adjunctive therapies have overall reduced the fatal outcomes for such a lethal disease. Aim: This review article focuses on gathering data in relation to immunosuppression due to whatsoever reason and pathogenesis, management, and chance of positive prognosis for patient suffering from mucormycosis . Including surgical and prosthetic options which ascertain descent quality of life for the patient. Materials and Methods: Existing data compilation including the latest research and co-relation of various types of immunosuppression as a nidus for mucormycosis, including the role of novel covid-19 from all relevant electronic databases. Results: Definite co-relation has been stablished for diabetes melitus and covid-19 and speculative co-relation for various types of malignancy and various conditions. Discussion: A strong immunity is an antagonist for mucormycosis, and new advances in field of medicine and surgery have changed the grim look of past where this disease had a 50% mortality rate. Conclusion: Existing literature supports immunosuppression in any form as a nidus for mucormycosis, still further, elaborate research and development is required for identifying the particular cocktail for different diseases process.
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ORIGINAL ARTICLES Top

Management preference of deep carious lesion in permanent mature teeth among dentists in Riyadh city p. 17
Afra H Elrashid, Nada A Alsulaiman, Alanoud M Alqahtani, Farah M Algholamy, Abdulaziz M Alobaida
DOI:10.4103/sjoralsci.sjoralsci_28_21  
Introduction: The management of deep caries lesion can be accomplished by complete caries excavation, partial caries removal, and stepwise excavation techniques. Dentists do not agree on a single management due to available evidence about the effectiveness of different treatment options of deep carious lesion that are inconsistent. Aim: The aim is to investigate the attitude and behavior of management preference of deep caries in mature permanent teeth among dentists in Riyadh city. In addition, to compare these findings with academic standards, World Dental Federation and International Caries Consensus cooperation (ICCC). Materials and Methods: A randomized cross-sectional study was conducted in which 540 questionnaires were distributed to dentists in Riyadh city. The questionnaire included four clinical scenarios to investigate the participant's attitude and behavior of management preference of deep carious lesion of permanent teeth in Riyadh city in 2019. Results and Discussion: Response rate was 74%. Findings illustrate that 86.8% of participants preferred complete caries excavation in case of deep caries with no pain nor risk of pulpal exposure. 41.3% of the participants preferred complete caries excavation in case of deep caries with no pain but risk of pulpal exposure presence. 64.8% participants preferred complete caries excavation in case of deep caries with pain on provocation and no risk of pulpal exposure. 58.3% participants preferred root canal treatment in case of deep caries with pain on provocation and with risk of pulpal exposure. About 76.80% of participants believed that after 2 years from complete caries removal, a high success rate (more than 80%) will result. Conclusion: The majority of participants prefer more invasive approaches in the treatment of deep carious lesions and unaware of the minimally invasive dentistry.
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Symptom manifestation of dental local anesthesia with patients who recently received COVID-19 vaccine p. 23
Ahmed Abdullah Alaskari, Ebtihal Saad Almutairi, Demah Saleh Midshil Alharthi, Deena Ali Obaid Alqahtani, Atheer Ali Mueedh Alhassan, Roula S Albounni
DOI:10.4103/sjoralsci.sjoralsci_49_21  
Introduction: As a result of Coronavirus Disease (COVID-19) pandemic. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) caused the severe viral pneumonia . Countries have been applying test regulations, vaccination is the top strategy to combat it. Aim: To determine if there was any negative impact of dental local anesthesia on the vital medical condition of patients who recently received the Covid-19 vaccine. Materials and Methods: Before participating in the study, patients had to read and sign a consent form. The following treatments were performed under local anesthesia: ten definitive restorations; two tooth extractions; two scalings and prophylaxis; three root planning; and one root canal treatment. Lidocaine with epinephrine was used on three patients, lidocaine without epinephrine on one patient, and scandicaine2% (mepivacaine hydrochloride) on 13 patients. A questionnaire containing nine specific questions was developed for this study, beginning with a patient's personal information. In the second group, we asked about the symptoms after getting the covid 19 vaccine, and in the third group, we asked about the symptoms after dental work. Results and Discussion: With the limitation of this study, it was evident that there was no correlation between vaccination against Covid-19 and local anesthesia in dental treatment with healthy patients. As the Local anesthetics produce anesthesia by inhibiting nerve ending excitation or by blocking the conduction of peripheral nerves. And COVID-19 vaccine works on the body's immune system. Statistical significance was established at P ≤ 0.05. Conclusion: According to this study, there was no correlation between vaccination against Covid-19 and local anesthesia in dental treatment with healthy patients.
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Efficiency of Miswak as an oral hygiene aid among the madrasa going children of Nuh – A socioeconomically disadvantaged district of India p. 27
Amita Sharma, Parveen Ranga, Sonam Sharma
DOI:10.4103/sjoralsci.sjoralsci_37_21  
Introduction: Resources for oral health care remain limited in in rural and backward areas where an inherent need to exists to explore inexpensive cleaning aids at ease. Aim: To assess the efficiency of Miswak stick as an oral hygiene aid among madrasa-going 12–14 years old children, by comparing it with toothbrush and toothpaste in Nuh district of Haryana, India. Materials and Methods: The study population comprised of 540 madrasa-going children. 400 cases were Miswak users, whereas 140 toothbrush and toothpaste users were in the control group. Their oral hygiene status was assessed using the Gingival Index (GI), Oral hygiene index- simplified (OHI-S) and Plaque Index (PI). Decayed, Missing, Filled Teeth (DMFT) index was used to measure the dental caries incidence. The data were recorded, tabulated, and statistically analyzed. Results and Discussion: The results showed that Miswak users had significantly less mean GI score and OHI-S index scores (P = 0.001) but no statistically significant difference in PI score as compared to toothbrush and toothpaste users. Second, DMFT score was more in toothbrush and toothpaste users as compared to Miswak users. Conclusion: This study concluded that the oral hygiene status of Miswak users in the madrasa-going children of Nuh district was better than that of toothbrush and toothpaste users.
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Determination of clinical efficiency of pediatric rotary file systems for root canal preparation in primary molars - A comparative study p. 32
K L Girish Babu, G Kavyashree, Geeta Maruti Doddamani
DOI:10.4103/sjoralsci.sjoralsci_50_21  
Introduction: To meet the demand of pediatric endodontists, exclusive pediatric rotary file systems have been recently introduced by the manufactures. However, no study has been conducted to compare the clinical efficiency between pediatric rotary file systems. Aim: To determine the clinical efficiency (instrumentation time, obturation time, quality of obturation and postoperative pain) of two pediatric rotary file systems following the root canal preparation of primary molars. Materials and Methods: A total of 75 primary molars requiring pulpectomy were selected from children aged 4 to 7 years. These teeth were divided into three groups of 25 teeth each. In the first, second, and third groups, the cleaning and shaping of the root canals were carried out with Pedo-Flex pediatric rotary files (Group PF), Kedo-S pediatric rotary files (Group KS), and, manual nickel-titanium K-files (Group MF), respectively. Obturation was carried out with zinc oxide eugenol cement with an engine-driven Lentulo spiral. The instrumentation and obturation times were recorded. The quality of the root filling was radiographically assessed immediately after obturation. The postoperative pain was evaluated at time intervals of 6, 12, 24, 48, 72 h, and 1 week. Results and Discussion: The instrumentation and obturation times were significantly less with the use of pediatric rotary file systems compared to the manual file system. The quality of obturation was superior in the root canals instrumented with pediatric rotary file systems compared to manual files. There was decreased postoperative pain with the use of pediatric rotary file systems as compared to manual files. In all three groups, postoperative pain decreased over time. The optimally filled root canals showed a significant correlation with the absence of postoperative pain. Conclusions: The use of pediatric rotary file systems for root canal instrumentation of primary molars resulted in the superior quality of obturation in decreased instrumentation and obturating times with the least postoperative pain. The overfilled root canals were not associated with significant postoperative pain.
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Effect of anterior dental caries on psychological behavior and quality of life of Saudi pediatric patients p. 41
Rafi Ahmad Togoo, Hanan Qasem Alfaifi, Fatimah Mohammed Algarny, Jamilah Dafer Alahmari, Raghad Ayed Ali AlQhtani, Hanin Ahmed Asiri
DOI:10.4103/sjoralsci.sjoralsci_40_21  
Introduction: Dental caries is the most common chronic infectious disease involving children and toddlers. Carious invasion of anterior teeth causes infection, pain, compromised speech, mastication, and impacts the esthetics and appearance of the child. Dental caries' immediate and long-term effects affect the child's quality of life and his family, leading to significant social, economic, and psychological consequences. Aim: The present study was conducted to evaluate the effect of anterior dental caries on Saudi pediatric patients' psychological behavior and quality of life. Materials and Methods: A self-administered, structured questionnaire was used to assess the demographic variables, the prevalence of dental caries (anterior teeth), and their psychological effects on children. The data obtained were subjected to statistical analysis using IBM SPSS version 20.0 software. Results and Discussion: Five hundred and twenty-two children were included in the study, out of which 67.62% were affected with anterior carious lesions, with a mean age of 4.90 ± 1.981 years. Most parents reported that their child has anterior carious lesions, with 50% of children having toothache and 49% difficulty in eating food, especially sweets. Affected children showed psychological issues as they avoided playing, hesitated to smile, were introverted, and covered their faces while smiling. Conclusion: A high anterior dental caries prevalence and the resultant effect on psychological behavior and quality of life were observed among young children in Saudi Arabia. Enhanced educational, counseling, and preventive programs among parents and children will reduce dental caries incidence and ensure young children have a good quality of life.
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Permanent teeth loss: A 5-year retrospective analysis of the patterns and indications of intra-alveolar exodontia in Najran, Kingdom of Saudi Arabia p. 48
Ramat Oyebunmi Braimah, Dawood Ali-Alsuliman, Harit Kanwar Sharma, Abdulrazaq O Taiwo, Adebayo Aremu Ibikunle, Yahyah Alsalah, Reham Makrami, Abdullah S Alwalah, Mohammed S Alajam, Abdullrahman Saeed Alalharith
DOI:10.4103/sjoralsci.sjoralsci_55_21  
Introduction: Tooth loss is a worldwide public health concern of huge proportion. Problems associated with permanent tooth loss are enormous. Aim: This study aims to investigate the major reasons and patterns of permanent tooth extraction in a government referral dental center. Materials and Methods: This retrospective study was conducted on patients who had intra-alveolar extraction of teeth in our facility between January 2016 and December 2020. Sociodemographic data and type of tooth extracted were recorded. Reasons for extraction were classified into the following: caries, failed root canal treatment, failed restoration, periodontitis, prosthodontic, orthodontic, trauma, and over-eruption. Data were stored and analyzed with SPSS for MOS, Version 20.0. Results and Discussion: A total of 8065 (3248, 0.3%) males and 4817 (59.3%, females) patients presented for teeth extraction during the study period with 11,746 extractions done, giving an average of 1.5 extractions per individual. The age range of 11–102 years with a mean (±standard deviation) of 36.0 (16.6) was observed. The majority of the patients were in the age groups of 21–30 years (1992 (24.7%), then 31–40 years (1773 (22.0%). Caries and its sequelae accounted for the main reasons for tooth mortality. In the mandible, a total of 5321 (45.3%), while in the maxilla, a total of 6425 (54.7%) teeth were extracted. Molars were the most extracted tooth in both jaws (3485 (29.7%)) Conclusions: The current study found that dental caries, and its sequelae, was the main reason for tooth extraction in a Saudi subpopulation, Najran. Molars were the most commonly extracted teeth.
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Psychosocial effects of COVID-19 pandemic on dental patients p. 54
Hani Mawardi, Mohammed Zahran, Dania Sabbahi, Siraj Dakhil, Lena Elbadawi, Rawah Eshky, Danish Pathan
DOI:10.4103/sjoralsci.sjoralsci_53_21  
Introduction: The spread of coronavirus infection (COVID-19) has been increasing exponentially with significant impact on every aspect of people's lives. Dentists in particular are at a greater risk of disease contraction since majority of the procedures are based on direct contact with patients. Aim: This study attempted to understand the attitude of patients seeking dental treatment during the pandemic. Materials and Methods: This was a cross-sectional, self-administered survey which included validated questions on (1) sociodemographic information of participants; (2) participants' basic knowledge on COVID-19; and (3) the willingness and mindset of participants to pursuit dental treatment during, and after the curfew period. Data were collected and statistically analyzed for significance. Results and Discussion: A total of 904 residents from 25 countries. Participants who, or their family members, experienced dental complaints during the curfew period were able to manage via in-office emergency visit, using over counter medication, tele-dentistry or following friends' advice. In total, 48% (433/904) stated to likely seek dental treatment (if needed) with local curfew lifting and 50.4% (456/904) were likely to wait for more than 4 weeks before visiting the dentist. In total, 70% of participants reported sufficient social distancing and wearing masks by the dental staff would address their concerns during dental treatments. Conclusion: Personal financial conditions, lack of awareness, and fear of contracting COVI-19 were identified as important influencing factors for the general public to return for professional dental care. Future, long-term studies to better understand the psychosocial effects of the current pandemic on individuals should be considered.
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Pretreatment expectations and posttreatment satisfaction with different prosthodontic treatments in a Saudi population p. 63
Ahmed Yaseen Alqutaibi, Abdullah Faisal Alharbi, Abdullah Mohammed Alharbi, Ghofran Ali Karbouji, Emad Yahya Dagharire, Afaf Aboalrejal
DOI:10.4103/sjoralsci.sjoralsci_52_21  
Introduction: The dentist–patient relationship and the patient's expectation before prosthodontic treatment are significant in achieving patients' satisfaction. There are not enough studies in the Saudi population on how the expectation can affect patients' satisfaction for patients rehabilitated with different prosthetic options. Aim: This study aimed to investigate the effect of gender, prosthesis type, and patients' expectations of different prosthetic treatments on the patient's satisfaction. Materials and Methods: Data were collected at the dental hospital, Faculty of Dentistry, Taibah University. A total of 125 participants evaluated their expectations of and satisfaction with different prostheses types regarding esthetics, chewing, comfort, and phonetics, also assessed their perception of the dentists' conduct by using a Visual Analog Scale. Results and Discussion: The study included 125 participants (50.4% females, 49.6% males), with a mean age of 39.76 ± 15.42. Regarding the prosthesis type, there were no statistically significant differences between expectations and satisfaction in all domains except with chewing with a fixed denture prosthesis, in which satisfaction exceeded expectations with a statistically significant difference (P < 0.05). Most participants scored their perception of the dentist's conduct above average and described their dentists as professional, very concerned, and careful. Female participants recorded statistically insignificantly lower expectations and satisfaction scores than males regarding esthetics, comfort, and phonetics with all prosthesis types (P > 0.05). Conclusion: The study's findings suggested that satisfaction levels were correlated with prosthesis type, pretreatment expectations, and the gender of the treated patients.
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CASE REPORT Top

Bartonellosis in maxillofacial region p. 72
Bistra Blagova, Daniel Markov, Nia Sаrbianova
DOI:10.4103/sjoralsci.sjoralsci_3_22  
Cat-scratch disease (CSD) manifests as a painful regional lymphadenopathy that occurs after a cat scratch or bites transmitted by the bacterium Bartonella henselae. The diagnosis is made by biopsy or puncture of the affected lymph nodes, which must undergo histopathology, serology, or polymerase chain reaction. An 18-year-old woman presented with progressive, painful, right submandibular adenomegaly in the absence of systemic symptoms. She denied the previous contact with cats or any other animals. A computed tomography scan of the cervix showed nodular images corresponding to the affected lymph nodes. The patient underwent a lymph node biopsy, which suggested CSD as the primary diagnosis. The biopsy does not reveal specific diagnoses. B. henselae was confirmed serologically. This case illustrates a typical evolution of CSD in which a patient is affected by subacute lymphadenopathy, but with no epidemiological history. The only certain diagnostic mean was the positive serology of Bartonella. Good general condition, despite pronounced adenomegaly without signs of toxemia, is characteristic of CSD. The lack of more accurate laboratory tests, the difficulty in culturing the pathogen, and the need for histopathology prevent the rapid diagnosis of CSD and contribute to the nonrecognition of this disease. B. henselae testing should be considered when monitoring lymphadenopathy, especially if there is subacute evolution, as in the presented case.
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