Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), milk derivative helps in remineralization of the carious lesion by replenishing lost minerals like calcium, phosphate ions into the tooth structure. Several in vitro and in vivo studies have proven that CPP-ACP to be useful in the treatment of white spot lesions, early childhood caries, dental erosion, root caries, and dentin hypersensitivity. CPP-ACP is delivered in the form of oral hygiene products such as chewing gum, tooth cream, and even incorporated in dental restorative materials also.

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Cleft palate is a common congenital maxillofacial disorder leading to feeding problems in a newborn baby. Due to the malformed palate, infants are unable to apply adequate negative pressure to squeeze the nipple for the release of milk. This disability leads to malnutrition, middle ear infection, and even death if not treated early. To obtain better nutritional intake prior to surgical correction, a feeding appliance is recommended. In the present report, we present a case of a 1-month-old baby with cleft palate, treated with a novel feeding appliance made up of soft silicone-based denture liner.

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Introduction: Oral health is significantly related to oral hygiene behaviors and their knowledge. Poor oral hygiene can have a profound effect on the quality of life. Oral hygiene practices are those measures taken to ensure that the mouth is clean. Oral hygiene practices are essential for the prevention of dental and other associated systemic diseases. The aim of this study is to determine the level of knowledge, attitude, and oral hygiene practices among secondary school students in Debre Tabor town, Amhara region, North Central Ethiopia 2018. Materials and Methods: An institution-based cross-sectional study was conducted among 422 systematically selected students using stratified random sampling technique from January 20 to 30, 2018. Data were collected using a pretested questionnaire on 422 selected students in three secondary schools found in Debre Tabor town. Variables collected included the frequency of brushing teeth and the use of toothpaste, knowledge of plaque, and students' perception of the importance of oral hygiene practices. The data were entered into Epi-Info version 3.5 and cleaned and analyzed using SPSS version 20. Results: A total of 422 patients participated in the study; among whom 216 (51.2%) were female students. The study revealed that 253 (60%) of the respondents had good knowledge with regard to oral hygiene, more than half 281 (66.6%) of the students had positive attitude toward oral hygiene, but their oral hygiene practices were still low that 260 (61.6%) of the students had poor oral hygiene practice. Conclusions: The study showed that more than half of the respondents had good knowledge and positive attitude toward oral hygiene to maintain proper oral health, but their practices toward oral hygiene were remain poor. The majority of students were aware that teachers and parents had not an important role to play in their oral hygiene. Establishment of oral health education programs in the school curriculum that will help a life-long oral hygiene practice in the school environment and at large in the community with the support of teachers and parents are crucial.

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Objectives: The current study was intended to compare and to evaluate in vitro the antimicrobial efficacy of Morinda citrifolia juice (MCJ) with chlorhexidine (CHX) as endodontic irrigants and their effect on micro-hardness of root canal dentin. Methodology: The study was divided into two parts. Part I for antibacterial testing consisted of preparing 60 dentin blocks of 4 mm height. All the dentin blocks were infected with Enterococcus fecalis for a period of 21 days. The experimental groups were Group I: 0.2% CHX; Group II: 6% MCJ; Group III: 6% MCJ + 0.2% CHX; Group IV: Saline. After 28 days of medication with the irrigants, the dentin shavings from root canal dentin was harvested and colony forming units counted. Part II for micro-hardness testing consisted of preparing 32 root halves and mounting them on blocks of acrylic resin. 8 samples per group were randomly divided into the experimental groups. The samples were then medicated with the irrigants for a period of 15 min and micro-hardness values were recorded. Results: Data obtained was analyzed using one-way ANOVA, Kruskal-Wallis and Mann-Whitney U-test and Student's paired t-test. Part I: Group I showed highest antibacterial activity followed by Group III with Group II taking the third place and were statistically significant (P < 0.001). Part II: None of the groups showed any effect on micro-hardness of root canal dentin, which was not statistically significant (P > 0.4). Conclusion: Nearly 0.2% of CHX showed the highest antimicrobial activity even after 28 days and 6% of MCJ also showed antibacterial activity, but to a lesser degree than CHX. None of the irrigants tested had any effect on the micro-hardness of root canal dentin.

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Recent advances in color matching have been driven by the market demand for high-quality esthetic restorations. Improved shade guides, availability of shade-taking devices and research in the area of human color vision have improved the potential of clinicians to achieve excellent color-matched restorations. A thorough understanding of appearance attributes of natural teeth is required along with these new tools to maximize shade-matching results.

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For ethical reason, initiation and progression of periodontal disease as well as certain types of periodontal treatment cannot be studied in humans. Instead, numerous studies in this field have been carried out in laboratory animals. Animal models are needed to objectively evaluate the pathogenesis of human periodontal disease and its various treatment modalities. A number of animal models have been used in studying etiology and pathology of periodontitis. The primate model is recommended because the pathogenesis in primate model closely resembles that in humans. In addition, the dog model is used frequently because of ease of ligature placement as well as the natural occurrence of periodontal disease. However, ease of handling, inexpensive, short study time, low variation among strains and controlled microflora, relatively disease resistant, make the rat model extremely versatile and suited for a wide range of research endeavors. Rats are used mainly for research in toxicity, nutrition, behavior, and cancer. Normal oral structure and physiology and the pathogenesis of periodontal diseases have been studied more extensively in the rat than in any other rodents. Rats are used extensively to study the effects of drugs on the gingiva because their tissue overgrowth is similar to that of humans. The purpose of this review is to evaluate rats as models for studying various aspects of periodontal disease, including disease process and its treatment handling, advantages and limitations of these models.

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Aim: The aim of this study is to assess canine tooth impaction (TI) among population of Riyadh, Saudi Arabia. Subjects and Methods: We performed a retrospective analysis of 2157 patients' panoramic radiographs who visited any of the three campuses of Riyadh Colleges of Dentistry and Pharmacy clinics between August 2014 and May 2015. Analysis was performed specifically for the purpose of this study. Results: Among the 2157 panoramic radiographs analyzed, we found canine impaction in 79 patients (3.65% of the total sample size). Seventy-three cases had maxillary canine impaction (3.37% of the total population) and eight patients with mandibular canine impaction. Conclusions: Higher than the reported figures, in this large cohort of Riyadh population reviewed, canine TI is 3.6%.

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Aim: An Anganwadi worker (AW) can be a vital link in the health care delivery system as she provides a package of services to mothers and children. Oral health knowledge among these workers is an integral component of preventing early childhood caries (ECC). The present study aimed to assess the existing knowledge of early childhood oral health-related factors among AWs. Materials and Methods: A questionnaire-based survey was conducted among AWs in Davangere city, India. The study involved face-to-face interviews and recording the response to a pretested 12-item questionnaire. Of the 80 participants, 74 participants responded to the questionnaire. Results: Of the 74 respondents, 34.3% agreed that a mother's diet during pregnancy affects the development of the infant's teeth, while 47.6% disagreed. Sixty-four percent of the participants agreed that problem with babies' teeth affect the adult teeth, and 85% of the participants agreed that breastfeeding is important for the health of the child's teeth. Ninety-two percent of the participants agreed that untreated tooth decay affects the general health of the child, and 47.3% agreed that bacteria that cause decay can spread from mother to child. Conclusion: Our study concluded that AWs showed some degree of knowledge about certain aspects of ECC. The knowledge however appeared to be inconsistent. We recommend that AWs need to be educated by conducting periodic oral health education programs, which will increase their awareness about ECC.

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Context: The therapeutic procedures used in the treatment of caries do not always eliminate all the microorganisms. The persisting cariogenic bacteria can cause recurrent caries leading to failure of the restoration. Hence, incorporation of an agent with enhanced antimicrobial effect into the restorative material may be of paramount significance. Aim: To study the effect of 1% xylitol (XYL) (artificial sweetener) and 1% chlorhexidine (CHX) diacetate on antibacterial property against Streptococcus mutans and physical properties of conventional glass-ionomer cement (GIC). Settings and Design: An experimental in vitro intergroup randomized control trial. Materials and Methods: Study consisted of three test groups: Group 1 (conventional GIC), Group 2 (GIC + 1% XYL), and Group 3 (GIC + 1% CHX diacetate). A total of 135 samples were evaluated for antibacterial activity against S. mutans after 48 h and 7 days, and physical properties – compressive strength after 24 h and 7 days and setting time. Statistical Analysis: Multiple group comparison was made using one-way analysis of variance complemented by Tukey's post-hoc test, and intragroup comparison was made by Student's paired and unpaired t-test. Results: At the end of 48 h and 7 days, Group 3 exhibited highest antibacterial effect and Group 1 (control) showed the highest compressive strength after 24 h and 7 days, setting time was slightly prolonged for Groups 2 and 3. Group 2 and 3 exhibited a similar effect on physical properties. Conclusion: CHX diacetate displayed superior antibacterial activity, although both CHX and XYL affected the physical properties of conventional GIC to an equal extent.

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Aim: The aim of this study was to compare the amount of postoperative pain after using three different nickel–titanium file systems. Materials and Methods: Ninety patients with necrotic molar pulps were selected and divided into three groups. Group I (n = 30) was instrumented with ProTaper Next (PTN) file system, Group II (n = 30) was instrumented using WaveOne reciprocating system, and Group III (n = 30) was instrumented using Twisted File system. All canals were instrumented and obturated in the same visit. Postoperative pain response of patients was evaluated using the visual analogue scale (VAS) score. Results: For VAS pain scores, a statistically significant difference was found between the PTN and WaveOne technique (P = 0.000). Statistically significant difference was also found between the Twisted File and WaveOne technique (P = 0.002). Conclusion: It can be concluded that the difference in the postoperative pain is related to the instrumentation technique. Reciprocating system, WaveOne resulted in maximum pain followed by Twisted File and PTN file system.

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Introduction: The aim of this study was to evaluate the effects of calcium hydroxide [Ca(OH)₂] and propolis intracanal medicaments on the push-out bond strength of a resin-based sealer (AH Plus) to root dentin. Materials and Methods: After chemomechanical instrumentation using ProTaper rotary system, three groups of root canal specimens were prepared: 10 root canals were left untreated as controls (G1), 10 received Ca(OH)₂intracanal medicament (G2), and another 10 received propolis intracanal medicament (G3). Canals were obturated with AH Plus and gutta-percha. After bond strength evaluation using push-out test, data was analyzed using 2- way ANOVA and Tukey post hoc tests (P = 0.05). Results: At coronal and middle thirds, there were no significant differences in bond strength among the three groups (P > 0.05). At apical third, G3 was significantly superior to G2 and G1 (P < 0.05), but there was no significant difference between G2 and G1 (P > 0.05). Conclusion: The use of propolis as an intracanal dressing material, with AH Plus used as the sealer in endodontic therapy was shown to have better sealer-dentin interfacial bond strength.

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Background: For an attractive smile, health and color of the gingiva are essential components. Hyperpigmented gingiva is considered unaesthetic and unsightly by many, and there is an increasing demand for depigmentation of gingiva from patients. Many techniques are available for gingival depigmentation. Aims and Objectives: To compare the effectiveness of scalpel and laser techniques for depigmentation in terms of patient comfort using visual analog scale (VAS) for pain, changes in ImageJ intensity values of gingival pigmentation, and to compare the frequency and area of repigmentation postoperatively between two groups up to a period of 3 months using Adobe Photoshop. sMaterials and Methods: The study was conducted in the Department of Periodontics, Indira Gandhi Institute of Dental Sciences. Fifty individuals, aged between 18 and 30 years, with an esthetic complaint of hyperpigmented gingiva were enrolled in the study. The study comprised two groups of 25 individuals each. One group was taken up for scalpel method of depigmentation and the other for laser depigmentation. Results: The difference between the mean pain scores of scalpel and laser group on day 1, day 4, and day 7 were recorded, with a P value of 0.123, 0.000, and 0.037, respectively. The difference in intensity values between baseline and 90 days for both scalpel and laser groups was highly significant, with a P value of 0.000. When surface area of repigmentation was compared between two groups, scalpel group (557.20 mm²) of patients had less repigmentation than laser group (737.08 mm²). Conclusion: The patient apprehension for anesthetic infiltration, bleeding during the procedures, and VAS scores for pain were less in laser group as compared to scalpel group. Efficiency of depigmentation and frequency of recurrence of gingival pigmentation were similar in both the groups. However, in terms of patient's comfort, laser appeared to have a significant advantage over scalpel.

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A combined education, promotion, and preventive program in the school would greatly reduce the amount of classroom time lost in traveling to a treatment facility. Comprehensive school programs also would obviate the loss of study time due to pain and apprehension before and after treatment. Today, there is a need for research and evaluation on the best approaches to promoting oral health in schools with a focus on school-based clinics. Data from original scientific papers published in PubMed, PubMed Central, and Google Scholar were taken for review. Articles published in English are only included. The review concluded that the primary objective of school oral health promotion programs must focus on the 3 M's – manpower, money, and material, plus the amount of classroom time it will take from conventional classroom education.

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Periodontal disease is a chronic inflammatory disease affecting the supporting structures of teeth and may lead to bleeding gums, tooth mobility, and eventually tooth loss. With the limited effectiveness of current forms of mechanical therapy in the management of periodontal diseases, there has been a shift in focus on to alternative therapies. One such area where maximum research has been going on is phytotherapy. Several studies now focus on the efficacies of herbal extracts on various important periodontal pathogens such as Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum, Aggregatibacter actinomycetemcomitans, Treponema denticola and Tannerella forsythia. Furthermore, recent studies have explored the benefits of using plant-based products on various periodontal clinical parameters such as gingival inflammation, gingival bleeding, etc. The aim of this review to focus on potential, of pros and cons of the several plants/extracts that have been used in vitro or in vivo for management of periodontal diseases and also to highlight the direction of future research to improve their efficacy.

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After tooth loss, alveolar ridge resorption is a common phenomenon, which alters the size and shape of the host bone available for the dental implant placement. In the era of prosthetic driven implant dentistry, the final prosthesis type and design dictates the number, size and the ideal implant position. In clinical practice, though patients often demand osseointegrated implants to replace their missing teeth; the deficiency of bone volume is the primary reason for avoiding such treatment options. The solution to such situations lies in the re-establishment of the ridge height consistent with prosthetic design and with suitable load-bearing lamellar bone for implant placement and long-term stability. Despite recent advances in bone grafts and bone-substitute technology, the use of autogenous bone grafts continues to represent the "gold standard" in implant site reconstructive surgery. The mandibular symphysis (chin bone in interforaminal region) is a favorable donor site as it has an excellent risk-benefit ratio. Several reconstruction procedures by using chin graft have been proposed to increase alveolar bone volume both vertically and laterally to prepare the ridge for a correct placement of oral implants. This article reviews the various aspects of chin grafts, wherein the regional surgical anatomy, various incision designs, surgical protocols for harvesting and the possible clinical and esthetic complications of chin grafts have been discussed.

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The mastication, phonation and esthetics: The trident factors are very important and should be given due consideration when any dental procedure is initiated to achieve the successful outcome of treatment. The prosthetic management of edentulous patient has long been a major challenge for dentistry. For well over a century, complete maxillary and mandibular denture have been the traditional standard of care. However, most of the patients report significantly more problems adapting to their mandibular denture due to a lack of comfort (e.g., they suffer from an increase in pain and soreness), retention, stability and inability to chew and eat. Recent scientific studies carried out over the past decade have determined that the benefits of a mandibular two implant over denture/coping retained are sufficient to propose the two implant over denture - rather than conventional denture - as the first treatment option. This in the prosthodontics literature has led to shift in therapeutic philosophy regarding restoration of the edentulous patient. This article presents four and two tooth supported conventional over denture - two case reports.

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Plasmacytoma is a monoclonal neoplastic proliferation of plasma cells of unknown etiology, presenting as a solitary discrete mass either in soft tissue as extramedullary plasmacytoma (EMP) or in bone as solitary bone plasmacytoma or as disseminated multiple myeloma (MM). EMP is a very rare manifestation, accounting for approximately 3% of all plasma cell neoplasms and <1% of all head and neck malignancies, with oral cavity being the rarest. We hereby report a series of three unusual cases of EMP, involving buccal mucosa, hard palate, and right retromolar trigone, rarely reported in literature, treated with definite radiotherapy after immunohistochemical studies confirmed the diagnosis. At present, patients are on regular follow-up without evidence of progression to MM. This series is presented with review of literature to highlight the extremely uncommon sites in head and neck where this disease entity can manifest, thus posing a diagnostic and therapeutic dilemma for treating physicians.

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A nonvital tooth with open apex is a challenging clinical condition for the dentist as it requires a systematic diagnosis of the problem and a customized treatment plan. A 17-year-old male patient reported to the clinic with fractured upper right central incisor (11– Federation Dentaire Internationale Notation) with discoloration, and the X-ray showed open apex which was treated using calcium hydroxide and mineral trioxide aggregate (MTA) to form apical barrier (apexification) and then obturation was completed using gutta-percha. The metal ceramic crown was placed to restore the function and esthetics. As the tooth lacked natural apical constriction, an alternative to standard root canal treatment called as apexification or root-end closure is advised.

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We report a case of disseminated histoplasmosis in a 70 year old immunocompetent male patient. Generally most of the cases of Histoplasmosis in India present with skin lesions and oral ulcers, mass lesions are uncommon presentation. The close masquerade with malignancy makes it an interesting rare case with lot of academic learning for considering Histoplasmosis as one of the differential diagnosis in oral mass lesions.

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Background: Endodontic treatment of immature permanent teeth with necrotic pulp, with or without apical pathosis, poses several clinical challenges. Regenerative endodontics is a promising alternative for the treatment of such immature necrotic permanent teeth. Aim: To assess the regenerative potential of young permanent teeth with necrotic pulps with platelet-rich fibrin (PRF) and blood clot using radiographic and clinical methods. Settings and Design: This was an experimental, in vivo study comparing the two groups. Materials and Methods: Immature necrotic permanent teeth (n = 14) in patients who belonged to the age group of 10-12 years were selected and divided into two groups. Group 1 was treated by conventional revascularization with blood clot and Group 2 with revascularization using PRF. Follow-up was done for 6 months. Standardized radiographs were analyzed for the periradicular healing and apical closure, and clinical analysis was performed using mobility index as compared to baseline values. Statistical Analysis Used: Results were analyzed using Friedman test, Wilcoxon test, and Mann-Whitney U-test. Results: There was increased periradicular healing and apical closure at 3 months and 6 months in Group 2 (PRF) when compared to Group 1 (conventional). Conclusions: Revascularization with PRF procedure leads to better and faster healing, reduced radiolucency, enhanced apical closure, and reduction in mobility of necrotic immature teeth.

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Background: In the field of dentistry, various myths and misconceptions prevail among patients that hamper them from availing proper treatment from a dental professional. Therefore, this study was conducted to assess the prevalence of myths regarding oral health and hygiene among out-patients visiting a dental school in North India and suggest possible remedial measures. Materials and Methods: A cross-sectional survey was conducted utilizing a convenience sample of 552 participants. A self-designed pretested questionnaire containing 15 questions on myths regarding oral health and hygiene was distributed among the study participants. Demographic details of the subjects were also recorded. Results were statistically analyzed using Chi-square test. Results: More than half (58.7%) of the participants thought that there is a worm inside a decayed tooth, and this was significantly associated with age, gender, and educational status of participants. Three-fourth (75%) of the participants were of the opinion that decay is caused by eating sweets, and more than 70% of males believed this and this was significantly associated with age and educational status of study participants (P < 0.05). Conclusion: Myths and misconceptions regarding oral health prevailed among majority of the participants in this study. There is an urgent need to educate the public regarding various oral health issues.

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Aim: To assess the clinical performance of zirconia (ZrO₂) infused glass ionomer cement (GIC) compared to conventional GIC. Study Design: Experimental, in vivo, intergroup split-mouth study. Methods: Cavities were prepared on bilateral teeth and restored with Conventional GIC on one side and ZrO₂infused glass ionomer on the other. The two sides were compared with regards to their clinical performance and color stability. Results: Statistically significant differences were found with respect to surface texture and color match between ZrO₂infused GIC and conventional GIC. Statistics: Results were analyzed using Friedman test and Wilcoxon test. Conclusions: ZrO₂infused GIC showed better color stability but conventional GIC was much better as far as color match, surface texture, and marginal adaptation were concerned.

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Background: The aim of the present finite element study was to analyze effect of cuspal inclination on stress distribution and implant displacement in different bone densities for a single tooth implant. Materials and Methods: A three dimensional finite element model of mandibular molar section of the D1 bone (entirely cortical) and D4 bone (1 mm cortical shell with low density trabecular core) to receive an implant was constructed. Three ceramic crowns with cusp inclinations of 0 degree, 10 degree and 30 degree were modeled. A mechanical load of 202.23 N was applied at three different regions; the central fossa and 1- and 2-mm offsets horizontally from the center to the buccal side for the varying inclinations. The finite element analysis was performed and stress levels using von Mises stresses and maximum displacement (in mm) were calculated. Results: The maximum stress concentration in cortical bone was seen around the neck of the implant. There was favorable distribution of stresses during loading at the central fossa with maximum stress being 15.10 Mpa for 0 degree, which increased to 54.09 Mpa for 10 degree and 86.19 Mpa for 30 degree inclination at 2 mm offset. Higher stresses were generated in D4 than D1 bone density under all loading conditions. Conclusion: The occlusal topography plays an important role in stress distribution and may be helpful in preventing crestal bone loss. This phenomenon is more pronounced in poor quality bone. Therefore, proper occlusal morphology becomes a critical issue in poor quality bone for implant longevity.

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Background: Stainless steel crowns (SSCs) till now accepted as the best restorative modality for primary teeth, are being frowned on due to their poor esthetic appeal. The recently introduced preformed zirconia crowns are a more esthetic alternative, but the ability of these crowns to withstand stresses in the intraoral environment has not been tested. This study is a continuation of an earlier study done by the same authors to understand the stresses an SSC is subjected to under occlusal forces. Aims: The aim of this study is to compare the effectiveness of preformed zirconia crowns with the gold standard SSC for the restoration of primary teeth through a finite element analysis. Settings and Design: In vitro. Materials and Methods: The study design employed two finite element models, with the same amount of tooth structure, one restored with SSC and the other with preformed zirconia crown. The finite element models were exported to ANSYS software and subjected to an average simulated bite force of 245N. Statistical Analysis Used: The finite element models were exported to ANSYS software subjected to an average simulated bite force of 245N. Results: Preformed zirconia crowns suffered lesser Von maximal stresses along with its underlying dentine. Conclusions: Even at maximal physiologic masticatory force levels, a grossly destructed tooth restored with preformed zirconia crown can withstand stress better than a tooth restored with SSC.

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Peripheral ossifying fibroma (POF) is one of the few reactive lesions of the gingiva which are clinically similar in presentation. The lesion occurs over a wide age range with females being affected more often than males. Furthermore, the POF has a propensity to occur in the incisor cuspid area affecting maxilla more than the mandible. POF is known to arise as a focal exophytic mass exclusively on the gingiva commonly appearing to originate from the interdental gingiva and does not commonly involve the underlying bone. Irritation to the gingiva by calculus, plaque, ill-fitting dentures, and hormonal influence has been considered in the etiopathogenesis. The recurrence has been found to be as high as 16% making it important for the clinician to identify the lesion and treat accordingly.

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