Guident May-2020

RNI No. UPENG/2007/22988 | Vol. 13, Issue 6, May 2020 | Rs. 80/- | ISSN No.: 0976-2248 GUIDENT
Your Guide on the Path of Dentistry

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EdEidtitoorriiaal l May 2020

Dr. Parvez A. Khan Editor’s Desk

Editor Dear Readers,
Greeting from team GUIDENT.
This is really a maiden scenario in my whole career after joining dentistry two
decades back, I’m away from my dental chair i.e. my workplace for more than
two months. We can’t work from home as others. Now in lockdown 4.0, there
are some positives as the guidelines for opening dental clinics is issued by the
ministry.
According to the advisory, dental clinics will remain closed in the containment
zones However, they can continue to provide teleconsultation and the patients
in these zones can seek ambulance services to travel to the nearby COVID dental
facility.
Emergency dental procedures can be performed in the dental facilities falling
under “red” zones. The dental clinics in the “orange” and “green” zones can provide
consultancy, but such operations should be restricted to emergency and urgent
treatment procedures only. All routine and elective dental procedures should be
deferred for a later review until new policy/guidelines are issued.
Dentists who are asymptomatic can resume work without undergoing COVID
tests but
they are advised to take HCQ prophylaxis after medical consultation. Moreover,
they should ensure availability of sufficient three-layer masks and sanitisers and
paper tissue at the registration desk, as well as nearby hand hygiene stations.
The minute details about clinic sanitization, air ventilation, etc. can be taken from
the issued guidelines.
Let’s all follow these guidelines and manage your the patients accordingly.
After following these guidelines, we have some demands which I’ll raise to the
government and stakeholders in the next issue.

Stay at home, stay safe and pray to Almighty.

Thanking you.

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4 |GUIDENT    Your Guide on the path of Dentistry

EditorialMay2020
Editorial

Associate Editor’s Desk

TELESCOPIC OVERDENTURE: PERIO-PROSTHO
CONCERN FOR ADVANCED PERIODONTITIS

The crown‑ and sleeve‑coping denture is a removable prosthesis that is supported Dr. Manesh Lahori
by both selectively retained teeth and the residual ridge or mucosa. It is a versatile
and successful means of achieving long‑term restoration of partially edentulous B.D.S, M.D.S, F.I.S.O.I, F.I.C.O.I, Principal, Professor & HOD, Department of Prosthodontics,
jaw. Insertion and removal of the denture and routine oral hygiene are easy to K.D. Dental College and Hospital, Mathura (U.P), Email: [email protected]
perform. The beneficial results of this form of treatment can be considered for a
wide variety of clinical applications for the severely advanced periodontitis case.
Telescopic copings have been used for several years in oral rehabilitation of
patients with advanced periodontal disease. Patients with periodontal disease
undergoing prosthetic
reconstruction often present with teeth with minimal supportive tissue and
increased tooth mobility. Therefore it is extremely important for the prosthesis
not to cause periodontal destruction or worsen an existing periodontal condition.
[3,6] Three different types of double crown systems are used to retain RPDs.
They are distinguished from each other by their retention mechanisms:
• Cylindrical crowns that exhibit retention through friction fit of parallel‑milled
surfaces
• Conical crowns or tapered telescopic crowns exhibit friction only when
completely seated using a “wedging effect.” The magnitude of the wedging effect
is mainly determined by the convergence angle of the inner crown; the smaller
the convergence angle, the greater is the retentive force
• Double crown with clearance fit (hybrid telescope or hybrid double crown)
exhibits no friction or wedging during insertion or removal. Retention is achieved
by using additional attachments or functional‑molded denture borders.

Guident Advisory Board Review Board-2020

Dr. S. P Aggarwal, Delhi Dr. A. K. Munshi Dr. Praveen Parachuru
Dr. Porus Turner, Mumbai
Dr. U. S. Krishna Nayak, Mangalore (Pedodontics) (Periodontics)
Dr. Usha Mohandas, Bangaluru
Dr. Himanshu Aeran, Rishikesh Dr. Kumar Raghav Dr. Umesh Chandra Prasad. G
Dr. Vivek Hegde, Pune
Dr. Zahra Hussaini, Mumbai (Pedodontics) (Oral Pathology)
Dr. Lanka Mahesh, Delhi
Dr. N. N. Singh, Moradabad Dr. Gopu Kumar Nair Dr. Usha Balan
Dr. Deepak Mehta, Bangaluru
Dr. Mohammad Abbas Khan (USA) (Oral Medicine & Radiology) (Oral Pathology)
Dr. Parvesh Mehra, Delhi
Dr. S. S. Ahmad, Patna Dr. Vidya Krishnan Dr. Shishir Mohan Garg
Dr. Edward Lynch, Warwick (UK)
Dr. Ajay Sharma, Delhi (Oral Medicine & Radiology) (Oral & Maxillofacial Surgery)
Dr. Abdul Hameed, Mumbai
Dr. Rathika Rai Dr. Gagan Sabharwal

(Prosthodontics) (Oral & Maxillofacial Surgery)

Dr. Rahul Nagrath Dr. Shrish M. Bapat

(Prosthodontics) (Orthodontics)

Dr. Annil Dhingra Dr. Prathapan Parayaruthottam

(Endodontics) (Orthodontics)

Dr. Shashit Shetty Dr. Vincy Antony

(Endodontics) (Orthodontics)

Dr. Sriniwas S.R.

(Periodontics)

The Views expressed in this issue are those of the contributors and not necessarily those of the Magazine. Though every care has been taken to ensure the accuracy and authenticity of information, “GUIDENT”
is however not responsible for damages caused by misinterpretation of information expressed and implied within the pages of this issue. All disputes are to be referred to Uttar Pradesh Jurisdiction.

| Your Guide on the path of Dentistry   GUIDENT 5

CoCnontteenntsts May 2020

CONTENTS
MAY

08 IMMEDIATE IMPLANT PLACEMENT WITH IMMEDIATE 28 CONSERVATIVE TREATMENT OPTIONS IN ORAL SUBMUCOUS
LOADING IN MANDIBULAR ANTERIOR REGION FIBROSIS
Dr. Gaurav Gupta, Dr. D. K. Gupta, Dr. Neelja Gupta Dr. Surej Kumar LK, Dr. Nikhil M Kurien, Dr. Georgie P Zachariah

11 RAPID PROTOTYPING IN DENTISTRY 31 A STEP TOWARDS PRIMORDIAL PREVENTION OF TOBACCO USE
Dr. M. Sumati, Dr. Rathika Rai, Dr. Nirmal Betty AMONG SCHOOL CHILDREN
Dr. Hegde Vijaya K, Dr. Pooja J Shetty, Dr. Nair Meera V
16 TISSUE RETRACTORS, BRINKERS CLAMPS AND THEIR
APPLICATIONS 34 AGGRANDIZE ORAL HEALTH CARE SYSTEM A NEED OF AN
Dr. Pavana Kamath HOUR!
Dr. Jyotsna Seth, Dr. Anubha Agarwal, Dr. Himanshu Aeran
18 PINK TOOTH OF MURMMERY (INTERNAL RESORPTION)
Dr. Annil Dhingra, Dr. Unnati Nautiyal 36 RECENT ADVANCES IN PREVENTIVE DENTISTRY
Dr. Sunil K Chaudhary, Dr. Navpreet Kaur, Dr. Manish Bhalla
22 ENDOCROWN: AN ALTERNATIVE APPROACH FOR POST
ENDODONTIC RESTORATION IN MOLARS 43 MANAGEMENT OF TOBACCO USE & DEPENDENCE-A DENTAL
Dr. Sneha Mann, Dr. Sunil Kumar, Dr. Rohit Paul PRACTITIONER’S PERSPECTIVE
A REVIEW OF A MUCOCELE OF A LOWER LIP IN A Dr. Tanmay Mittal, Dr. (Maj) Richa Gupta, Dr. Megha Mittal

25 PEDIATRIC PATIENT; EXCISION WITH A DIODE LASER AND 46 DENTSPLY SIRONA CHAMPIONS FEMALE LEADERSHIP IN
HISTOPATHOLOGICAL EVALUATION: CASE REPORT WITH A DENTISTRY
ONE YEAR FOLLOW UP
Dr. Dhaval P. Pandya, Dr. Kanir H. Bhatia

6 |GUIDENT    Your Guide on the path of Dentistry



ImImppllaannt t May 2020

IMMEDIATE IMPLANT PLACEMENT WITH IMMEDIATE
LOADING IN MANDIBULAR ANTERIOR REGION

A Safe Zone

Wisdom Dental Clinics ®, Jaipur, India

Dr. Gaurav Gupta Dr. D. K. Gupta Dr. Neelja Gupta

Private Practice Consultant Consultant

INTRODUCTION Traumatic experience for the patient is the loss of tooth in
the esthetic area leading them to suffer real or perceived
To maintain proper mastication, digestion, phonation, appearance, and detrimental effects of it. The most cost-effective and long-
psychological well-being, oral health and oral health care are very important. term solution for replacement of missing teeth is dental
Loss of one or more teeth due to any reason may adversely affect the oral implant which give high average life expectancy, sense
health with the most serious consequence for the patient.Variety of reasons of security and well-being. Nowadays early loading after
causes tooth loss which includes dentaldiseases (e.g., caries or periodontal extraction followed by immediate implant placement has
disease), congenital absence, trauma,, or mechanical failure. Some secondary become more common as this procedure include fewer
or concomitantly to various systemic diseases such as cancer,1 cardiovascular surgical interventions, reduction in overall treatment
disease,2 diabetes mellitus, and osteoporosis may also lead to tooth loss.3 time,loss of soft and hard tissue reduced along with
Hence, it is important to maintain overall health. psychological satisfaction of the patient. This case report
describes the procedure for immediate implant placement
Patients may suffer from real or perceived detrimental effects due to tooth with immediate loading of implants in mandibular anterior
loss leading topsychological effects range from minimal to neuroticism region as a safe zone.
and also contributes to loss of confidence, avoidance of laughing in public, Keywords:  Early loading, esthetic rehabilitation, immediate
reluctance to form close relationship, especially when anterior teeth are implants, immediate loading
missing following the loss of one or more teeth.4
CASE REPORT -1
For implant placement conventional procedure involves extraction of offending
tooth, wait for 2–4 months for socket to heal, insertion of implant and again A 50 year old lady came with the chief complain of mobile lower front teeth
for integration of implant with surrounding bone wait for 3–6 months. Then causing pain while biting and also not look good aesthetic wise. Because of
another surgery is necessary to expose the implant and to place a prosthetic the demand of the patient, two active implants were placed in the suitable
abutment.5 As a result, the patient had to wait up to 8–12 months for a lost available bone, after achieving good insertion torque, immediate abutment
tooth to be replaced. Due to all of these shortcomings, placing the implant level. Impressions were made and 2 days later cement retained crowns
immediately after extraction of tooth followed by immediate loading of were delivered. With 6 years follow up, there were favorable soft and hard
implant with prosthesis were developed to substantially shorten the entire architecture present. (Figure.1)
treatment.6

The present case report discuss about the early loading in the mandibular
anterior teeth which is the safe zone followed by extraction with preservation
of soft and hard tissue architecture.

8 |GUIDENT    Your Guide on the path of Dentistry

May 2020 ImImppllaannt t

CASE REPORT - 3

A 42 year old lady came with the chief complain of dirty teeth and mobile
lower front teeth causing pain and bleeding.All the lower mobile failing teeth
were extracted followed by immediate implants. After getting excellent
primary stability, it was confirmed with encouraging ISQ values, that
immediate loading was done after 2 days. Proper hygiene measures and
dietary advisories were given and regular follow ups were done. 2 years
follow ups showed highly acceptable implant-prosthesis-patient relation, soft
tissue harmony and stable bony architecture.(Figure. 3)

Figure 1

CASE REPORT- 2 Figure 3

A 58 year old man came with the chief complain of loosing of lower front DISCUSSION
teeth causing pain while biting and bleed while brushing teeth.It was planned
to place immediately 2 nobel biocare active implants with insertion torques of In the modern era, replacing missing teeth especially when anterior teeth are
more than 50 NCM. ISQ also gave very promising readings of more than 75, missing,immediate implant concept is gaining popularity. Krump and Barnett
henceforth implant level open tray impressions were made on the same day reported that placement ofdental implants at the time of extraction has
and cement retained prosthesis was delivered 48 hrs later with patent lingual high success rates.7 Evidence has shown advantages of immediate implant
screw hole for easy retrievability. Patient was advised strictly to remain placement over delayed implant insertion, which includes placing implants in
on soft diet for few months and efficient oral hygiene measures. Patient fresh extraction sites thereby minimizing the need for angled abutments, have
was highly satisfied with the result and was on regular follow up, with Oral favorable osseointegration, preventing atrophy of the alveolar ridge thereby
prophylaxis sittings given. 3 years follow up showed excellent soft and hard preventing recession of the mucosal and gingival tissues, contaminants of
tissue harmony.(Figure 2) extraction socket are kept away byplacing immediate implants, elimination of
primary healing of the soft tissues and regeneration of the osseous structure,
immediate restorations can be provided. Elias and Sheiham carried out a review
of available literature and found that, in general, patients rated esthetics above
function in their priority for replacement of tooth and replacement of missing
anterior tooth than posterior tooth is more preferred.8

Though immediately placed and immediate loading implants are more
predictable and successful than before9 butnot every immediate implant
patientcan show desired result. Various treatment consideration has to be
taken as the procedure requires more chair-side time at the time of implant
placement for both the restorative dentist and the patient, careful screening
and selection of patient,screw-shaped implants, rough implant surface
and minimum implant length of 10 mm,adequate bone quality (D2 or D3
bone), avoidance of lateral forcesand adequate primary stability.10 The most
important factor in immediate loading isprimary stability.

Figure 2

| Your Guide on the path of Dentistry   GUIDENT 9

ImImppllaannt t May 2020

Attard and Zarb carried out a review and concluded thatas long as history of Restorative Dent. 2006;26:249–63. [PubMed] [Google Scholar]
marginal periodontitis is avoided, the success of early loading implants may 10. Vidyadharan A, Hanawa Y, Godfrey S, Resmi PG. Immediate implants and
not be compromised by placement in fresh extraction sockets11 while Quirynen
et al. concluded thatwhen combining immediate implant insertion with immediate loading in full arch maxilla and mandible of a bruxer – A case report.
immediate loading it resulted insignificantly higher implant failure.12 Ferrara IOSR J Dent Med Sci. 2014;13:62–7. [Google Scholar]
et al. conducted a study they found satisfactory esthetic and functional results 11. Attard NJ, Zarb GA. Immediate and early implant loading protocols: A literature
from patient’s point of view which was combining immediate placement and review of clinical studies. J Prosthet Dent. 2005;94:242–58. [PubMed] [Google
early loading of 33 implants.13 Scholar]
12. Quirynen M, Van Assche N, Botticelli D, Berglundh T. How does the timing of
In present scenario after completion of treatment patient was very satisfied implant placement to extraction affect outcome? Int J Oral Maxillofac Implants.
with the outcome of treatment and got excellent esthetic rehabilitation. 2007;22(Suppl 1):203–23.[PubMed] [Google Scholar]
13. Ferrara A, Galli C, Mauro G, Macaluso GM. Immediate provisional
CONCLUSION restoration of postextraction implants for maxillary single-tooth replacement.
Int J Periodontics Restorative Dent. 2006;26:371–7.[PubMed] [Google Scholar]
To fulfill both functional and esthetic requirements implant therapy must to
be considered as a primary treatment modality. Immediate placement of INTERNATIONALLY
endosseous implants into extraction sockets aim to reduce the process of INDEXED JOURNAL WITH
alveolar bone resorption and treatment time, hence it is known to achieve
a high success rate of between 94 and 100 %, compared to the delayed DOWNLOAD APP HERE
placement. The present report described the satisfactory rehabilitation of an
lower anterior tooth region with multiple implants on which a provisional Submit your Article at [email protected]
restoration was placed immediately after the surgery. [email protected] | [email protected] | www.guident.net

REFERENCES 01126941512, +91 9990922853

1. Meyer MS, Joshipura K, Giovannucci E, Michaud DS. A review of the relationship F-41/B, UGF, Barkat Appartment, Shaheen Bagh, Abul Fazal Enclave II
between tooth loss, periodontal disease, and cancer. Cancer Causes Control. Okhla, New Delhi-110025
2008;19:895–907. [PMC free article][PubMed] [Google Scholar]

2. Desvarieux M, Demmer RT, Rundek T, Boden-Albala B, Jacobs
DR, Jr, Papapanou PN, et al. Relationship between periodontal disease,
tooth loss, and carotid artery plaque: The oral infections and vascular disease
epidemiology study (INVEST) Stroke. 2003;34:2120–5. [PMC free article]
[PubMed] [Google Scholar]

3. Anil S, Preethanath RS, AlMoharib HS, Kamath KP, Anand PS. Impact of
osteoporosis and its treatment on oral health. Am J Med Sci. 2013;346:396–
401. [PubMed] [Google Scholar]

4. Craddock HL. Consequences of tooth loss: 1. The patient perspective – Aesthetic
and functional implications. Dent Update. 2009;36:616–9. [PubMed] [Google
Scholar]

5. Schropp L, Isidor F. Timing of implant placement relative to tooth extraction.
J Oral Rehabil. 2008;35(Suppl 1):33–43. [PubMed] [Google Scholar]

6. Singh A, Gupta A, Yadav A, Chaturvedi TP, Bhatnagar A, Singh BP. Immediate
placement of implant in fresh extraction socket with early loading. ContempClin
Dent. 2012;3(Suppl 2):S219–22.[PMC free article] [PubMed] [Google Scholar]

7. Krump JL, Barnett BG. The immediate implant: A treatment alternative.
Int J Oral Maxillofac Implants. 1991;6:19–23. [PubMed] [Google Scholar]

8. Elias AC, Sheiham A. The relationship between satisfaction with mouth and
number and position of teeth. J Oral Rehabil. 1998;25:649–61. [PubMed]
[Google Scholar]

9. Del Fabbro M, Testori T, Francetti L, Taschieri S, Weinstein R. Systematic review
of survival rates for immediately loaded dental implants. Int J Periodontics

10 |GUIDENT    Your Guide on the path of Dentistry

ProsthodonticsMay2020
Prosthodontics

RAPID PROTOTYPING IN DENTISTRY

Department of Prosthodontics
Thai Moogambigai Dental College & Hospital, Mogappair, Chennai

Dr. M. Sumati Dr. Rathika Rai Dr. Nirmal Betty

P. G. Student HOD & Principal Senior Lecturer

INTRODUCTION The advent of Rapid prototyping has opened new prospects in
medical field, especially dentistry with its accuracy and speed.
Digital technology has been influencing every possible field and dentistry and Rapid prototyping is an additive manufacturing technology
medicine is no exception to it1. From data analysis to innovative diagnostic that produces prototype models by adding materials, layer
tools, novel prevention and treatment methods,digital dentistry is flooded by layer. The earlier subtractive technologies manufactured
with a plethora of options. Patients and doctors have benefited from these objects via milling or grinding of a material resulting in
advancements in dentistry which provide solutions to dental ailments that replication of only external surface details. On the contrary,
makes it possible to bring forth the visualisation of treatment outcome in rapid prototyping provides a replica with internal complex
one click. shapes. This article discusses the various Rapid prototyping
technologies commonly employed in dentistry such as
CAD-CAM systems are probably one of the most significant development selective laser sintering, stereolithography, fused deposition
in the field of technology related to engineering, design and drafting. Using modelling. inkjet printing and solid ground curing.
these technologies, manufacturing time for parts of virtually any complex Keywords: Rapid prototyping, Selective laser sintering,
structures has been cut down to hours instead of days or months. In other Stereolithography, Fused deposition modelling. Inkjet printing
words, it is rapid. A software typical to each system “slices” the CAD model
into a number of thin (~0.1 mm) layers, which are then built up one on Some of the more widely used rapid-prototyping technologies in dentistry
top another.2 Rapid prototyping is an “additive” process,building layers of include stereolithography apparatus (SLA), fused-deposition modeling (FDM),
paper, wax,plastic or metal to create a solid object. On the other hand, selective laser sintering (SLS), laminated object manufacturing (LOM), three-
most machining processes (milling, drilling, grinding, etc.) are “subtractive” dimensional printing (3DP), and inkjet methods including thermal-phase-
processes that remove material from a solid block. Rapid prototyping’s additive change inkjet and photopolymer-phase-change inkjet.
nature allows it to create objects with complex intricate details that cannot
be manufactured by other means. The advent of rapid prototyping system THE BASIC PROCESS
offered new potential outcomes for management of oral and maxillofacial Although there are several rapid prototyping techniques,basic step remains
deformities. Introduced in aeronautical and automobile industry to reduce the the same. The steps are:
time required for planning and development of delicate and intense model
parts, it works on the principle of depositing material in layers or cuts to
develop a model instead of creating a model from a strong block of material.
Thus, fabrication of an accurate prosthesis by replicating the inner geometry,
as opposed to the external surface details, compared to conventional dental
prosthesis fabrication results in more accurate prosthesis. Rapid-prototyping
(RP) technologies also called as additive fabrication (AF), three-dimensional
(3D) printing, solid freeform fabrication, and layered object manufacturing,
add and bond materials in layers to form physical objects directly from
computer-aided design (CAD) data sources

| Your Guide on the path of Dentistry   GUIDENT 11

ProsthodonticsProsthodontics May 2020

Figure 1: Basic steps in rapid prototyping body,like hard and soft tissues. After processing these images using suitable
software tools, it is transferred to a RP process and a physical part is obtained,
1. CAD Model Creation called a medical model
First step involves the creation of object to be built via a CAD software Various Rapid prototyping techniques employed in the field of dentistry are:
package
XXStereolithography (SL)
2. Conversion to STL Format XX3-D Printing
The various CAD packages unique of each processing system employs a XXFused Deposition Modeling (FDM)
number of different algorithms to represent solid objects.For the purpose XXSolid Ground Curing
of consistency, the STL (Standard Triangulation Language) format has XXLaminated Object Manufacturing (LOM)
been adopted as the standard norm of the rapid prototyping industry. The XXSelective Laser Sintering (SLS)
second step involves conversion of the CAD file into STL format. This format
represents an object in three dimensions as an assembly of planar triangles, STEREOLITHOGRAPHY(SLA)
like the facets of a cut jewel. This process is same for all of the RP build It is the most widely used process in the Rapid prototyping field. Patented
techniques. in 1986, stereolithography is a free form fabrication technology, developed
by 3D Systems, Inc. It has become the most popular of the rapid prototyping
3. Slice the STL File methods due to its accuracy and surface finish. The technique builds three-
In the next step, the STL file is prepared by, a pre-processed program. The dimensional models from liquid photosensitive polymers that solidifies on
pre-processing software slices the STL model into many layers ranging from exposure to ultraviolet light. Stereolithography binds plastic parts or objects
0.01 mm to 0.7 mm thick, depending on the inbuilt technique. a layer at a time by tracing a laser beam on the surface of a vat of liquid
photopolymer.4
4. Layer by Layer Construction
The fourth step is the main construction part. The protyping machines build Figure 2: Schematic diagram of the stereolithography process
one layer at a time from polymers, paper, or powdered metal.
In this process, the prototype model is constructed using a photosensitive
5. Clean and Finish liquid resin,that is cured on a platform by exposing it to computer controlled
The last step is post-processing. This involves removal of prototype from the ultraviolet laser beam. After curing the first layer, the platform is then
machine and detaching any supports. Some photosensitive materials need to lowered into the bath containing the photosensitive resin, and a new layer
be fully cured before use and some also require minor cleaning and surface of a particular thickness is added. It is then cured and gets bonded to the
treatment. previous formed layer. The layers are added in sequence until the building up

RAPID PROTOTYPING IN DENTISTRY

The convergence of three distinct technologies, namely Medical Imaging,
Computer Graphics and Computer Aided Designing, and Rapid Prototyping
Technology has given rise to modern day medical applications.3 Computer-
Assisted Tomography (CT) and Magnetic Resonance Imaging (MRI) provide
high resolution images of once inaccessible, internal structures of the human

12 |GUIDENT    Your Guide on the path of Dentistry

ProsthodonticsMay2020
Prosthodontics

of the model is complete. On completion of the process,the model is removed Figure 3: Schematic image of SLS technique
carefully from the platform and washed in a solvent to remove the uncured
resin from the surface. The model is then placed in an ultraviolet oven for It makes use of a high power laser to fuse small particles of plastic, metal,
complete curing of the resin.5 Early prototypes were brittle and underwent ceramic or glass powders into a desired three dimensional structure. The Laser
warpage and distortion, but recent modifications have largely rectified these selectively fuses powdered material by scanning cross-sections generated
problems. from a 3-D digital description of the part on surface of a powder bed.7 After
scanning of each cross-section, powder bed is lowered by one layer thickness
Application in dentistry and a new layer of material is deposited on top of it, repeating the process is
repeated until the part is completed. SLS machine preheats the bulk powder
»» Production of auricular and nasal prosthesis material in powder bed below its melting point by infrared heating in order to
minimize thermal distortion (curling) and facilitate fusion to the previous layer.
»» Obturators Various materials can be used such as fine polymeric powder – polystyrene,
polycarbonate or polyamide, within the range of 20 to 100 micrometer
»» Duplication of existing maxillary/mandibular prosthesis especially crucial diameter. The laser is modulated in such a way that only those grains, which
when an accurate fit to natural teeth or an osseointegrated implant is are in direct contact with the beam, are fused. The finished objects have a
needed matte, powdery surface.

»» Manufacturing of surgical stents for patients with large tumors scheduled Application in dentistry
for excision
»» Anatomical study models
»» Manufacturing of lead shields for protection of healthy tissue during
radiotherapy treatment »» Surgical guides and splints

»» Fabrications of burn stents, where burned area can be scanned rather than »» Dental models
subjecting delicate, sensitive burn tissue to impression - taking procedures
»» Cobalt chromium RPD frameworks
Advantages
»» Maxillo-facial prostheses
»» Good dimensional accuracy
Advantages
»» Good surface finish
»» Capable of producing the toughest part compared with other process
»» High mechanical strength
»» A variety of material can be used, including plastic, wax, metal, ceramic,
»» Prototypes can be used as master patterns for injection molding, etc.
thermoforming, blow molding, and various metal casting processes.
»» Parts can be produced in short time
»» It is a high resolution process and can build parts with rather complex details
»» No post curing of parts is required
Disadvantages
»» Inbuilt support process, so no additional support required.
»» Curling and warping is common especially in the relatively thin areas due to
water sorption by the resin with passing time »» Parts can be built on top of others

»» Relatively high cost

»» Narrow range of materials - The material available is only photosensitive
resin due to its undesirable physical property,cannot be used for durability
and thermal testing.

»» Post curing - A post curing process is normally required due to incomplete
curing.

»» High running and maintenance cost

SELECTIVE LASER SINTERING (SLS)

Developed by Carl Deckard at the University of Texas, for his master’s thesis,
selective laser sintering was patented in 1989. In this technology,CAD files
are transferred to the system, where they are sliced and drawn, one cross-
section at a time, by focusing laser beam to a thin layer of powder. The laser
beam fuses the powder particles to form a solid mass that is in match with
the CAD design. As each layer is added, the prototypes take shape within
the system.6

| Your Guide on the path of Dentistry   GUIDENT 13

ProsthodonticsProsthodontics May 2020

Disadvantages Disadvantages

»» The powder material takes about 2 hours to reach the temperature below »» Resolution is low
the melting point before the building process is started.8 And after building
the parts, it also takes 5 to 10 hours to cool down before removing the »» Lack of surface smoothness
parts from the powder cylinder.
»» Long working time needed
»» The surface smoothness is restricted to the size of the powder particles and
the laser spot resulting in porous surface. Smooth surface can be obtained »» Limited accuracy due to the configuration of the material used
only by post processing
»» Delamination can occur due to temperature fluctuations during production
»» To provide a safe environment for the sintering process the process chamber
requires continuous nitrogen supply resulting in expensive running cost. INK-JET PRINTING

FUSED DEPOSITION MODELING (FDM) This technology is also called as Three Dimensional Printing (3DP).There is a
wide range of diverse technologies that is grouped under the ink-jet printing
Next to stereolithography,Fused Deposition Modeling (FDM) is the second category, but all are based on squirting a build material in a liquid or melted
most widely used rapid prototyping technology. Fused deposition modelling state, which cools or hardens to form a solid on impact. Inkjet method employs
builds up a product in thin layers using thermoplastic wire-like filaments a single jet for a plastic build material and a wax-like support material, that
eliminating the need for messy liquid photopolymers, powders, lasers. are held in a melted liquid state in reservoirs.10 The liquids are supplied to
individual jetting heads which ejects tiny droplets of the materials as they are
moved in X-Y fashion in the required pattern to form a layer of the object. The
materials harden by rapid drop in temperature as they are deposited. After an
entire layer of the object is formed by jetting, a milling head is passed over
the layer to make it uniform. Particles are captured in a filter as the milling
head cuts repeating the process to form the entire object. After the completion
of the process the wax support material is either melted or dissolved away.

Figure 4: Schematic representation of fused deposition modelling Figure 5: Schematic image of inkjet printing

In this technique, heated thermoplastic filaments are extruded from a tip that Application in dentistry
moves along the x-y plane. First layer is formed by controlled deposition of
very thin beads of material from the extrusion head onto the build platform.9 »» Dental and anatomical study models
The platform is maintained at a very lower temperature, to quicken the »» Implant drill guides
hardening of thermoplastic material. The extrusion head deposits the second
layer upon lowering the platform on the first. Several materials are available Advantages
for the process including investment casting wax,polycarbonate, acrylonitrile,
butadiene styrene, poly phenyl sulfone, calcium phosphate based ceramic and »» Ability to print multiple monomers at the same time (i.e., multimaterial
nylon. The supporting structures are staged for overhanging geometries and printing)
are later removed by cutting them out from the object.
»» Extremely fine resolution and surface finishes
Application in dentistry
Disadvantages
»» Fabrication of custom impressions
»» Overall printing time quite slow
»» Custom bite registrations »» Limited material selection

»» Wax set up for try in

Advantages

»» No chemical post processing,

»» Cost-effective

14 |GUIDENT    Your Guide on the path of Dentistry

ProsthodonticsMay2020
Prosthodontics

SOLID GROUND CURING (SGC) CONCLUSION
Rapid prototyping could establish itself as a milestone in the field of dentistry due
It is a type of additive technique in which laser polymerizes successive to its accuracy, efficacy, potency and minimal time consumption in the fabrication
layers of resin through a stencil using ultraviolet light to selectively harden process.12 Its utility in treatment planning and analysis of treatment outcomes
photosensitive polymers. Solid Ground Curing (SGC) cures an entire layer at improvises the quality of treatment provided by the dentist to the patient enhancing
a time.11 The photosensitive resin is sprayed on build platform. The machine the patient satisfaction. Rapid prototyping is transforming digital dentistry by
develops a photomask (like a stencil) of layer to be built. The Photomask is extensively giving opportunities in diagnosis, treatment and education. With the
printed on glass plate above build platform using an electrostatic process. increased use of intra-oral scanning system, it is already applied practically in
Then the Mask is exposed to UV light, which only passes through transparent prosthodontics by high resolution printing resin, printing models for restorative
portions of mask to selectively harden shape of current layer. Later Machine dentistry and lost wax process pattern. In craniofacial and implant surgery 3D
vacuums up excess liquid resin and sprays wax in its place to support model. printed anatomical model is becoming more essential as it guides in treatment
The top surface is milled flat and the process repeats to build next layer. When planning of complex surgeries. It is also widely accepted that the surgery
the part is complete, it must be de-waxed by immersing in solvent bath. becomes less invasive, more predictable and accurate with the help of surgical
guides made from resins. Even though 3D printing is becoming cost effective
in the present but still the cost of running, materials used and maintenance of the
machines are still areas of concern. The demand for well trained operators, post
processing, adherence to strict health and safety measures should be considered.
As the technology evolves, it is important for the dentist to be alongside the
advances that may have the future to benefit both the dentist and the patient.

Figure 6: Schematic representation of solid ground curing REFERENCES

Applications in dentistry 1. Van Noort R. The future of dental devices is digital. Dental materials.
2012 Jan 1; 28(1): 3-12.
»» Wax pattern fabrication- PFM crowns,pressed ceramic crowns, RPD
frameworks 2. Mahindru DV, Priyanka Mahendru SR, Tewari Ganj L. Review of rapid
prototyping-technology for the future. Global journal of computer science and
»» Maxillofacial prosthesis technology. 2013 May 31.
»» Mold for metal casting
»» Mold for complete denture 3. Kim GB, Lee S, Kim H, Yang DH, Kim YH, Kyung YS, Kim CS, Choi SH, Kim BJ,
»» Direct metal prosthesis fabrication Ha H, Kwon SU. Three-dimensional printing: basic principles and applications in
medicine and radiology. Korean journal of radiology. 2016 Apr 1; 17(2): 182-97
Advantages
4. Ramya A, Vanapalli SL. 3D printing technologies in various applications. International
»» High structural strength and stability Journal of Mechanical Engineering and Technology. 2016;7(3):396-409.
»» Minimum shrinkage
5. Harrison C, Cabral JT, Stafford CM, Karim A, Amis EJ. A rapid prototyping
Disadvantages technique for the fabrication of solvent-resistant structures. Journal of
Micromechanics and Microengineering. 2003 Oct 14; 14(1): 153.
»» Requires large space
»» Difficult to clean 6. Hutmacher DW, Sittinger M, Risbud MV. Scaffold-based tissue engineering:
rationale for computer-aided design and solid free-form fabrication systems.
TRENDS in Biotechnology. 2004 Jul 1; 22(7): 354-62.

7. Sharma A. RAPID PROTOTYPING TECHNOLOGY FOR PROSTHODONTICS.
International Journal of Clinical Dentistry. 2014 Nov 1;7(4).

8. Pham DT, Gault RS. A comparison of rapid prototyping technologies. International
Journal of machine tools and manufacture. 1998 Oct 1; 38(10-11): 1257-87.

9. Agarwala MK, Jamalabad VR, Langrana NA, Safari A, Whalen PJ, Danforth SC.
Structural quality of parts processed by fused deposition. Rapid prototyping
journal. 1996 Dec 1.

10. Singh V. Rapid prototyping, materials for RP and applications of RP. Int J Eng
Res Sci. 2013 Jul; 4: 473-80.

11. Pratik Bhatnagar, Jaspreet Kaur, Pooja Arora, Vipin Arora. International Journal
of Life Sciences.2014; 3(2): 50-53

12. Reddy CS, Areddy Manasa Reddy P, Solomon RV. 3D Printing-An Advancing
Forefront in Imprinting the Inner Dimensions of Tooth with Precision. Journal of
Academy of Dental Education. 2017; 19:24.

| Your Guide on the path of Dentistry   GUIDENT 15

EndodonticsEndodontics May 2020

TISSUE RETRACTORS,BRINKERS CLAMPS AND
THEIR APPLICATIONS

Director, Upskill Dental Academy
Mumbai, India

Dr. Pavana Kamath

Private Practice

Rubber dam clamps are an essential part of the rubberdam kit ,which helps They are very useful for deciduous molars where they can be applied with
you retain the rubberdam sheet on the tooth. Innumerable designs of clamps minimal pinching of the gingiva, hence ensuring the patient comfort.
are available in the market, where the operator can choose them based on
the requirement . XXB4 can be used for isolation, by tissue retraction of cervical carious lesion, it
is also useful for isolation of structurally compromised teeth with additional
The effective use of a rubber dam requires stable, accurately fitting clamps. retention.
The design of the jaws of the clamps and the forces of retention are therefore
important. Clamps should engage the teeth as closely as possible along the XXB5 brinkers are excellent for class 5 caries isolation as well as for isolation of
entire length of the jaws, at least with contact at four points, to prevent incisors both upper and lower
movement during the operation (Wiland, 1973). The forces exerted by clamps
should not be so great as to fracture the teeth.1 XXB6 can be used for class 5 caries isolation in incisors and canines.

One of the set of clamps specially designed for a specific purpose are the B-1 B-2
brinkers clamps.
The buccal jaw is always wider than the lingual in B2 and B-3
Brinkers or tissue retractors are specially designed clamps designed primarily
for the purpose of tissue retraction, while providing secondary retention. B-4

APPLICATIONS

They are used as retainers in pedodontics .

For isolation of cervical carious lesions by tissue retraction.

The brinkers clamps are available as metal clamps.They are metal clamps
made of tempered carbon steel or stainless steel.

THE TYPES OF BRINKERS CLAMPS

XXThe B1 is primarily for lower molars in deciduous molars

XXThe B2 and B3 are useful for upper molars in deciduous molars

When observed carefully these retractors have relatively smaller jaws with
broader bows.

Molar brinkers display a broader jaw and a narrower jaw. The broader jaw
always is applied on the buccal surface of the molar.

16 |GUIDENT    Your Guide on the path of Dentistry

EndodonticsMay2020
Endodontics

Isolation with B4 for badly broken down teeth B-5

DISADVANTAGES
The only disadvantage of brinkers clamps is that they are gentle on the tissues
hence an additional retainer is required for retention of the rubber dam sheet .

REFERENCES

1. Rubber Dam Clamps Classified by Stiffness and Gap between the Jaws ,
OPERATIVE DENTISTRY, 1981, 6, 117-123. OLAV MOLVEN • NILS R GJERDET

2. https://www.coltene.com/fileadmin/Data/EN/Products/Treatment_Auxiliaries/
Dental_Dam/Dam_It__It_s_Easy__FINAL.pdf

www.rolence.com.tw

Ergonomic design
Plug and Use
Durability

Digital Sensor
Easy cable exchange.
Excellent image quality, available instantly.

Portable X-ray

Large Capacity battery provides more than
450 exposures per charge.
Reliable X-Ray tube provided by Canon.

| Your Guide on the path of Dentistry   GUIDENT 17

EndodonticsEndodontics May 2020

PINK TOOTH OF MURMMERY (INTERNAL RESORPTION)

Department of Conservative Dentistry and Endodontics
Seema Dental College And Hospital, Rishikesh

Dr. Annil Dhingra Dr. Unnati Nautiyal

Professor & H.O.D. P.G. Student

INTRODUCTION 1. Trauma induced tooth resorption
a. Surface Resorption
According to the Glossary of the American Association of Endodontists, b. Transient Apical Internal Resorption
resorption is defined as “a condition associated with either a physiologic or c. Pressure
a pathologic process resulting in the loss of dentin, cementum, or bone”. d. Orthodontic
Bell first reported on internal resorption in 1830. Fothergil referred to the e. Replacement
condition as “pink spot”. In 1920, Mummery published the first extensive 2. Infection induced tooth resorption
study of pink spots, and Pritchard later showed histologically that internal a. Internal Inflammatory (Infective) Resorption
resorption is comparable to a granuloma of the pulp.1 Root resorption is the i. Apical
loss of dental hard tissues as a result of clastic activities. It might occur as ii. Interradicular
a “physiologic” or “pathologic” phenomenon. Root resorption in the primary b. External Inflammatory Resorption
dentition is a normal physiologic process except when the resorption occurs c. Communicating External Inflammatory Resorption
prematurely. The initiating factors involved in physiologic root resorption in 3. Hyperplastic invasive tooth resorption
the primary dentition are not completely understood, although the process a. Internal (invasive) Replacement Resorption
appears to be regulated by cytokines and transcription factors that are similar b. Invasive Coronal Resorption
to those involved in bone remodelling.3 Unlike bone that undergoes continuous c. Invasive Cervical Resorption
physiologic remodeling throughout life, root resorption of permanent teeth d. Invacive Radicular Resorption
does not occur naturally and is invariably inflammatory in nature. Thus, root
resorption in the permanent dentition is a pathologic event; if untreated, this Andreasen classification remains the most widely accepted classification:
might result in the premature loss of the affected teeth.4
1. INTERNAL
PREVALENCE a. Inflammatory
b. Replacement
Internal root resorption has been described as intraradicular or apical according 2. EXTERNAL
to the location in which the condition is observed.4 The condition is more a. Surface
frequently observed in male than female subjects. Although intraradicular b. Inflammatory
internal root resorption is a relatively rare clinical entity even after traumatic c. Replacement
injury a higher prevalence of the condition has been associated with teeth that
had undergone specific treatment procedures such as autotransplantation.11

CLASSIFICATION OF TOOTH RESORPTION

Classification proposed by Lindskog subdivides resorption into 3 broad groups:

18 |GUIDENT    Your Guide on the path of Dentistry

EndodonticsMay2020
Endodontics

ETIOLOGY 3. The OPG/RANKL/RANK transcription factor system controls clastic
functions during bone remodeling has also been identified in root resorption.
Traditionally, internal resorption has been associated with a longstanding The system is responsible for the differentiation of clastic cells from their
chronic inflammation in the pulp.6 The process is initiated by a variety of stimuli precursors via complex cell-cell interactions with osteoblastic stromal cells.
such as trauma, pulpotomy, extreme heat produced during cutting of dentin,
chronic inflammation of the pulp following caries perpetuated by bacterial INTERNAL INFLAMMATORY ROOT RESORPTION
factors, cracked tooth, tooth transplantation, and orthodontic treatment.6,7
The literature also cites the association of herpes zoster with resorption and Internal (inflammatory) root resorption can be characterized both as a well-
the degeneration of odontoblast due to systemic viral infection.12 known and poorly known disease entity destroying the dental hard tissue. It
is well known in the sense that most dentists recognize the diagnosis ‘internal
PATHOGENESIS resorption.’2 Internal inflammatory resorption is rare and often detected after
its activity has ceased. Clinical symptoms and signs are usually not identified
See Figure 1 until the internal inflammatory resorption is advanced. The tooth may may
be discoloured and respond negatively to sensitivity testing with advanced
lesions.5 Internal inflammatory resorptions may be classified according to
location as: apical and intraradicular.10

1. Osteoclasts are motile, multinucleated giant cells that are responsible INTERNAL REPLACEMENT (INVASIVE) RESORPTION
for bone resorption. They are formed by the fusion of mononuclear precursor
cells of the monocyte-macrophage lineage derived from the spleen or bone Internal root canal replacement resorption is characterized by an irregular
marrow, as opposed to osteoblasts and osteocytes that are derived from radiographic enlargement of the pulp chamber, with discontinuity of the
skeletal precursor cells.4 normal canal space. Because the resorption process is initiated within the
root canal, the defect includes part of the canal space, and hence the outline
XXOsteoclasts are recruited to the site of injury or irritation by the release of many of the original canal appears distorted. The enlarged canal space appeared
proinflammatory cytokines. radiographically to be obliterated by a fuzzy-appearing material of mild to
moderate radiodensity.13 This type of resorption is relatively rare and may
XXThey attach themselves to the bone surface. appear clinically as a pink area in the crown of the affected tooth.10 This
form of resorption is typically asymptomatic, and the affected teeth might
XXOn contact with mineralized extracellular matrices, the actin cytoskeleton of respond normally to thermal and/or electric pulp testing unless the resorptive
an actively resorbing osteoclast produces an organelle-free zone of sealing process results in crown or root perforation.14 A variant of internal root canal
cytoplasm (clear zone) associated with the osteoclast’s cell membrane to enable replacement resorption has previously been reported as ‘‘internal tunnelling
it to achieve intimate contact with the hard tissue surface. resorption’’

XXThe clear zone surrounds a series of finger-like projections (podosomes) of cell CLINICAL FEATURES
membrane known as the ruffled border.
Internal resorption is usually asymptomatic and approximately only 2%
XXIt is underneath this ruffled border that bone resorption occurs. shows clinical signs.

XXThe resorptive area within the clear zone, therefore, is isolated from the It is more frequently observed in males than females.8 Usually found either
extracellular environment, creating an acidic microenvironment for the in the mid or apical area of root. They are discovered by chance on routine
resorption of hard tissues. radiographs or by the clinical sign of a “pink spot” on the crown. The pulp can
either show partial or complete necrosis. In an actively progressing lesion, the
2. Odontoclasts resorb dental hard tissues and are morphologically tooth may be partially vital and may present symptoms typical of pulpitis.2
similar to osteoclasts. Odontoclasts differ from osteoclasts by being smaller Pain may be a presenting symptom if there is complete perforation of the
in size and having fewer nuclei and smaller sealing zones. Both resorb their crown and the granulation tissue is exposed to oral environment. Another
target tissues in a similar manner. Both cells possess similar enzymatic characteristic feature that gives an indication about the centre of origin of
properties, and both create resorption depressions termed Howship’s lacunae the resorption is the location of “the spot”: a color change from inflammatory
on the surface of the mineralized tissues. internal resorption seen typically in the middle of the tooth in the mesiodistal
direction (except in multirooted teeth), whereas in cervical resorption it is
located eithermesially, centrally, or distally.2

| Your Guide on the path of Dentistry   GUIDENT 19

EndodonticsEndodontics May 2020

DIFFERENTIAL DIAGNOSIS1 Diagrammatic representations of midroot resorptive lesions (Based on
drawings by Leppg)1
External XXApex shortened, flattened, blunted, or
Resorption square MANAGEMENT OF INTERNAL RESORPTION

Early Pulpal XXForamen is at apex, opening can be 1. Conservative Dental Treatments of Resorbed Teeth -
Death seen Root canal treatment remains the treatment of choice of internal root resorption
(Incomplete as it removes the granulation tissue and blood supply of the clastic cells. The
Formation) XXWalls of canal converge apically access cavity preparation must be as conservative as possible to preserve tooth
structure and avoid further weakening of the already compromised tooth. The
XXMargins of lesion are ragged and workinglength determination with an apex locator is not possible in case of
irregular resorptive perforation. A great emphasis must be placed on the chemical
dissolution of the vital and necrotic pulp tissue with sodium hypochlorite. The
XXLesion may be superimposed over use of calcium hydroxide as an interappointment dressing maximizes the effect
canal of disinfection procedures, helps to control the bleeding, and necrotizes residual
pulp tissue. About the root canal filling, thermoplastic guttapercha techniques
XXCanal cab be followed all the way to seem to give the best results when the canal walls are respected.16
apex, unaltered
2. Complete Root Canal Filling with Warm Gutta Percha
XXForamen wide open - This option is for IRR with no perforation of the canal walls which is the most
favorable situation in long-term prognosis. The treatment is performed in two
XXWalls do not converge apically but sessions.16
diverge
3. Sealing of Internal Root Resorption with Bioactive
XXApex blunt and square Cements as MTA - This option is indicated in presence of a perforation
of the canal walls giving a communication between the root canal system and
XXRoot length short the periapical tissue. In this clinical situation, the smaller the perforation size,
the more predictable the prognosis of the tooth. The treatment is performed in
Dental XXUsually closer to the crown of the two sessions.16
Caries tooth
4. Surgical Treatment of Internal Root Resorption - Surgical
Internal XXLess sharp and more poorly defined approach is needed when it is not possible to get access to the lesion through
Resorption lesion the canal. Surgical treatment should always be performed in a second intention,
after orthograde treatment (or retreatment) has been performed, the coronal
XXProgresses from outward to inward part of the canal being filled. In these cases, because of the shape of the lesion,
surgical approach allows to get direct access to the lesion and to perform a
XXMargin of lesion is abrupt mechanical cleaning of the resorbed defect.16

XXCanal or chamber shows enlarged REFRENCES
areas
1. Gartner, A. H., Mack, T., Somerlott, R. G., & Walsh, L. C. (1976). Differential
XXLesion can be symmetrical or diagnosis of internal and external root resorption. Journal of Endodontics, 2(11),
eccentric 329–334. doi:10.1011/s0099-2399(76)80071-4

XXMargins of lesion are sharp, smooth 2. HAAPASALO, M., & ENDAL, U. (2006). Internal inflammatory root resorption:
and clearly defined the unknown resorption of the tooth. Endodontic Topics, 14(1), 6079.
doi:10.1111/j.1601-1546.2008.00226.x
XXCanal cannot be present in area of
lesion 3. Harokopakis-Hajishengallis, E. (2007). Physiologic root resorption in primary
teeth: molecular and histological events. Journal of Oral Science, 49(1), 1 12.
XXSize and location can vary
considerably 4. Patel, S., Ricucci, D., Durak, C., & Tay, F. (2010). Internal Root Resorption:
A Review. Journal of Endodontics, 36(7), 1107–1121. doi:10.1016/j.
Internal resorption: normal outline External resorption: normal joen.2010.03.014
of canal cannot be followed outline of canal can be followed
through lesion 5. Patel, S., & Ford, T. P. (2007). Is the Resorption External or Internal? Dental
through lesion Update, 34(4), 218–229. doi:10.12968/denu.2007.34.4.218

6. Tronstad, L. (1988). Root resorption - etiology, terminology and
clinical manifestations. Dental Traumatology, 4(6), 241–252.
doi:10.1111/j.1600-9657.1988.tb00642.x

More references are available on request

20 |GUIDENT    Your Guide on the path of Dentistry



EndodonticsEndodontics May 2020

ENDOCROWN: AN ALTERNATIVE APPROACH FOR POST
ENDODONTIC RESTORATION IN MOLARS

Department of Conservative Dentistry & Endodontics
K.D. Dental College & Hospital, Mathura

Dr. Sneha Mann Dr. Sunil Kumar Dr. Rohit Paul

P.G. Student Reader Professor & HOD

INTRODUCTION Gutta percha was removed to a depth of 1mm and the root canal orifices and
pulp floor was lined with glass ionomer cement.
Traditionally the gold standard for the restoration of endodontically treated Endocrown preparation consisted of a circumferential depth of 1.2 mm. The
teeth (ETT) has been all metal, metal-ceramic or all-ceramic full coverage cervical margin was supragingival. A cylindrical-conical diamond bur with an
crowns.1 In the recent years, emphasis has been given to tooth tissue occlusal convergence of 7° was used to create continuity between coronal
preservation and this principle also apply to ETT.2 pulp chamber and endodontic access cavity.
The endocrown was fabricated using CAD-CAM technology in the laboratory.
Pissis introduced the monoblock heat pressed ceramic technique in 1995. A try-in of the endocrown done and checked for any occlusal, internal and
The technique utilized the pulp chamber to increase macromechanical proximal adjustments and was sent to the laboratory for glaze application.
retention of crown.3 Bindl and Mörman evolved the proposal by Pissis in In the following session, the internal surface of endocrown was etched with
1999 and named it ‘endocrown’. They described it as a CAD/CAM all ceramic hydrofluoric acid and rinsed with water and dried with air syringe. A coat of
crown, macromechanically anchored to the internal portion of the pulp a silane coupling agent was applied for 1 minute and dried. The tooth surface
chamber and adhesively cemented to the remaining tooth structure, gaining was etched with phosphoric acid for 15 sec on dentin and 30 sec on enamel,
micromechanical retention.4 then washed and dried. Adhesive was applied and polymerised for 20 sec
with light curing.
Endocrown is indicated in cases of extensive loss of the crown tissue, limited Dual polymerizing resin was applied to the endocrown and then inserted into
interproximal space and when rehabilitation with post and crown is not the tooth and polymerized for 60 seconds on all surfaces. The restoration was
possible.5 Low cost, short preparation time, ease of application, minimal chair examined for any occlusal interference.
side time and aesthetic properties are the advantages of endocrowns.6
Figure 1: endodontically treated maxillary molar
The guidelines for tooth preparation for an endocrown include(6) :

1. Overall reduction of 2mm in height is necessary

2. Butt joint margin of 1-1.2 mm is suggested, but not always needed

3. Occlusal divergence of 5-7 degree is obligatory for the coronal pulp chamber

4. Cervical margins should be placed as supragingivally as possible.

CASE REPORT

A 45 year old female reported to the Department of Conservative Dentistry
and Endodontics with the complain of pain in upper right back region of jaw
since past 2 months. Tooth was tender on percussion. Clinical and radiographic
evaluation showed deep occlusal caries involving the pulp.

The tooth was treated endodontically. Endocrown was decided as the post
endodontic restoration.

22 |GUIDENT    Your Guide on the path of Dentistry

EndodonticsMay2020
Endodontics

Figure 5: maxillary and mandibular teeth in occlusion

Figure 2: root canal orifices and pulpal floor lined with GIC

Figure 3: tooth preparation for endocrown Figure 6: post treatment radiograph
FIGURE 4: Occlusal view of cemented crown
DISCUSSION

Restoration of teeth that have undergone endodontic treatment is one of the
most challenging aspect for the dentist and is widely debated. Conventional
crowns are still considered as a restorative option but the invasive protocol
for tooth preparation is criticized widely. With the introduction of adhesive
materials, the range of restorative options have increased. Restorative
options utilizing adhesive materials are a more conservative and cost effective
treatment.7,8

The restorative treatment of molars is challenging, particularly is cases of
large coronal destruction.

Endocrown is made of ceramic or composite material and is a partial crown.
It is cemented with resin cement. It provide complete occlusal coverage. The
adhesive surface area is increased with the pulp chamber. Composite resin,
composite hybrid resin, feldspathic and glass ceramic and CAD/CAM ceramic
can be used for its fabrication.6,9

The principles for the preparation of endocrown is similar to the preparation
principles followed for indirect inlays and onlays.The depth, extension, and
inclination of the pulp chamber wall are utilized to improve the retention and
stability of the restoration.2

| Your Guide on the path of Dentistry   GUIDENT 23

EnEdndooddonotincstics May 2020

Indications of endocrown include small intermaxillary spaces where metal Event
pegs and crowns can not be given because of insufficient thickness of ceramic CALENDAR
material, where the use of posts is contraindicated and in extensive loss of
tooth structure.10 4TH INTERNATIONAL DENTAL LAB EXPO & CONFERENCE-2020
Date : 18th -19th July-2020
The advantages of endocrown include easy procedure, less time for fabrication Venue : New Delhi
and good esthetics. Endocrowns have also shown better mechanical Contact Person : Mr. Manzar
performance than conventional crowns. The advantages of ceramic like Contact No.: +91-9212582184,+91- 9990922853
biocompatibility and biomimicry and its wear coefficient can also be utilized. Email: [email protected]
Also, the single interface of a 1-piece restoration makes cohesion better.11 Website: www.dentallabexpo.com

However, it is not indicated when adhesion cannot be assured,the pulp EXPODENT BENGALURU-2020
chamber depth is less than 3 mm, or when the width of the cervical margin is Date : 5th - 6th September-2020
less than 2 mm for most of its circumference.The cavity of the pulp chamber Venue : BIEC Tumkur Road Bengaluru
provides stability and retention. It is triangular shape in maxillary molars and Contact Email : [email protected]
trapezoidal shape in mandibular molars and increases the stability.The saddle Contact No.: 011-41722123
form of the pulp floor also increases the restoration’s stability.12
EXPODENT CHANDIGARH-2020
The compressive stresses are distributed over the walls of the pulp chamber Date : 19th - 20th September-2020
and the cervical butt joint and reduced.13 Venue : Palm Resorts Zirakpur
Contact Email : [email protected]
Dual cure resin cement (CALIBRA)was used in this case. The combination Contact No.: 011-41722123
of two polymerization mechanisms, light and chemical, guarantees
polymerization under no light conditions. THE 12TH IFEA WORLD ENDODONTIC CONGRESS
Date: 23rd -26th September 2020
CONCLUSION Venue: Chennai Trade Center, Chennai
Contact No.: +91 9840218818
Post endodontic restoration of a maxillary molar with an all-ceramic Website: www.ifea2020india.com
endocrown presented with good results. Endocrown can be considered an
alternative treatment for endodontically treated teeth. It adheres to the new EXPODENT MUMBAI-2020
concept of minimal intervention dentistry. Date : 3rd - 4th October-2020
Venue : NSE Exhibiton Complex Goregaon
This reconstruction, though still not common, should be understood and Contact Email : [email protected]
practiced. Contact No.: 011-41722123

REFERENCES 33rd ANNUAL CONFERENCE ISDR-2020
Date : 9th - 11th October-2020
1. Dietschi D, Duc O, Krejci I, Sadan A. Biomechanical considerations for the Venue : The Leela Ambience New Delhi
restoration of endodontically treated teeth: a systematic review of the Contact Email : [email protected]
literature, part II (evaluation of fatigue behavior, interfaces, and in vivo studies) Contact No.: 9811955553
Quintessence Int. 2008; 39: 117–129.
EXPODENT INTERNATIONAL-2020
2. Rocca GT, Krejci I. Crown and post-free adhesive restorations for endodontically Date : 25th - 27th December-2020
treated posterior teeth: from direct composite to endocrowns. Eur J Esthet Venue : Pragati Maidan New Delhi
Dent. 2013; 8: 156–179. Contact Email : [email protected]
Contact No.: 011-41722123
3. Pissis P. Fabrication of a metal-free ceramic restoration utilizing the monobloc
technique. Pract Periodontics Aesthet Dent. 1995; 7: 83–94. 39TH IDS-2021 COLOGNE
Date: 9th -13th March 2021
4. Bindl A, Mörmann WH. Clinical evaluation of adhesively placed Cerec endo- Venue: Cologne, Germany
crowns after 2 years--preliminary results. J Adhes Dent. 1999; 1:255–265. Contact No.: +49 221 821-0
Website: http://english.ids-cologne.de
5. Chang CY, Kuo JS, Lin YS, Chang YH. Fracture resistance and failure modes of
CEREC endo-crowns and conventional post and core-supported CEREC crowns.
J Dent Sci 2009; 4(3): 110–7. 10.1016/S1991-7902(09)60016-7

6. Dietschi D, Duc O, Krejci I, Sadan A. Biomechanical considerations for the
restoration of endodontically treated teeth: a systematic review of the
literature, Part II (Evaluation of fatigue behavior, interfaces, and in vivo studies).
Quintessence Int 2008. February; 39(2): 117–29.

More References are available on request

24 |GUIDENT    Your Guide on the path of Dentistry

PedodonticsMay2020
Pedodontics

A REVIEW OF A MUCOCELE OF A LOWER LIP IN A
PEDIATRIC PATIENT; EXCISION WITH A DIODE LASER AND

HISTOPATHOLOGICAL EVALUATION:
CASE REPORT WITH A ONE YEAR FOLLOW UP

Dr. Dhaval P. Pandya Dr. Kanir H. Bhatia Dr. Kanir Bhatia Dental Clinic,
1, Jain Vihar, Swastik Society, Near Mithibai College, Juhu,
Private Practice Private Practice
Mumbai-400056

INTRODUCTION A mucocele is a well circumscribed painless swelling within
the oral cavity. They rarely resolve on their own and surgical
Mucoceles are common non neoplastic minor salivary gland neoplasms removal under local anaesthesia is required in most cases.
characterised clinically by a singular or multiple, spherical, fluctuant and well Various treatment approaches are described in the
circumscribed nodules which are generally asymptomatic (Anastassov et al, literature. The objective of this article is to review and report
2000; Gatti et al, 2001). They may also be called ‘sialocele “ or ‘ptyalocele’. It a case of a mucocele involving the lower lip of a six year old
affects both genders1 with peak incidence among children and young adults.1,2,3 boy which was excised using a diode laser and examined for
histopathological analysis with a follow up of one year.
Mucoceles are defined as as pooling of mucin in a cyctic cavity. It may be Key words:  Mucocele; pediatric;diode laser; histopathology
formed because of trauma to the excretory duct of the salivary glands.
Two types of mucoceles are recognised; A) Retention type; in which the CASE DESCRIPTION AND RESULTS
mucin pooling is confined within a dilated excretory duct or a cyst and B)
Extravasation type; in which mucin is spilled into the connective tissues from A six year old, healthy, Indian male patient presented with his parents at our
a ruptured or traumatised salivary gland duct.4 private dental office at Mumbai, India with a complaint of of asymptomatic
swelling in the labial mucosa of his lower lip. (Fig 1 Pre op view) No significant
Congenital mucoceles may be formed by congenital atresia of the salivary medical history or known allergies were reported. Clinical examination
duct or by trauma of the infants oral tissues during pregnancy or at birth (intra revealed a one by one cm, transluscent, painless, fluid filled swelling on
uterine finger sucking, passage through the delivery channel or use of forceps lower lip. The mother reported that the swelling started about two weeks
during delivery, newborn manipulation by attending nurses and doctors (Gatti prior to the day of clinical examination at the dental office. They denied any
et al 2001; Yagne – Garcia et al, 2009; Granholm et al, 2009). The provisional previous trauma or habit of lip biting. Treatment options were discussed
diagnosis of mucocele is made from the clinical history, clinical presentation and with the parents before the procedure appointment scheduled and risks and
palpation whereas the definitive diagnosis is made by histopathology.5 Different advantages of conventional and diode laser assisted excision were discussed.
treatment options for treating mucoceles of the oral cavity include needle It was decided by the parents to use the diode laser assisted excision method
aspiration (Silva et al, 2004), cryosurgery, surgical excision, marsupialisation and the procedure appointment was scheduled accordingly.
(Anastassov et al, 2000, Cataldo and Mosadomi, 2002), micro marsupialisation
(Delbem, 2000), laser ablation (Kopp and St – Hilaire, 2004; Frame, 1985;
Pogrel et al 1990; Huang et al 2007). There have also been few reported cases
of spontaneous resolution of these lesions (Granholm et al, 2009; Jinbu et al,
2003; Silva et al, 2004). We report a pediatric case of mucocele in a six year old
boy whose lesion on the lower lip was excised using a diode laser and sent for
histopathological examination.

| Your Guide on the path of Dentistry   GUIDENT 25

PePoeddodoonntitciscs May 2020

Post operative care instructions involved requesting the parents to avoid hot,
spicy and hard crusty food for their child for a day and to rinse with normal
saline mouthwash two to three times a day for the following one week.
The patient was advised to avoid everting his lip and not to bite the lips.
Telephonic follow up the next day followed by in office follow up at two
weeks and four weeks and one year follow up (Fig. 3) showed no signs of
recurrence and uneventful healing over the lower lip.

Figure 1: Pre op pic Figure 3: One year follow up clinical pic

At the time of the procedure, infiltration anesthesia locally around the At the follow up visits, minimal post operative discomfort and pain was noted
periphery of the lesion, was given with lidocaine 2% with 1: 100000 and no recurrence of the lesion was observed with good secondary healing
epinephrine. Following the manufacturers instructions, the fibre tip of the of the wound margins.
diode laser handpiece (SOL soft tissue diode laser; Den-mat holdings, Ca;
USA) was moved across a piece of articulating paper with the unit set to The diode laser devices has advantages such as relatively small size, portable
one watt, to accomplish the initiation of the fibre to become a useful thermal and lower cost that attract the dental practitioners for use in various surgical
contact device. Working wavelength of the beam is 808 nm wavelength 2) indications in comparison to other laser equipment.
Energy (Power setting 1.2 Watts) 3) Continuous wavelength (CW)mode used
with intermittent cooling of the site 4) Diameter of the tip used is 400 µm

The patient, operating dentist and the assistant all wore laser safety eye
glasses. A tissue holding forcep was used to grasp the lesion and the laser
assisted excision was carried out by having the laser incision parallel to the
long axis of the lesion. (Fig 2) This was done to ensure minimal damage to
the adjacent tissue.

Figure 2: Immediate post op pic after laser excision HISTOPATHOLOGICAL REPORT

Intermittently, water cooling with water moistened gauze was used to control Microscopic examination revealed sections of soft tissue with keratized
the tissue temperature and to remove tissue debris and char adhering to the stratified epithelium with mixed inflammatory infiltrate, congested blood
hot fibre tip of the laser handpiece. High speed air suction was employed vesslsand mucous glands. No mitotic activity or nuclear atypia was noted.
over the treatment site. There was no bleeding reported during or after the No evidence of any specific granulomatous pathology was noted. The
procedure and the wound was left to heal with secondary intention. No histopathology diagnosis confirmed the initial diagnosis of mucocele.
antibiotics were prescribed. The excised lesion was placed in sterile water (Histopathology views 1 and 2)
container for about two minutes and were then stored in 10 % formalin
labelled container with the patient details and sent sent for histopathological
examination to the oral pathologist.

Mucocele histopath view 1 Mucocele histopath view 2

26 |GUIDENT    Your Guide on the path of Dentistry

PedodonticsMay2020
Pedodontics

Histopath view 3 examination of laser excised tissue shows improved epithelization and less
inflammation. Intact basement membrane and connective tissue matrix can
DISCUSSION be observed. Matrix proteins initiate reparative synthesis on these tissues.
Resistance of matrix proteins against laser application and replacement as
The incidence of mucoceles in the general population is 0.4 % to 0.8 %.6 As well as removal of residual matrix is responsible for reduced scarring and
regards its location, the lower lip is the frequently affected location followed contraction. Thus the use of this modality is a good treatment alternative to
by the cheek mucosa and the floor of the mouth. treat such lesions in the pediatric age group.

The principle etiology of a mucocele is mechanical trauma, causing the CONCLUSIONS
rupture of a salivary gland duct and consequent mucus extravasation with the
surrounding tissue. A second mechanism for mucus accumulation is obstruction Mucoceles are benign lesions which are primarily diagnosed as a clinical
or narrowing of the salivary duct walls causing ductal expansion.7 Differential finding followed by definitive diagnosis based on histopathological report.
diagnosis includes fibroma, lipoma, sialolith and a salivary gland neoplasm.
In children it may also include vascular malformation like hemangiomas and Diode laser excision of a mucocele in a pediatric lower lip is an effective
varices. An early surgical intervention provides a prompt and satisfactory clinical procedure. Minimal post operative discomfort and healing by
resolution of the problem as it may interfere with speech, mastication and secondary intention is seen in patients treated with diode laser excision with
esthetics. The semiconductor diode laser used in this case achieved excellent no recurrence observed at follow up visits.
hemostasis due to good affinity to pigments like hemoglobin.8 The advantages
of laser application are relatively bloodless surgery, minimal swelling, scarring ACKNOWLEDGEMENT AND CONFLICT OF INTERESTS
and coagulation, no need for suturing, reduction in surgical time and less or
no post surgical pain. Also, the laser instantly disinfects the surgical wound as The author reports no conflict of interest related to this manuscript and
well as allowing a noncontact type of operative procedure and therefore no would like to thank Dr. Bhavin Patel (N.K.Patel and Sons, Mumbai, India) for
mechanical trauma to the tissue. The choice to intervene with a dental laser providing valuable assistance with the diode laser unit.
was considered with the above advantages and to enhance cooperation in a
six year old young patient with the dental team and reduce the anxiety of the REFERENCES
patient and his family related to profuse bleeding associated with the excision
of the lesion on the lip with a surgical blade and also the suturing associated 1. Baur mash,H.D. Mucoceles and ranulas. J Oral Maxillofac Surg:2003,61;369-
for closure of the wound especially with no removal of sutures required with 378. [cross ref] [pubmed]
a dental laser procedure in follow up visit.
2. Rececconi D;Achilli A;Tarozzi M;Lodi G;Demarosi F;Sardella A;Carrasi A:
The diode laser devices has advantages such as relatively small size, portable Mucoceles of the oral cavity:A large case series (1994-2008) and a literature
and lower cost that attract the dental practitioners for use in various surgical review: Med.Oral.Pathol.Oral.Cir.Bucal 2010,15;e551-e556.[cross ref] [pubmed]
indications in comparison to other laser equipment.
3. Cataldo E, Mosadomi A:Mucoceles of the oral mucous membrane:Arch
Absorption of laser energy into target tissue releases heat by photothermal Otolaryngol: 1970;91;360 – 365. [cross ref] [pubmed]
process which causes further intra and extra cellular explosion and tissue
ablation. Adjacent lateral tissues will also absorb heat on laser application. This 4. Lester D R, Thompson M D: Mucoceles: Retention and Extravasation types: Ear
will occur in concentric serial circles around the homogenous target tissue. Nose Throat J: 2013 Mar; 92(3): 106- 108.
Reversible or irreversible damage of areas surrounding the target tissue by
thermal effects of laser results in zone of coagulation necrosis. Histological 5. Tran T A, Parlette H L: Surgical pearl: Removal of a large labial mucocele
J Am Acad Dermatol 1999;40:760 – 762. [cross ref] [pubmed]

6. Navya L.V, sabari C, Seema C: J Scientific Dent, 6 (2),2016; p30 – 35.

7. Jata-Ali, C CarrillC Bonet: Oral mucocele: Review of the literature: J Clin Exp
Dent 2010;(2)(1):e18-21.[cross ref] [pubmed]

8. G.Agarwal, A.Mehra, A.Agarwal:Laser vapourization of extravasation mucocele
of the lower lip using 940nmdiode laser: Ind J Dent Res Vol 24;No 2;pg 278:
2013 [cross ref] [pubmed]

9. E.Azma and N.Safavi:J laser Med Sci Vol 4 no 4;pg 206-211;2013

| Your Guide on the path of Dentistry   GUIDENT 27

OralSurgeryOral Surgery May 2020

CONSERVATIVE TREATMENT OPTIONS IN
ORAL SUBMUCOUS FIBROSIS

A Review

Department of Oral & Maxillofacial Surgery
PMS College of Dental Sciences and Research, Trivandrum

Dr. Surej Kumar LK Dr. Nikhil M Kurien Dr. Georgie P Zachariah

Professor & HOD Professor Junior Resident

INTRODUCTION Oral submucous fibrosis (OSMF) is a potentially malignant
disease or condition that results in progressive
Oral Submucous Fibrosis, which is a relatively unknown disease in the early intraepithelial & juxta fibrosis of the oral soft tissues, and
60s, is now widely regarded as a precancerous condition.1 Oral submucous an eventual inability to open the mouth. The treatment
fibrosis (OSMF) is a potentially malignant disease that results in progressive of oral submucous fibrosis ranges from pharmacological
juxta-epithelial fibrosis of the oral soft tissues, mainly occurring in the Indian means like iron, multivitamins including lycopene, spirulina,
subcontinent. It is a chronic, insidious, disabling disease involving oral pentoxifylline, local submucosal injections of steroids,
mucosa, the oropharynx, and rarely, the larynx. OSMF results in an increasing hyaluronidase and chylomicrons, an aqueous extract of
loss of tissue mobility marked rigidity, and an eventual inability to open the healthy human placenta, and surgical excision of the fibrous
mouth.2,3 The most commonly involved site is buccal mucosa, followed by tissues/bands.
palate, retromolar region, faucial pillars, and pharynx.1 The etiopathogenesis
of OSMF is complex and not fully understood. The principal agent involved in It is very unlikley that the patients will undertake extensive and scrupulous
the etiopathogenesis of OSMF is areca nut. Areca nut is made up of alkaloid oral hygeine measures, because of pain, trismus, and mucosal irritation,
and flavonoid components. Four alkaloids, namely arecoline, arecaidine, thereby predisposing to wound infection.
guvacine, and guvacoline, have been identified in areca nut, of which arecoline
is the most potent agent and plays a significant role in the pathogenesis DRUG TREATMENT
of OSMF by causing an abnormal increase in collagen production.4 The
compounds of tobacco products may act synergistically in the pathogenesis Corticosteroids
of oral mucosal lesions in areca quid chewers.4 Many treatment protocols Corticosteroids are immunosuppressive agents that are believed to decrease
for oral submucous fibrosis have been proposed to alleviate the signs and inflammation and collagen formation, thereby reducing the symptoms and
symptoms of the disorder. The patient is advised to quit the habit of betel resulting in increased mouth opening. Corticosteroids such as hydrocortisone,
nut chewing thoroughly. The treatment options of oral submucous fibrosis triamcinolone, dexamethasone, and betamethasone have been used in the
is rare, which includes iron, multivitamins including lycopene, pentoxifylline, treatment of OSMF. Steroids suppress inflammatory reactions, thereby
local submucosal injections of steroids, chylomicrons and hyaluronidase, an preventing fibrosis by decreasing fibroblastic proliferation and deposition of
aqueous extract of healthy human placenta, and surgical excision of the collagen.
fibrous bands. OSF is adeptly recognized as a potentially malignant disorder.5,6

SURGICAL MANAGEMENT

In OSMF, there is atrophy of the mucosa and collagen deposition beneath
the basement membrane. There is a decrease in ground substance, cellular
elements, and vascularity with increasing fibrosis.7. Hence a deleterious effect
on wound healing after dentoalveolar surgery is to be expected.

28 |GUIDENT    Your Guide on the path of Dentistry

Oral SurgeryMay 2020
Oral Surgery

A study by Borle RM et al.8 studied three hundred twenty-six patients with compared, mouth opening and burning sensation was found to be statistically
oral submucous fibrosis with conventional submucosal injections of steroids very highly significant in favor of the spirulina group. Spirulina can bring
and hyaluronidase; and another group with a conventional therapy topical about symptomatic improvements in OSMF patients and can be put to use as
vitamin A, steroid applications, and oral iron preparations. The results were adjuvant therapy in the inceptive management of OSMF patients.
compared. The conventional treatment with injections was found to be
hazardous, whereas the conservative treatment was found to be safe. Peripheral vasodilators

Another study by Ameer NT et al.9 evaluated the effect of intralesional Vasodilators like pentoxifylline have vasodilating properties, and hampered
triamcinolone in OSMF by giving biweekly submucosal injections of 40 mg mucosal vascularity in OSMF could be increased by the use of pentoxifylline.
triamcinolone for 12 weeks and followed up for a period of 1 year. The effect Pentoxifylline suppresses leucocyte function and alters fibroblast physiology
of therapy was evaluated subjectively by improvement in symptoms and and stimulates fibrinolysis. In one study, the effect of pentoxifylline was
objectively by an increase in mouth opening. studied on the clinical and pathologic course of OSMF. This investigation
was conducted as a randomized clinical trial incorporating a control
Enzymes group (Standard drug group SDG, multivitamin, and local heat therapy) in
comparison to pentoxifylline test cases (Experimental drug group EDG, 400mg
Enzymes such as collagenase, hyaluronidase, and chymotrypsin are being 3 times daily, as coated, sustained release tablets). The authors concluded
used for the treatment of OSMF. Hyaluronidase by breaking down hyaluronic that pentoxifylline could be used as an adjunct therapy in the management
acid (the ground substance in connective tissue) lowers the viscosity of of oral submucous fibrosis17. In another study, Pentoxifylline 400mg for a
inter¬cellular cement substance. Better results are observed concerning period of 7 months, showed an improvement in total signs and symptoms of
trismus and fibrosis. Patients receiving hyaluronidase alone showed a faster OSMF. No significant side effects were observed.18 Oral isoxsuprine, as well
improvement in the burning sensation and painful ulceration produced by the as dexamethasone with hyaluronidase injections combined to physiotherapy,
effects of local by-products, although a combination of dexamethasone and showed improvement in oral submucous fibrosis. Oral isoxsuprine may be a
hyaluronidase gave better long-term results than other regimens.10 more effective treatment modality used in the management of OSMF.19

Chymotrypsin hydrolyzes ester and peptide bonds and thus can be useful Other drugs
as a proteolytic and anti-inflammatory agent in the treatment of oral
submucous fibrosis.11 Another enzyme of interest is collagenase, a lysosomal Drugs like interferon-gamma (IFN-gamma) is a known anti-fibrotic cytokine.
enzyme capable of degrading collagen. Intralesional injections of collagenases In a study by Haque MF et al18 intralesional IFN-gamma treatment showed
markedly improved mouth opening and at the same time, reduced the improvement in the patients mouth opening from an inter-incisal distance
hypersensitivity to spices, sour-tasting foods, cold, and heat12. before treatment of 21 +/- 7 mm, to 30 +/- 7 mm immediately after
treatment and 30 +/- 8 mm 6-months later, giving a net gain of 8 +/- 4 mm
In another study by Singh et al., no statistically significant difference in sign (42%) (range 4-15 mm). In this study, patients also reported reduced burning
and symptom was seen in OSMF patients between hydrocortisone acetate dysesthesia and increased the suppleness of the buccal mucosa.
and hyaluronidase versus triamcinolone acetonide and hyaluronidase13. The
treatment regimen of group B was more convenient to the patients because Apart from the above therapies, immunized cow’s milk has shown promising
less number of visits required and cheap. No side effects were evident. The results in OSMF.20 The milk from cows immunized with human intestinal
authors concluded that hyaluronidase is much swifter in ameliorating painful bacteria contains an anti-in-flammatory component that suppresses the
ulceration and burning sensation than dexamethasone, but the effect is short inflammatory reaction and modulates cytokine production in OSMF.
term, although its combination with steroids gives somewhat better longer-
term results. Ayurvedic therapy

Vitamins and minerals Turmeric, as a spice and household remedy, has been known to be safe
for centuries. Turmeric oil is proved to be effective in OSMF21 The anti-
Vitamins, micronutrients, and minerals are useful in controlling the burning inflammatory, antioxidant, and antifibrotic properties of curcumin interfere
sensation and ulceration in OSMF. In one study, OSMF patients received with the progression of OSMF at multiple stages in the pathogenesis of this
supplementation of vitamins and minerals for one to three years. Significant complex disease22 The antioxidative and scavenger properties of curcumin,
improvement in symptoms, like intolerance to spicy food, burning sensation, making it a beneficial chemopreventive agent in the prevention of cancer.
and mouth opening was observed at exit.14 Vitamins A, B, C, D, E, and Tea, when used in combination with vitamins, with its antioxidant property,
minerals like copper, iron, and magnesium stabilize and deactivate the can bring about an improvement in mouth opening in OSMF.
free radicals before they attack cells. In a study by Kumar A et al.15, oral
lycopene therapy showed improvement in the signs and symptoms of OSMF. CONCLUSION
In a study by Shetty P et al.16, the efficacy of spirulina as an antioxidant
adjuvant to corticosteroid injections in the management of 40 OSMF subjects Management of OSMF should include counseling of patients along with
of south Karnataka and north Kerala was evaluated. Syptomatic clinical lycopene/spirulina/ multivitamin /minerals in the initial stages. Moderate
improvements in mouth opening were significant in the posttreatment period stages of OSMF should be treated with intralesional steroids or pentoxifylline,
in both Spirulina and placebo groups. The two groups showed a statistically whereas advanced stages may be treated surgically.
significant reduction in a burning sensation. However, when both groups are

| Your Guide on the path of Dentistry   GUIDENT 29

OralSurgeryOral Surgery May 2020

FUTURE RESEARCH OPPORTUNITIES 14. Maher R, Aga P, Johnson NW, Sankaranarayanan R, Warnakulasuriya
S. Evaluation of multiple micronutrient supplementation in the management
Epigenetic networks are increasingly considered to be essential elements in of oral submucous fibrosis in Karachi, Pakistan. Nutrition and Cancer.
many human diseases and this is likely to include oral submucous fibrosis.23 1997 Jan; 27(1):41–7.

Research on the role of epigenetic changes in the development of oral 15. Kumar A, Bagewadi A, Keluskar V, Singh M. Efficacy of lycopene in the
submucous fibrosis has just started to emerge. Epigenetic mechanisms management of oral submucous fibrosis. Oral Surgery, Oral Medicine, Oral
have become significant contributors to our knowledge of the pathogenesis Pathology, Oral Radiology, and Endodontology. 2007 Feb; 103(2):207–13.
of many human diseases. As these alterations are frequent and reversible,
they have become attractive candidates for the development of disease 16. Shetty P, Shenai P, Chatra L, Rao P. Efficacy of spirulina as an antioxidant
biomarkers and as targets of modern and emerging therapeutics in several adjuvant to corticosteroid injection in the management of oral submucous
human cancers. Given the understanding of epigenetics and combining the fibrosis. Indian J Dent Res. 2013; 24(3):347.
knowledge of genetic alterations, the focus of future research should be early
diagnosis and the development of therapeutic strategies targeting epigenetic 17. Rajendran R, Rani V, Shaikh S. Pentoxifylline therapy : A new adjunct in the
mechanisms. treatment of oral submucous fibrosis. Indian J Dent Res. 2006; 17(4):190.

REFERENCES 18. Mehrotra R, Singh HP, Gupta SC, Singh M, Jain S. Pentoxifylline therapy
in the management of oral submucous fibrosis. Asian Pac J Cancer Prev.
1. Paissat DK. Oral submucous fibrosis. International Journal of Oral Surgery. 2011; 12(4):971–4.
1981 Oct; 10(5): 307–12.
19. Bhadage CJ, Umarji HR, Shah K, Välimaa H. Vasodilator isoxsuprine
2. Warnakulasuriya S, Johnson NewellW, Van Der Waal I. Nomenclature alleviates symptoms of oral submucous fibrosis. Clin Oral Invest.
and classification of potentially malignant disorders of the oral mucosa: 2013 Jun; 17(5):1375–82.
Potentially malignant disorders. Journal of Oral Pathology & Medicine.
2007 Jul 26; 36(10): 575–80. 20. Haque MF, Meghji S, Nazir R, Harris M. Interferon-gamma (IFN-gamma) may
reverse oral submucous fibrosis. J Oral Pathol Med. 2001 Jan; 30(1):12–21.
3. Aziz SR. Oral submucous fibrosis: an unusual disease. J N J Dent Assoc.
1997; 68(2): 17–9. 21. Tai YS, Liu BY, Wang JT, Sun A, Kwan HW, Chiang CP. Oral administration of
milk from cows immunized with human intestinal bacteria leads to significant
4. Chang Y-C, Hu C-C, Tseng T-H, Tai K-W, Lii C-K, Chou M-Y. Synergistic effects of improvements in symptoms and signs in patients with oral submucous fibrosis.
nicotine on arecoline-induced cytotoxicity in human buccal mucosal fibroblasts. J Oral Pathol Med. 2001 Nov; 30(10):618–25.
J Oral Pathol Med. 2001 Sep; 30(8): 458–64.
22. Joshi J, Ghaisas S, Vaidya A, Vaidya R, Kamat DV, Bhagwat AN, et al. Early
5. Zain RBte, Ikeda N, Gupta PC, Warnakulasuriya S, Wyk CW, Shrestha P, et al. human safety study of turmeric oil (Curcuma longa oil) administered orally in
Oral mucosal lesions associated with betel quid, areca nut and tobacco chewing healthy volunteers. J Assoc Physicians India. 2003 Nov; 51:1055–60.
habits: consensus from a workshop held in Kuala Lumpur, Malaysia, November
25-27, 1996. Journal of Oral Pathology & Medicine. 2007 Feb 27; 28 (1):1–4. 23. Xu C, Zhao J, Loo WTY, Hao L, Wang M, Cheung MNB, et al. Correlation of
epigenetic change and identification of risk factors for oral submucous fibrosis.
6. Meghji S, Warnakulasuriya S. Oral submucous fibrosis: An expert symposium. JBM. 2012; 27(4):314–21.
Oral Diseases. 2008 Jun 28;3(4):276–276.

7. Canniff JP, Harvey W, Harris M. Oral submucous fibrosis: its pathogenesis and
management. Br Dent J. 1986 Jun; 160(12): 429–34.

8. Borle RM, Borle SR. Management of oral submucous fibrosis: A conservative
approach. Journal of Oral and Maxillofacial Surgery. 1991 Aug;49(8):788–91.

9. Ameer NT, Shukla RK. A cross-sectional study of oral submucous fibrosis in
central India and the effect of local triamcinolone therapy. Indian J Otolaryngol
Head Neck Surg. 2012 Sep; 64(3): 240–3.

10. Kakar PK, Puri RK, Venkatachalam VP. Oral Submucous Fibrosis—treatment
with hyalase. J Laryngol Otol. 1985 Jan; 99(1): 57–60.

11. Passi D, Bhanot P, Kacker D, Chahal D, Atri M, Panwar Y. Oral submucous
fibrosis: Newer proposed classification with critical updates in pathogenesis and
management strategies. Natl J Maxillofac Surg. 2017 Dec; 8(2): 89–94.

12. Lin H-J, Lin J-C. Treatment of oral submucous fibrosis by collagenase: effects
on oral opening and eating function. Oral Diseases. 2007 Jul; 13(4): 407–13.

13. Singh M, Niranjan HS, Mehrotra R, Sharma D, Gupta SC. Efficacy of
hydrocortisone acetate/hyaluronidase vs. triamcinolone acetonide/
hyaluronidase in the treatment of oral submucous fibrosis. Indian J Med Res.
2010 May; 131:665–9.

30 |GUIDENT    Your Guide on the path of Dentistry

ResearchMay2020
Research

A STEP TOWARDS PRIMORDIAL PREVENTION OF TOBACCO
USE AMONG SCHOOL CHILDREN

Dr. Hegde Vijaya K Dr. Pooja J Shetty Dr. Nair Meera V Department of Public Health Dentistry
A. J. Institute of Dental Sciences, Kuntikhana
Professor & Head Reader Intern
Mangalor, 75004, Karnataka, India

INTRODUCTION Objective: To assess the effectiveness of tobacco control programme
among the 8th Standard students attending the Schools of Mangalore city,
Tobacco use is the single most preventable cause of death in the world today. India.
Approximately 5.4 million people die in the world every year due to tobacco Basic Research Design: Interventional Study
related diseases. More than 80% of these deaths occur in the developing Study setting: Schools of Mangalore, India
countries.1 Prevention of tobacco use is necessary for primordial prevention of Participants: School children
tobacco related morbidity and mortality. Primordial prevention means action Interventions: Tobacco Control Interventions like awareness programme
taken to prevent the emergence of risk factors in populations. It promotes on ill effects of tobacco and tobacco control laws for school children
healthier lifestyles among people.2 and teachers.
Main outcome measures: Knowledge and Attitude regarding tobacco
As per Global Youth Tobacco Survey (GYTS) 2009, 14.6% of the 13-15 pre and post-intervention.
year old school going children used tobacco in any form.3 A large number Results: In the present study the mean age of the participants was 12.86
of children are exposed to second hand smoke.1 In India the average age years and among them 61.6% were males. The study results show that there
of initiation of tobacco use is 17.8 years. Children form the important focus was an improvement in the knowledge of participants post intervention.
groups for effective primordial prevention strategies as this is the period when Pre-intervention only 63.5% knew that both smoked and smokeless forms
lifestyle habits are formed.2 of tobacco were harmful to health while post-intervention it improved to
79.5%. Among the participants 80.3% of them knew that tobacco use can
Schools form a logical setting for health promotion and population based cause oral cancer and post-intervention 90.5% of them knew about it. There
primordial prevention for tobacco control.2,4 They reach out to a large number was a change in attitude post-intervention. The number of participants
of children and through them reach out to the school staff, families and the with an attitude to smoke, if a friend offered a cigarette decreased to
community as a whole. Health promotion during the most influential part of 2.3% as compared to 8.4% pre-intervention. Pre-intervention 26.3% felt
a child’s life can lead to sustainable habits and attitudes during adulthood.4 that smoking cigarettes makes people feel more comfortable at parties or
This population based approach would be primordial prevention for non users gatherings, while post-intervention 64.8% felt that it does not make them
of tobacco which can bring about a behavior modification at the population feel comfortable.
level. The overall aim is to sensitize the young to the issue of tobacco use. For Conclusion:  There was an improvement in the knowledge and awareness
a long term impact it is necessary to direct health promotion strategies for students attending the Schools of Mangalore City after implementing the
prevention of tobacco use at the population level which should be augmented tobacco control training programme.
by high risk approach for tobacco cessation.2 Keywords: Schools; Students; Tobacco; Knowledge; Attitude;
Key message:  Health promotion programs about the ill effects of tobacco
Awareness programs in Schools will help the youth and the adolescents to at schools will reach out to a large number of people at an influential age
acquire the knowledge, attitude and skills that are required to make informed which might enable them to develop sustainable healthy lifestyles.
choices and decisions and understand the consequences of tobacco use. It will
empower students to contribute to the creation of tobacco-free environment
in which they can learn and live. It is important to sensitize children at an early
age and prevent the occurrence of this habit among the youth. School based

| Your Guide on the path of Dentistry   GUIDENT 31

ReRseseeaarcrhch May 2020

tobacco control program is a key component of National Tobacco Control RESULTS
Programme.5 Schools has the potential to reach out to a large number of
children repeatedly at an age when they are tempted to experiment with In the present study the mean age of the participants was 12.86 years and
tobacco.1 among them 61.6% were males and 38.4% were females.

More than 80% of adult smokers begin smoking before 18 years of age.6 To Table 1 shows the knowledge of participants about ill effects of tobacco pre
combat this significant public health problem we need to redouble the efforts. and post intervention. The study results shows that there was an improvement
Interventions directed towards reducing tobacco use among the youth are a in the knowledge of participants post intervention. Pre-intervention only
critical component of these strategies.7 63.5% knew that both smoked and smokeless forms of tobacco were harmful
to health while post-intervention it improved to 79.5%. Pre-intervention only
Children can be crusaders against tobacco. Tobacco prevention programs 33.6% knew that there were more than 4000 harmful chemicals in tobacco
which are school based have been considered to be quite effective in reducing smoke, while it was known to 87.7% post-intervention. Only 44.6% of them
use of tobacco among adolescents. Such interventions have been shown to knew that passive smoking is hazardous to the health of others, while post
improve the knowledge about ill effects of tobacco, bring about a change in intervention it was known to 51.4% of them. Among the participants 80.3%
attitude about use of tobacco and in turn reduce tobacco use intentions and of them knew that tobacco use can cause oral cancer and post-intervention
practices.8 90.5% of them knew about it.

Hence this study was conducted to assess the effectiveness of tobacco Table 1: Table showing knowledge about tobacco and its ill effects pre
control programme among the 8th Standard students attending the Schools and post-intervention among the participants
of Mangalore city, India to enable us to suggest possible plan of actions or
strategies to improve their knowledge and attitude regarding tobacco control. Knowledge about ill effects of tobacco Pre Intervention Post Intervention
80.7%
METHODOLOGY Tobacco was introduced to India by 15.7% 79.5%
Portuguese traders 87.7%
A school based interventional program was conducted to assess the 51.3%
effectiveness of tobacco control programme among the 8th Standard Both smoked and smokeless forms of 63.5% 54%
students attending the Schools of Mangalore city, India. Ethical clearance
was obtained from the Institutional Ethical committee. tobacco are equally harmful 61.1%
51.9%
Permission to conduct the intervention was obtained from the concerned There are more than 4000 chemicals in 33.6% 53.9%
authorities. Among the High Schools, 6 schools which gave permission were tobacco smoke 68.4%
included in the study. Informed consent was obtained from the parents and 51.9%
assent from the participants before the start of the study. A total of 359 Tobacco smoke contains atleast 69 12.9% 38.1%
students participated in the study. 47.4%
carcinogens
A close ended pre-tested questionnaire was used to assess the impact of 51.4%
the intervention on knowledge and attitude regarding tobacco among the Nicotine is the chemical in tobacco which 40.1% 41.3%
participants. is present in insecticides and causes 91.1%
90.5%
The Tobacco control Intervention was categorized as follows addiction

a. Anti-tobacco awareness program to school children using Audio-Visual aids Within 8 seconds of inhaling it nicotine 52.8%
and role plays. The program provided the following information on tobacco: reaches the brain
History of tobacco, its various forms, chemicals in tobacco, statistics related to
tobacco use, reasons for starting the habit, effects of tobacco on health, second Tar in tobacco leaves stains on teeth, 16.4%
hand smoke and its effects, Tobacco control laws, Role of students in tobacco
control. lungs and fingers

b. An awareness program on Tobacco control laws to teachers Ammonia used in cleaning toilet bowls is 36.4%
found in tobacco
c. Banners regarding Tobacco control laws pertaining to School campuses were
distributed Maximum number of Oral cancer cases in 63.7%

d. Students were motivated to pledge against the use of tobacco the world are found in India

The intervention was conducted for a period of four months. Towards the COTPA section 6a is prohibition on sale of 34.6%
end of the intervention, inter-school competitions were conducted among the tobacco products to and by minors
participating schools. This further enforced the students on issues related to
tobacco. COTPA section 4 is prohibition of 18.1%
smoking in public places
Statistical Analysis:  Data was coded, entered and analyzed using SPSS
version16. Descriptive data was obtained. COTPA section 6b is prohibition on 17.6%
sale of Cigarette and other tobacco
products around a radius of 100 yards of
educational institutions

Passive smoking is hazardous to the 44.6%
health of others

Smoking does not relieve stress and does 37.2%
not lower blood pressure

Tobacco use affects heart and lungs 86.2%

Use of tobacco can cause oral cancer 80.3%

Table 2 shows the attitude about tobacco use among the participants pre
and post intervention. There was a change in attitude post-intervention.

32 |GUIDENT    Your Guide on the path of Dentistry

ResearchMay2020
Research

The number of participants with an attitude to smoke, if a friend offered et al. (2011) 11.2% of the school children aged 11-19 years in Noida used
a cigarette decreased to 2.3% as compared to 8.4% pre-intervention. Pre- tobacco in some form.9 In a study done by Philip et al. (2013) in Kerala among
intervention 26.3% felt that smoking cigarettes makes people feel more students aged 13-17 years, the prevalence of tobacco use was 9.85%.6 The
comfortable at parties or gatherings, while post-intervention 64.8% felt lower prevalence of tobacco use in the present study may be attributed
that it does not make them feel comfortable. Among the participants 10.1% to the lower self reporting of tobacco use by the students, since it was a
of them said that they might use tobacco when they grow up, while post- questionnaire study.
intervention only 2.6% said that they will use tobacco when they grow up.
According to the Global Youth Tobacco Survey (2009) in India two thirds of
Table 2: Table showing attitude about tobacco use pre and post- the students think smoke from others is harmful to them.3 In the present
intervention among the participants study 44.6% believed that passive smoking was injurious to health before
intervention while it improved to 51.4% after intervention.
Pre- Intervention Post-Intervention
In the present study there was an improvement in the knowledge and a
Attitude about tobacco use Yes No Yes No more favorable attitude after providing the intervention similar to the study
conducted by Tahlil et al. (2013) and Stigler et al.(2011) where there was
If one of your best friends 8.4% 91.6% 2.3% 97.7% an improvement in the awareness about ill effects of tobacco.8,10 The results
of the study are similar to that of the study by Sorensen G et al. (2012)
offered you a cigarette, would where a significant improvement in the knowledge about tobacco and related
legislation was seen after a school based tobacco control program was
you smoke it? conducted.7

Do you think people who smoke 37.2% 38.1% 32.1% 47% The limitation of this study was that convenience sampling was used to select
the schools. Since it was a short term study the long term impact of the
cigarettes have more or less program on the knowledge, attitude and practices were not evaluated. The
effect of the educational intervention on tobacco use could not be evaluated.
friends? Tobacco use by the students could have been under reported since it was
a questionnaire based assessment and no biochemical parameter was used
Does smoking cigarettes help 26.3% 51.7% 20.3% 64.8% to confirm the same. Inspite of these limitations an improvement in the
knowledge and a change in attitude was observed after the school based
people feel more comfortable at interventional program. Hence more such school based tobacco control
programmes should be conducted, its long term impacts should be evaluated.
celebrations, parties, or in other An attempt should also be made to incorporate tobacco control activities into
the school curriculum.
social gatherings?

Do you think smoking cigarettes 19.8% 56% 14.1% 66.3%

makes people look more

attractive?

Do you think cigarette smoking 82.3% 17.7% 18.5% 81.5%

is harmful to your health?

I might use tobacco when I 10.1% 89.9% 2.6% 97.5

grow up

DISCUSSION CONCLUSION

School based interventions can be an integral part of primordial prevention. There was an improvement in the knowledge and awareness of 8th Standard
Easy accessibility, peer and family influences, low price have been the students attending the Schools of Mangalore City after implementing the
important factors contributing to the use of tobacco among school children. tobacco control training programme. More such school based programs
Strategies to reduce tobacco use can be integrated to general health should be conducted and the long term impacts of such interventions should
promotion in schools. This will strengthen their capacity and improve the be assessed.
health of the students, the staff, the families and the community.5
RECOMMENDATIONS
The WHO global school health initiative aims to encourage health promoting
schools.5 Health education is one of the important component of health The impact of the school based intervention program in the long term is a
promotion and school based tobacco prevention programs are considered to major concern. Hence “Booster” programs should be conducted at regular
be an effective strategy for tobacco control.5,8 School based activities can intervals to enhance the retention of the interventional effects.
have a lasting effect not only on them, but also on the later generations.
A multi-pronged intervention involving the families, teachers and peers should
In the present study, the mean age of the study subjects was found to be be conducted which will enable to reinforce tobacco prevention strategies.
12.86 years. Only eighth standard students were included in this study. This
is similar to the study done by Tahlil et al to evaluate the impact of education ACKNOWLEDGEMENT
programs on smoking prevention where only 7th and 8th grade students
were included.8 We acknowledge ICMR for funding the study. We are grateful to the study
participants and the school authorities for their co-operation throughout the study.
In the present study 6.6% of the students reported to having used tobacco We also acknowledge all our friends who were a part of the role play.
in some form. According to the Global Youth Tobacco Survey (2009) in India
14.6% of the youth aged 13-15 years use tobacco.3 In a study done by Narain

References are available on Request

| Your Guide on the path of Dentistry   GUIDENT 33

GeGneneerraal l May 2020

AGGRANDIZE ORAL HEALTH CARE SYSTEM
A NEED OF AN HOUR!

1Dr. Jyotsna Seth 2Dr. Anubha Agarwal 3Dr. Himanshu Aeran 1,3Department of Prosthodontics

Reader Asst. Professor Director Principal, Professor & Head 1,3Seema Dental College & Hospital, Rishikesh, Uttarakhand, India
2Hospital Adminstration, All India Institute of Medical Sciences,
INTRODUCTION Rishikesh, Uttarakhand, India

Dental diseases are a significant public health burden in India as well as noted in India.4 Burden of oral diseases in our country is also increasing because
across the globe. It is fundamental and universal right of all citizens of India to of fast growing population, rapid westernization and lack of resources.5
health which needs to be respected and realized within a definite time frame.1
Nowthese days, as dental surgeonry is advancing in many ways but still it is Oral Health Promotion Barriers
access is dream to many, especially the rural population. In India, oral health is
not identified as a priority by policy makers nor by public.2 The situation is quiet The current concept of ‘access to dental care’ has changed completely
ironic where in India number of Dental Colleges and graduating dental surgeons nowthese days. Now, concept not only includes the adequacy of workforce
exceeds that of various developed countries, only 10% of dental surgeon serve which should be patient based but now the access to dental care services are
the rural population who constitutes around more than 68% of the population.3 being perceived as both the availability of care and willingness of the patient
There are various reasons for burden of oral diseases increasing like fast to seek care. Now, the connotation of access has changed to supply-demand
growing population, rapid westernization and lack of resources. consideration.6,7 India as being the developing country there are various
barriers which come across oral health promotion which are as follows:
Method of Literature Search
1. Workforce in Oral Health Care: According to survey, the number of 1,17825
Literature search for the current article was done both electronically and working dental surgeons in country8 but there is no improvement in the
manually. Electronic search was conducted using databases like PubMed, accessibility of oral health care services in rural population. Lack of perceived
Medline, and so on extracting relevant articles published in peer-reviewed oral health need and non-availability of dental health services to the rural areas
journals. Various web-based search engines like Goggle Scholar were also used are the main two reasons for this.
to find appropriate manuscripts. Various key words and their combinations were
used for literature search like oral health policy, rural India, dental surgeonry 2. Expenditure in Oral Health Care: Oral health care services are not being
in developing countries, dental policies. The present review emphasized on considered as life threatening except oral cancer along with this the treatment
various aspects of dental oral health care system in rural population. of these dental diseases are quiet expensive and time consuming. Budget
allocation in India the situation is quiet devastating as the budget allocated to
Oral Health Burden in India and reasons for increasing health is merely 2% and in which there is no separate budget for oral health.9

Oral problems are major emerging concern in Indian population. Oral problems 3. Affecting daily lives: Nearly 26% of Indian population is below poverty line
cause pain, agony, any functional, aesthetic problems and also leads to loss which works on daily wages so spending time or loss of working hours for
of working man hours. Oral precancers and cancers are emerging as a major dental treatment can stop them from working for one full day which may lead
threat to younger people and are increasing to alarming proportion in India. to situation where they can not arrange for their food and daily needs for their
There are drastic changes in dental sector and increase in dental workforce whole family.10
in India during the study period, opening of private dental sectors, it is logical
to believe that oral disease burden during the period should be reduced but 4. Geriatric Oral Health: With the advancement in health and medical field
on other hand, the explosion of population, particularly increase in geriatric person life expectancy has increased. Thus, in India as being developing country
population as well as disproportionate dental workforce distribution, is being two-third of population is elderly. So, policies are required including oral health
services serve as age processes.11 Govt. of India has to ensure that elderly
individual should receive affordable and quality oral health care services.

5. Children Oral Health: As geriatric dental surgeonry is to be focussed in same
way, children oral health care services have to improve. Dental caries is the
most common dental disease among children and even affects children socially
as well as psychologically. Such dental treatment can be expensive directly or

34 |GUIDENT    Your Guide on the path of Dentistry

GeneralMay2020
General

indirectly. Directly can be the charges and indirectly factors can be the time 7. Mobile Vans and Mobile Dental clinics should be more used as maximum
spent by child parents to take their kids to dental surgeons.12,13 population is in rural areas which are deprived from basic dental health care
6. Addressing Quackery: As in Medical field the policy makers have given importance facilities and can reach to door step.
to stop giving quackery training in there health care facilities but in dental surgeonry
this field is still to be focussed.14 The main motto of such quackery is in order to 8. Contributing more in community oral health programmes. All the privatized as
make money, or to maintain position of power in the society. well government institutions should contributes maximum in community health
7. Providing Dental services except traditional clinics: As about 80% of dental programmes.
surgeons work in urban areas and according to data available in rural India, one
dental surgeon is serving near about 250,000 population.15 CONCLUSION

Awareness through Denture Camps in remote areas It is clear from above data that our developing country India needs more strong
policies regarding oral health care services. Government and Dental Council of
Conducting Free Denture Camps in remote areas India is surely putting efforts to improve on this but still the bigger steps have to
be taken. The effort should not be put by any single organization this has to be
Measures can be taken to Improve Dental Health Care cumulative effort by various private as well government organizations. Preventive,
curative and educational health care programs are the need of an hour.
1. Improving condition of National Oral Health Policy which should integrate with
the general policy. REFERENCES

2. Promotion of Geriatric dental surgeonry in dental undergraduate and post 1. Sarojini N, Amit Sengupta. Realizing the right to health care a policy brief. Jan
graduate curriculum. Swasthya Abhiyan, 2014.

3. As Geriatric Dental surgeonry is to be promoted same like the Paediatric dental 2. Chandrashekhar Janakiram, Rajeev B Rudrappa, Farheen Taha, Venkatachalam
surgeonry has to be promoted because if oral disease can be diagnosed at the Ramanarayanan, Harikiran G Akalgud, Sushi Kadanakuppe. Equity in oral health
initial stage major oral diseases can be prevented at later stages as well as the care in India. A review on health system analysis. Economic and Political Weekly
monetary loss will be less as the disease will be treated at initial stage. 2017; 52(9): 83-89.

4. Public Health System or policies related to dental and general health care 3. Ashish K. Jaiswal, Pachava Srinivas, Sanikommu Suresh. Dental manpower in
services has to be strengthened. India: Changing trends since 1920. International Dental Journal 2014; 64(4): 213-8.

5. Government should be more focussed on training quackery in dental surgeonry 4. Balaji SM, Mathur VP. Dental practice, education and research in India. Oral
and implement methods to stop this and provide some means of earning to such health inequalities and health systems in Asia-Pacific Natl India 2017; [doi:
persons for which actually they are doing this. 10.1038/nindia. 2017.28]

6. As in completion of medical courses there is field training of graduate trainees 5. Tendon S. Challenges to the oral health work force in India. J Dent Educ 2004;
in the villages or rural areas to serve the population same like in Dental the 68:28-33.
trainees should be posted in such rural areas for certain amount of time by
which such population should have better dental health care facilities. 6. Sankalp Yadav, Gautam Rawal. The current status of dental graduates in India.
Pan African Medical Journal 2016; 23:22.

7. Albert H. Guay. Access to dental care solving the problem for underserved
populations. Journal of American Dental Association 2004; 135(11):1599-1605.

8. Sudhakar Vundavalli. Dental manpower planning in India: current scenario and future
projections for the year 2020. International Dental Journal 2014; 64(2): 62-67.

9. Parkash H, Shah N. National Oral Health Care Programme: Implementation
Strategies. New Delhi: National Oral Health Care Programme, Govt. of India; 2001.

10. Singh A, Purohit BM. Targeting poor health: Improving oral health for the poor
and the underserved. Int AffGlob Strategy 2012; 3:1-6

11. Singh A, Purohit BM. Addressing geriatric oral health concerns through national
oral health policy in India. Int J Health Policy Manag 2015; 4: 39-42.

12. Sheiham A. Oral health, general health and quality of life. Bull World Health
Organ 2005; 83: 644.

13. Sheihman A. Dental caries affects body weight, growth and quality of life in
pre-school children. Br Dent J 2006; 201: 625-6.

14. Sandesh N, Mohapatra AK. Street Dental surgeonry: Time to tackle quackery.
Indian J Dent Res 2009; 20: 1-2.

15. Ahuja KN, Parmar R. Demographics and current scenario with respect to dental
surgeons, dental institutions and dental practices in India. Indian J Dent Sci
2011; 3: 8-11.

| Your Guide on the path of Dentistry   GUIDENT 35

GeGneneerraal l May 2020

RECENT ADVANCES IN PREVENTIVE DENTISTRY

Department of Public Health Dentistry
K. D. Dental College & Hospital, P.O. Chhatikara, Mathura

Dr. Sunil K Chaudhary Dr. Navpreet Kaur Dr. Manish Bhalla

P.G. Student Professor & Head Reader

INTRODUCTION MODEL OF ANTIMICROBIAL PEPTIDES.
(a) Barrel-stave model, (b) Carpet model and (c) Toroidal model
Prevention of health is not an altruist concept. It is mankind’s primary hope
for improving health. Prevention is currently receiving much attention but B. Probiotics
the germ of the concept is far from new. Thus, the tradition of stressing In caries, there is an increase in acidogenic and acidtolerating species such
prevention through diet and modification of lifestyle has a long history. This as mutans streptococci and lactobacilli, although other bacteria with similar
review provides a perspective of the impact of research and development on properties can also be found like Bifidobacteria, nonmutans streptococci,
the prevention of oral disease especially dental caries, periodontal disease and Actinomyces spp., Propionibacterium spp., Veillonella spp. and Atopobium
oral cancer. It navigates through significant advances in oral health and new spp. Use of probiotics and molecular genetics to replace and displace
scientific approaches to prevention, and summarizes the key challenges and cariogenic bacteria with noncariogenic bacteria has shown promising results.4
opportunities in bringing new oral health measures into practice.1
C.  Chemoprophylactic agents
RECENT ADVANCES IN DENTAL CARIES PREVENTION Chemoprophylactic agents that are used in dental caries prevention include
classical antibiotics such as penicillin and vancomycin; cationic agents such as
1. Antibacterial and Antimicrobial Agents chlorhexidine and cetylpyridinium chloride; plant derived compounds such as
sanguinaria extract; anionic agents such as sodium dodecyl sulphate (SDS);
A  Antimicrobial peptides and non-ionic agents such as triclosan.

Antimicrobial peptides (AMPs) are a wide-ranging class of host-defense Chlorhexidine is one of the most tested compounds and its anti-plaque
molecules that act early to contest against microbial invasion and challenge. properties are wellknown. In a supragingival biofilm model, chlorhexidine was
These are small cationic peptides that play an important in the development shown to inhibit bacterial growth and biofilm formation.
of innate immunity. In the oral cavity, the AMPs are produced by the salivary
glands and the oral epithelium and serve defensive purposes.2 Triclosan is the most commonly used and most potent example of the
chlorinated diphenyl ether class of antibacterial compounds. Several large
The serious problems caused by drug resistant bacteria have created an clinical trials have shown that toothpastes containing triclosan and zinc citrate
urgent need for the development of alternative therapeutics. In this respect, significantly reduced plaque and gingival scores.
AMPs are considered as promising antimicrobial agents for producing new
generation antibiotics. Additionally, atomic level structures of AMPs are 2. Caries Vaccines
prerequisite information for the generation of improved peptide antibiotic
candidates. Although there are several obstacles to be overcome for clinical Another line of defense in human body that can be utilized against S. mutans
applications, natural and synthetic AMP’s are still attractive sources to the colonization is the specific antibody production from adaptive immunity.
pharmaceutical companies. In order to facilitate commercial development of
peptide antibiotics, it is reasonable to focus on small peptides. Successful
generation of short antimicrobial peptide molecules includes the Histatins,
Human Lactoferrin 1-11, Cathelicidins (LL37), (CKPV)2, P-113, and LKW
peptides. In terms of production cost, the use of those peptides would be
advantageous in the pharmaceutical field.3

36 |GUIDENT    Your Guide on the path of Dentistry

GeneralMay2020
General

Immune defense in dental caries is mediated mainly by secretory IgA (sIgA) Recently, new fluoridated foams, gels, varnishes, rinses, fluoridated
antibodies present in saliva and generated by the mucosal immune system. prophylaxis paste and restorative materials have been introduced in the
Mucosal immunization with S. mutans antigens at inductive sites, including market, which are presented in table.8
gut-associated lymphoid tissue (GALT) and nasopharynx-associated lymphoid
tissue (NALT), results in the migration of antigen-specific IgA-producing B 4. Sugar substitutes
cells to effector organs, such as the salivary glands. This is followed by the
differentiation and maturation of these B cells and the secretion of IgA in the Non-cariogenic sugar substitutes are widely used in medications, foods and
lamina propria, where it crosses the effector tissue ducts into the saliva.5 confectionery, including gum, candy and drinks. Such substitutes include
The technique of active and passive Immunization to conflict with the sorbitol, xylitol, saccharin, aspartame, sucralose and acesulfame K. The
pathogenesis of S.mutans in oral hole holds guarantee. Caries immunization, use of these sugar substitutes may have contributed in a limited way to
if effectively tried on people, could be a profitable immunomodulation when the decline in the prevalence of dental caries in industrialized countries. In
contrasted with different caries preventive measures.6 recent years, the potential of using specific non-cariogenic sugar substitutes
in drinks and chewing gum, in order to promote remineralization of initial
3. Fluorides caries lesions, has been investigated. The anticariogenic effect of the sugar
substitutes themselves has yet to be supported by evidenced-based data.
WHO Approach For 21st Century - In the second half of the 20th century However, enhancement of salivary flow when using chewing gum may have
the focus shifted to the development and evaluation of fluoride toothpastes a caries-preventive effect.9
and rinses and, to a lesser extent, alternatives to water fluoridation such as
salt and milk fluoridation.7 Table 2 is to evaluate the content xylitol in dental care and food products
available on the Polish market and their significance in caries prevention.10
Table 1- Types of Fluoride Products available in Market

| Your Guide on the path of Dentistry   GUIDENT 37

GeGneneerraal l May 2020

Table 2- Non cariogenic sugar available in market.

38 |GUIDENT    Your Guide on the path of Dentistry

GeneralMay2020
General

5. Ozone b. Optical Coherence Tomography
Optical Coherence Tomography (OCT) was introduced as a biomedical
The curative and disinfecting effect of ozone “heal ozone” are used in dental imaging modality in biological systems in 1991 by Huang et al. This non-
care as a new mode of therapy for dental caries. invasive imaging technique, based on low coherence interferometry, utilizes
coherent near infrared light. OCT is capable of obtaining images with a high
Diagnodent: Diagnodent operates by means of laser light. The light is resolution (5-15 μm) and penetration depth of 1-2 mm. Moreover, real time
passed via an optical fibre to the area of decay. The decayed area fluoresces 3-D tomographic images of the tissue can be provided.
and this fluorescence passes back to the probe and the decay is displayed and c. Endoscopic capillaroscopy for periodontal pocket
indicated both visibly and audibly.
microcirculation Imaging
Non cavitated pit and fissure caries: The lesions are first cleaned using Fiberscopes are flexible endoscopes that use fiber optics to inspect remote
prophylactic paste [prophyflex from kavo] before diagnodent and healozone inaccessible internal structures. Optical fibers are flexible and transparent
application. This thoroughly cleans the surface, removing all extraneous fibers that are formed of thin strands of glass or plastic. They can transmit
plaque, calculus and extrinsic stain which will make the Diagnodent reading light over longer distances and at higher bandwidths than metal wire cables.
more reliable as well as allowing the ozone to penetrate the lesion more In addition, optical fiber technology showed lower signal loss and less
predictable. Ozone application of the caries lesion for 40 seconds. electromagnetic interference in comparison to metal wires.
d. Photoacoustic imaging
Use of fissure sealants in combination with ozone treatment: Sealants Photoacoustic (PA) imaging is a hybrid biomedical imaging technology that
are recommended to be placed over the remineralized pit and fissure lesion combines the high contrast of optical imaging with the high resolution of
with early dentinal involvement usually at the 4 week recall visit. Ozone can ultrasound imaging.
be used to maintain or replace sealants and used in combination with sealant. e. Magnetic Resonance Imaging
MRI is a non-invasive tool for soft tissue diagnosis, without ionizing radiation.
6. Pit and fissure sealant MRI scanners apply a magnetic field that spins the hydrogen nuclei in water
molecules in the body. MRI machines pulse a radiofrequency (RF) that allows
These include glass ionomer sealants or resin‑based sealants containing nuclear spins to resonate in the strong static magnetic field.13
fluoride or Amorphous Calcium Phosphate (ACP). The caries‑preventive effect
of glass ionomer materials is due to their ability to release fluoride. These 2. Culture
materials are of very limited value as caries‑preventive material because of There are several systems that can be used to create an anaerobic atmosphere
the low retention rate. Fluoride‑containing resin‑based sealants (Embrace for cultivation of oral microbes. These include biobags, use of pre-reduced
WetBond™) with their higher retention rates are preferred to prevent caries. anaerobically sterilized (PRAS) media, anaerobic chambers and anaerobic jars
Newer technologies such as resin‑based sealant containing ACP have been that are used with a combination of basal and selective media for the isolation
recently introduced. ACP exhibits its remineralizing potential by increasing of periodontal pathogens. Among the aforementioned systems, anaerobic
calcium and phosphate ions within the carious lesion,especially in acidic chambers and jars are most commonly used. A combination of novel and
environment, to levels that exceed those existing in surrounding oral fluids, traditional culture techniques offers great promise in isolation and subsequent
thus leading to supersaturation and formation of apatite.11 domestication of oral bacteria. These efforts will go a long way in closing the
gap between microorganisms that could be cultivated in culture and those
RECENT ADVANCES IN PERIODONTAL DISEASES PREVENTION present in the oral cavity but as yet not cultivated. The additional knowledge
gained by using these newer isolation methods would hopefully fill in the
Available information on periodontal diseases are numerous, ambiguous and lacunae about the microbial role in periodontal infections.14
for the most part highly specialised. Through the years most of the research
was focused on the microbiological aspects of the periodontitis. It has been Anaerobic jar for routine isolation of anaerobe in our lab with
noticed that bacteria alone are not sufficient for the initiation of periodontal supplemented blood agar used for cultivation of black pigmented colonies
diseases, although they play an important part in the process. Host response,
smoking, stress and other risk factors influence the appearance of the disease,
and the susceptibility to aggressive forms of periodontitis is genetically
determined. This knowledge brought significant changes to the concept of
etiology, prevention and the treatment of periodontal diseases.12

1. Periodontal pocket imaging technologies

a. P eriodontal pocket X-ray- based imaging using radio-opaque
contrast agents

Periapical and panoramic radiographs are commonly used for periodontitis
diagnosis to detect the presence and extent of alveolar bone loss. These
radiographs are 2-D images of 3-D objects. Thus, a periodontal bony defect
can be hidden by superimposition of teeth and the surrounding alveolar bone.

| Your Guide on the path of Dentistry   GUIDENT 39

GeGneneerraal l May 2020

Model of diffusion chamber used for bacterial isolation Gel electrophoresis

PCR is used for research purposes to determine the prevalence of herpes
simplex virus, human papillomavirus, HIV, human cytomegalovirus, and
Epstein-Barr virus Type I and II in the gingival crevicular fluid of the individuals
with various forms of periodontal disease.

Diagnostic tests such as the MicroDent® Test, ParoCheck® kits, MyPerioPath®
Test and oral DNA® using multiplex PCR scheme are commercially available
to evaluate the microbiota in subgingival plaque samples and they give crucial
information for a prevention strategy for healthy patients and treatment plans
for “at risk” patients.15

Minitrap device used in the oral cavity for enrichment and isolation
of oral bacteria.

3. Polymerase chain reaction

The PCR technique is a more accurate, sensitive, and rapid technique for the
detection, identification, and quantification of periodontal bacteria.

Q-PCR or real-time PCR with species-specific primers provide accurate
quantification of individual microbial species and total bacterial count in dental
plaque samples. This precise and sensitive method serves as a useful tool for
studies on etiology of periodontal diseases.

Thermocycler Ultraviolet transilluminator

40 |GUIDENT    Your Guide on the path of Dentistry 4. Genetic analysis
Genetics of both humans and pathogens and the genetic interaction between
them are involved in both Periodontics and Medicine. There is increasing
awareness of the destructive processes involved in periodontitis which are
host-derived.

Prognostic tests: Clinicians tend to view the application of prognostic
knowledge in the context of currently available therapeutic approaches, that
is, they are accustomed to treating periodontal disease after it has occurred
and try to predict whether there will be recurrent disease in the future. They

GeneralMay2020
General

could predict the initiation of disease before it occurs that ultimately will Application of enamel matrix proteins in the form of Emdogain has set a
be linked to knowledge of the environmental factors that could initiate the modern standard for periodontal regeneration therapy. Surgical periodontal
inappropriate activation of genes that are problematic. Such tests would also treatment of deep intrabony defects with EMD promotes periodontal
be useful if they could be used to predict the ultimate success of a variety regeneration. Surgical periodontal treatment of deep intrabony defects using
of therapies. EMD may lead to significantly greater improvements in clinical parameters
Diagnostic tests: The currently immutable genetic susceptibility profile for compared with open flap debridement alone. The effect of treatment with
an individual can be used to develop assays of the patient’s variable gene EMD is comparable with that for GTR and can be maintained over a 10-
expression profile at any given time. This would require identification of the year period. Application of EMD seems to provide better long-term results
baseline ‘activity’ of susceptibility genes in subjects with no disease and the than coronally repositioned flaps alone. Application of EMD may enhance
change in activity that occurs during and as a result of initiation or progression periodontal regeneration in mandibular class II furcations, comparable with
of disease. It is conceivable that, should such tests be administered at an that obtained using GTR.17
opportune time, subclinical disease could be detected and appropriate
environmental or genetic therapies could be administered. 6. Bisphosphonates
Gene therapy: It is a technology of introducing foreign genetic material into
a patient for correcting its genomic defect. Genetic surgeons can now go Bisphosphonates (BPs) are a class of drugs that prevent the loss of bone mass,
deep into the cells and fix those defective genes with a new scalpel-a virus. used to treat osteoporosis and similar diseases. These are nonbiodegradable
The inherent benefit of this therapy is to permanently cure the physiological analogs of pyrophosphate that have a high affinity for calcium phosphate
dysfunction by repairing the genetic defect.16 crystals and that inhibit osteoclast activity.
5. Enamel matrix derivatives
Therapeutic approaches to the treatment of periodontitis generally fall Role in periodontal therapy:
into two major categories, ie, those designed to halt the progression of
periodontal attachment loss, and those designed to regenerate or reconstruct Topically administered bisphosphonates have been reported to reduce
lost periodontal tissues. the resorption of root associated with orthodontic tooth movement and
alveolar bone resorption following periodontal surgery. BPs also reported to
Diagram depicting inflammation-modifying changes induced by enamel modulate cementoblast behavior in an in-vitro study through the regulation
matrix derivative. of gene expression, and thus has the potential for cementum formation and
mineralization modifiers.18

7. Local antimicrobial delivery systems

Various investigated nanoparticulate drug delivery systems in periodontal
disease therapy are as follows-

»» a. Nanoparticles

»» b. Nanogels

»» c. Nanocomposites

»» d.  Nanofibers-Poly-ε-caprolactone (PCL) nanofibers

The advancement of nanotechnology in dental science has brought tremendous
progress in periodontal disease therapy. The technology offers significant
promise in the disease’s early diagnosis even at molecular and cellular level,
thereby reduces the waiting time for results. It also plays important roles
in the prevention of the disease, through using nanoscale agents to repel
bacterial biofilms deposition and accumulation on the tooth surface, and by
remineralization and desensitization of abraded teeth.19

8. Photodynamic therapy

Photodynamic therapy (PDT) utilizes singlet oxygen and free radicals produced
by a light-activated photosensitizer to kill microbes. The photochemical
process is initiated by a low-power laser/light at a relevant wavelength to
excite the photosensitizer. The ground state photosensitizer absorbs light,
resulting in a singlet state that can lose energy by fluorescence or undergo
intersystem crossing to a triplet state with longevity.

Antimicrobial PDT

Photosensitizers in antimicrobial PDT (aPDT), such as porphyrins,
phthalocyanines, and phenothiazines (e.g., toluidine blue O and methylene

| Your Guide on the path of Dentistry   GUIDENT 41

GeGneneerraal l May 2020

blue), can target both Gram-positive and –negative bacteria by bearing a recognition, priming with DNA vectors followed by boosting with viral vector,
positive charge, suggesting that aPDT may be useful in oral applications, and utilization of immunomodulatory molecules.22
especially for periodontal treatment.20

MECHANISM OF PHOTODYNAMIC REACTION21 2. Tretinoin biofilm

aPDT has been confirmed to be effective as a non-antibiotic antimicrobial Tretinoin (13-Cis-retinoic acid) inhibits development of second primary tumors
therapy. Two main advantages are frequently cited for aPDT in comparison in patient with previous head and neck cancer.22 It induces remission of
with other periodontal treatments. In aPDT, a photosensitizer placed directly oral leukoplakia and prevents development of cancer in patient with oral
into the pocket can be activated via an optical fiber also placed directly in the leukoplakia. Reversing oral carcinogenesis before its becoming invasive
pocket, which helps to avoid damaging adjacent host tissue. Additionally, the disease is the promise of treatment. Topical application of a chemo preventive
effects of aPDT are initiated by exposure to a light source, thus preventing the agent can reduce the toxic effects associated with a systemic medication.
selection of resistant bacteria species importantly, the eradication of biofilms Oral leukoplakia and other visible mucosal changes (such as erythroplakia),
and inactivation of inflammatory cytokines by aPDT has proven to be both which are known to have a high risk of malignant transformation, provide a
effective and safe.20 good target for topical chemoprevention. Use of polymer mucosal adhesive
film (MAF) technique for oral cancer prevention has been shown to be safe
RECENT ADVANCES IN ORAL CANCER PREVENTION and effective for such chemoprevention.23

1. DNA vaccine CONCLUSION

DNA vaccination has emerged as an attractive immunotherapeutic approach The fields of medicine and oral medicine are changing and have come a long
against cancer due to its simplicity, stability, and safety. Results from way. There is still much to be done as far as patient management and accuracy
numerous clinical trials have demonstrated that DNA vaccines are well of diagnostic methods is concerned, which will enable the society as a whole
tolerated by patients and do not trigger major adverse effects. DNA vaccines to be more productive and healthier. Changes are inevitable, even in the
are also very cost effective and can be administered repeatedly for long- science foundational to the clinical practice of dentistry. Increased diversity
term protection. Despite all the practical advantages, DNA vaccines face and sophistication are developing in the areas of molecular biology, basic
challenges in inducing potent antigen specific cellular immune responses as science, and social sciences. These will transform our traditional approaches
a result of immune tolerance against endogenous self-antigens in tumors. to oral and dental disease management. The recent technological advances in
Strategies to enhance immunogenicity of DNA vaccines against self-antigens the field of oral medicine make an impact on clinical dental practice.24
have been investigated including encoding of xenogeneic versions of antigens,
fusion of antigens to molecules that activate T cells or trigger associative REFERENCES

1. Harsh Priya, Peter S Sequeira, Shashidhar Acharya, Meghashyam Bhat,
Bharathi Purohit, Manoj Kumar. Recent Trends in Preventive Dentistry - A
Review. Journal of Dental Sciences, 2011;2(3):232-237.

2. Zohaib Khurshid, Mustafa Naseem, Zeeshan Sheikh, Shariq Najeeb,Sana
Shahab, Muhammad Sohail Zafar. Oral antimicrobial peptides: Types and role in
the oral cavity. Saudi Pharmaceutical Journal, 2016;24:515–524.

3. Min-Duk Seo, Hyung-Sik Won, Ji-Hun Kim, Tsogbadrakh Mishig-Ochir and
Bong-Jin Lee. Antimicrobial Peptides for Therapeutic Applications:A Review.
Molecules, 2012;17:12276-12286.

4. Jagat Bhushan, Sanjay Chachra. Probiotics – Their Role in Prevention of Dental
Caries. Journal of Oral Health Community Dentistry, 2010;4(3):78-82

More References are available on Request

42 |GUIDENT    Your Guide on the path of Dentistry

GeneralMay2020
General

MANAGEMENT OF TOBACCO USE & DEPENDENCE-A DENTAL
PRACTITIONER’S PERSPECTIVE

1Dr. Tanmay Mittal 2Dr. (Maj) Richa Gupta 3Dr. Megha Mittal 1Department of Orthodontics & Dentofacial Orthopedics
ESIC Dental College & Hospital, Sector 15, Rohini, Delhi
Tutor Assistant Professor Senior Lecturer 2Department of Conservative Dentistry & Endodontics

Army Dental Centre (Research & Referral hospital), Dhaula Kuan
3Department of Oral & Maxilofacial Pathology
Himachal Institute of Dental Sciences
Paonta Sahib, Himachal Pradesh

Every year 31st may is celebrated globally as “WORLD NO TOBACCO DAY” to XXSMOKELESS TOBACCO- It mainly contains Betel Quid which consists of Betel
disclose the message of ill effects of tobacco consumption on health and to leaf, Areca nut, few drops of lime, some flavouring and sweetening agents.
raise awareness against oral cancer. This article will highlight the risk factor
for oral cancer in Indian population, as well as what is being done to educate TOBACCO AND GENERAL HEALTH
the public and to prevent or intervene early in oral cancer. NAGALAND sets Tobacco is tremendously harmful, no matter how it is being consumed. It has
up the “first tobacco- free village” in the country. enormous effect on health.

INTRODUCTION
In India, tobacco use is very common. Tobacco is known as major risk factor
for oral cancer. The age of initiation of tobacco use in India is 17 years,
high among rural areas and teenagers nowadays. India has high incidence of
oral cancer, about 40% of all cancers are associated with tobacco. Almost 1
million people die of oral cancer in India every year. Number of deaths may
shoot up to 1.2 million by 2035. Currently, people in the 30-69 age group
account for over two-third of cancer deaths in India, with less than a third of
the patients surviving more than 5 years after diagnosis.

TOBACCO – SINGLE GREATEST CAUSE OF PREVENTABLE
DEATH GLOBALLY
Tobacco is consumed in variety of different ways, varied from smoked
tobacco to smokeless tobacco. Use of tobacco, either by chewing or smoking
can lead to many chronic diseases including detrimental effects on oral cavity.
The harmful effects do not end with the tobacco users. Non-smokers are
affected by second hand smoke, also known as environmental tobacco smoke or
passive smoking, which is smoke from other people’s cigarettes. Non-smokers
are at risk of many health problems associated with smoking. It is potentially
dangerous for children causing increased risk of respiratory diseases, asthma,
sudden infant death syndrome (SIDS). In pregnant women, it will end up as still
birth babies with birth defects like cleft palate, club foot, heart diseases.

HARMFUL CHEMICALS- THE SECRETS THEY KEEP…

XXSMOKED TOBACCO- There is more than 4000 harmful chemicals like Nicotine,
Tar, Formaldehyde, Benzene, Carbon Monoxide and Hydrogen Cyanide in
tobacco smoke. Due to its high content of nicotine, tobacco becomes addictive.

| Your Guide on the path of Dentistry   GUIDENT 43

GeGneneerraal l May 2020

1. Cardiovascular diseases 2. Tooth abrasion and tooth discoloration

XX Stroke 3. Periodontitis
XXIschemic or Coronary Heart Disease There are 5 folds to 20 folds increase risk of periodontal disease in smokers.
XXCerebrovascular Diseases Risk of alveolar bone loss is 7 times greater in smokers than non-smokers.
XXAtherosclerotic Peripheral Vascular Disease Localized gingival recession and high rate of tooth loss is also major concern
in these cases.
2. Respiratory diseases
4. Altered taste and smell & oral halitosis
XXChronic obstructive Pulmonary Disease
XX Asthma 5. Oral mucosal changes
XX Tuberculosis Smoker’s palate, Smoker’s Melanosis, oral Candidiasis.

3. Other diseases Premalignant lesion
LEUKOPLAKIA- Most common form of potentially malignant disorder in
XXPeptic Ulcer oral cavity. The appearance may vary from uniformly white homogenous to
XX Diabetes speckled non-homogenous red and/or nodular lesions.
XX Cataract
XXAcute Myeloid Leukaemia ERYTHROPLAKIA- A red fiery patch which cannot be characterized clinically
XXRheumatoid Arthritis or pathologically any other definable disease.
XXInflammatory Bowel Disease
XXErectile Dysfunction ORAL SUBMUCUS FIBROSIS- It is debilitating, potential malignant oral
condition characterized by inflammation and progressive fibrosis of lamina
4. SKIN, NAILS, HAIRS propria and other deeper tissues resulting in stiffening of mucosa and reduced
mouth opening.
XXSkin Discoloration
XX Wrinkles 6. Oral cancer
XXPremature Ageing Tobacco use alone accounts for about 40% of all cancers in India. Oral Cancer
XXYellow Staining of Fingernails is usually found on the Lip, Floor of the mouth, the ventrolateral surface of the
tongue, gingiva, and oropharynx. In initial stages, it is asymptomatic generally
5. Smoking during pregnancy leads to reddish in appearance, may have granular or smooth surface, elevated or non
elevated with <1mm in size, with intact surface epithelium not ulcerated, no
XX Miscarriage/Abortion bleeding and no indurations.
XXStill Birth
XXPremature Delivery TREATMENT OPTIONS
XXEctopic Pregnancy
Fortunately, there are treatments that help people to counteract the disruptive
TOBACCO AND ORAL HEALTH effects of addiction. Several public health actions have been taken by WHO to
control tobacco related oral diseases.
1. Dental caries
TOBACCO CESSATION CLINICS is an initiative by the WHO and ministry of
Tobacco contains high amount of caries promoting sugar like sucrose, fructose health of India. There are total 18 tobacco cessation clinics in India. The
which enhance the growth of cariogenic bacteria on the root surface of teeth services offered at the clinic include behavioural counselling, medication,
adjacent to which tobacco is placed. nicotine replacement therapy. The centres also intend the awareness
among the general public through awareness programs, exhibitions, training
programs for professionals.

NATIONAL CANCER CONTROL PROGRAM is also an initiative by WHO to
control oral cancer. It is designed to improve the quality of life of cancer
patients through early diagnosis and treatment.

XXBEHAVIOURAL THERAPY includes multiple sessions of individual or group
counselling, providing them skills training and providing social support as part
of treatment.

XXNICOTINE REPLACEMENT THERAPIES includes nicotine gum, the transdermal
patch, nasal spray and inhaler. They are used to relieve withdrawal symptoms,

44 |GUIDENT    Your Guide on the path of Dentistry

GeneralMay2020
General

because they produce less severe physiological alterations than tobacco based Nicotine Gum For 1-24 cigarettes / 2mg gum (24 pieces /
systems, and generally provide users with lower overall nicotine levels than they
receive with tobacco. (Available in 2 mg and bidis per day day) For 12 weeks
4 mg dosage)
XXNON- NICOTINE THERAPIES includes Bupropion, an atypical antidepressant,
is the first, and, so far, the only non-nicotine treatment licensed for smoking For 25 cigarettes/ bidis 4mg gum (24 pieces /
cessation.
per day day) For 12 weeks
ROLE OF DENTAL PROFESSIONALS
Nicotine Patches 21mg /24 hours for 4
Dental professionals plays major role in diagnosing the chronic diseases and Nicotine Inhaler weeks then 15mg/24
guiding the patient about ill effects of tobacco abuse. Dentists play unique hours for 2 weeks then
role in identifying the particular symptoms and explaining the consequences 7mg / 24 hours for 2
to the patient associated with smoking and smokeless tobacco use. weeks

XXAssemble dental team to provide support to the tobacco cessation program and 6-16 cartridges/day for
to determine the plan of action. 6 months

XXAppoint a dentist or hygienist as team coordinator who will responsible for Nicotine Nasal Spray 1-2 doses / hour for 3
tracking band assessing the effectiveness of program for each patient. to 6 months

XXWork with hygienist to counsel patients concerning oral effects of tobacco use Nicotine Lozenge If patient smokes first 2 mg lozenge for 1-6
and benefits of quitting. cigarette more than 30 weeks (one lozenge q
minutes after waking 1-2 hr)
XXRefer patients to the free helpline, for free coaching and information about local
tobacco dependence treatment programs. If patient smokes first 4 mg lozenge for 7-12
cigarette within 30 weeks (one lozenge q
XXRecommend and prescribe nicotine replacement products; varenicline (Chantix); minutes of waking 4-8 hr)
bupropion (Zyban); or a combination of bupropion and nicotine replacement
medication. NON-NICOTINE REPLACEMENT THERAPY

The 5 A’s of tobacco cessation are used in patients: Bupropion 150mg OD for 3days followed by 150mg BD for 7 to
Varenicline 12 weeks
»» ASK about tobacco use - every patient/every visit.
Initially 0.5 mg once daily for the first three days,
»» ASSESS willingness to make a quit attempt. changes in 0.5 mg twice daily for the next four days
then increased to 1mg twice daily for 12 weeks.
»» ADVICE to quit tobacco use.
INITIATIVES TAKEN BY HEALTH MINISTRY OF INDIA SO FAR…
»» ASSIST in quit attempt – set a quit date, emphasize total abstinence,
prompt support seeking, Provide supplementary material and recommend XXHealth Ministry proposes fine of RS 1000 on smoking in public places, ban on
pharmacotherapy sale of loose cigarettes.

»» ARRANGE follow up XXIn September 2014, health ministry of India issued a statement making it
mandatory for cigarette manufacturing company to convey statutory warning
1. Behavioral interventions against smoking on both sides of cigarette pack with graphic depiction of throat
and mouth cancer & stating that it must covers at least 85% of packaging.
»» Brief Advice – This consists of Advice to stop using tobacco, usually taking
only a few minutes, given to all tobacco users, usually during the course of XXOn March 2016, the supreme court of India issued notice to the health ministry
a routine consultation or interaction. on a public interest litigation seeking the immediate enactment of plain
packaging rules for cigarette and other tobacco products. The SC offered that
»» Behavioral support – This involves support, other than medications, aimed colorful and attractive covers on tobacco products are more eyes catching and
at helping people stop their tobacco use. It can include all cessation attract more tobacco users.
assistance that imparts knowledge about tobacco use and quitting, provides
support and teaches skills and strategies for changing behavior. XXTobacco sale to minors punishable by law. The new act says that the punishment
for those selling tobacco products to minors is seven years in jail and fine.
2. Pharmacotherapy
XXAnti-tobacco advertisements in films, banners and campaigns.
NICOTINE REPLACEMENT THERAPY
XXLast year, Sri Ramakrishna institute of oncology and research, Coimbatore,
Nicotine Replacement Therapy (NRT) is a method of substituting the nicotine launched a mobile phone app called “Tobacco Cessation” and a helpline service
in tobacco products by an approved nicotine delivery product so that the to help people quit smoking.
tobacco user does not have uncomfortable withdrawal symptoms upon
stopping the tobacco product.

References are available on Request

| Your Guide on the path of Dentistry   GUIDENT 45

MediaReleaseMedia Release May 2020

DENTSPLY SIRONA CHAMPIONS FEMALE
LEADERSHIP IN DENTISTRY

In support of this year’s International Women’s Day theme, #EachforEqual, Dentsply 2019 ADEA International Women’s Leadership Conference
Sirona continues to promote gender equality in the dental industry and oral health
sector. Every year, the company sponsors a variety of programs and events dedicated Celebrating female leadership is an important pillar for the empowerment of women in the
to the career advancement and leadership of women in dentistry. This support dental industry. Dentsply Sirona co-sponsored the 6th International Women’s Leadership
ranges from hosting awards events, which honor visionary treatment solutions and Conference in Brescia, Italy, hosted by the American Dental Education Association
outstanding achievements in research, to providing networking opportunities and (ADEA). Promoting female leadership within the health sector, the conference brought
knowledge exchange through panel discussions and conferences. together 120 women from 23 countries to tell their stories and share knowledge.
Charlotte/Bensheim, March 9th, 2020. This year’s International Women’s Day theme
highlights the importance of gender equality as a catalyst for thriving economies and Women in Dentistry (WID) Breakfast
communities. Under the hashtag #EachforEqual, this year’s campaign emphasizes how
individual and collective efforts can contribute to empowering women in society. As the Dentsply Sirona co-sponsors the annual WID Breakfast hosted each year by the AEGIS
world’s largest manufacturer of professional dental products and technologies, Dentsply Dental Network and other industry partners. With 130 participants, the event aims
Sirona is committed to advancing women’s interests in the dental and oral health sector. to raise industry leaders’ awareness of women in dentistry, as well as highlight their
“We want to empower all women in dentistry by supporting their professional roles as speakers at conferences and other industry events. Initially focused on the
development and recognizing their outstanding achievements in research and laboratory side of the business, the breakfast has expanded over the years to include
development, entrepreneurship, mentorship, and education,” says Dr. Terri Dolan, women from all areas of dentistry and oral healthcare.
Chief Clinical Officer and Vice President at Dentsply Sirona. “As part of our mission,
we support several programs for the advancement of women dentists, hygienists, and Annual GNYDM Women Dentists´ Leadership Conference
technicians within the dental industry.” Examples of programs and events supported
by Dentsply Sirona in 2019 and 2020 follow. Dr. Terri Dolan, Vice President and Chief Clinical Officer at Dentsply Sirona, was invited
to speak at the 1st Women Dentists Leadership Conference at the Greater New York
Smart Integration Award Dental Meeting (GNYDM) on December 1, 2019. The meeting was created to empower
and mentor current and future women dentists. Dolan enjoys sharing her experience
The Smart Integration Award celebrates women’s expertise in dentistry by recognizing and inspiring career in dental research and education, having served as professor
their innovative ideas and successful and visionary treatment concepts that elevate and dean of the University of Florida College of Dentistry for more than a decade
networked treatment centers to the next level. In November 2019, the awards ceremony before joining Dentsply Sirona. Recognized for her advocacy of diversity and support
was hosted for the first time by Dentsply Sirona as part of the Company’s commitment for women in dentistry, she inspired conference attendees with her presentation on
to integrate women’s expertise more closely into the development of new products. In mentorship, leading by example and mentoring others. She had the opportunity to
total, 24 winners were honored for their creative ideas and impressive success stories share stories about the people who inspired and mentored her throughout her career.
that make work processes at treatment centers more efficient and convenient.
Leading by example: excellence in innovation and education
Women in Science Network Awards
In October 2019, Dolan’s outstanding accomplishments in clinical education were honored
Research and innovation are at the forefront of Dentsply Sirona’s purpose and mission with the Dr. Edward B. Shils Innovator Award for Excellence in Industry. As the leader of
to empower dental professionals all over the world to provide millions of patients with Dentsply Sirona’s Clinical Affairs team, Dolan is the driving force behind the conceptualization
better dental care and make people smile. Dentsply Sirona is proud to be the sponsor and implementation of the Company’s global clinical education program. In 2019, the program
of two International Association for Dental Research (IADR) Women in Science reached more than 470,000 dental professionals from 99 countries. The Clinical Affairs team
Awards. The Distinguished Female Mentor award recognizes female researchers who also focuses on the development of new products and solutions designed to empower dentists,
have made a significant impact on the careers of fellow female researchers through technicians and dental team members to provide the best possible care to their patients.
their role as a mentor. The Award for Distinguished Research recognizes female
scientists for outstanding accomplishments in oral, dental or craniofacial research.
Dentsply Sirona is honored in 2020 to sponsor these awards for a second year.

46 |GUIDENT    Your Guide on the path of Dentistry

4th CONFERENCE SCHEDULE FOR 4th IDLEC 2020

18th & 19th JULY 2020, EXPOCENTRE NOIDA SEC. 62 DELHI NCR

DAY-1: 18th JULY 2020 INAUGURATION: 09:30 AM TO 10:00 AM

Lecture/ Live Demo: Lecture/ Live Demo: Lecture/ Live Demo:
FINAL RESTORATION WITH BIO HPP 3D PRINTING DIGITAL THE BEST WAY FOR IMPLANT
ABUTMENT ON SINGLE IMPLANTS DENTURES & AESTHETIC REHABILTATION
IN IMMEDIATE LOADING WITH NEW WITH PF KEEP & LITHIUM YZR
GENERATION BIO COMPATIBLE MATERIALS. Speaker: Dr. Shiva Shankar Speaker: Dr. Francisco Cabrera
11:00 AM to 12:00 PM 12:00 PM to 13:00 PM
Speaker: Mr. MK Shrikanth CDT
10:00 am to 11:00 am Lecture/ Live Demo:
DIGITAL SMILE LINE DESIGN
LUNCH BREAK 13:00 PM TO 13:30 PM & MOCK-UP TECHNIQUE IN
DENTAL LABS
Lecture/ Live Demo: Lecture/ Live Demo: Lecture/ Live Demo: Speaker: Mr. Rahul Rajput CDT
OPTIC FIBER IN DENTURE EXCEED EXPECTATIONS – 3D BIOPRINTED SOLUTIONS FOR 17:30 PM to 18:30 PM
MAKING IPS E.MAX CRANIOMAXILLOFACIAL DEFECTS
PATIENT SPECIFIC IMPLANTS
Speaker: Mr. Balbir Singh CDT Speaker:
13:30 PM to 14:30 PM Speaker: Dr. Abdul Hameed
Mr. Mohit Suryavanshi, CDT 16:30 PM to 17:30 PM
14:30 PM to 16:30 PM

DAY-2: 19th JULY 2020 Lecture/ Live Demo: Lecture/ Live Demo:
HYBRID DENTURE CLEAR ALIGNER/ RETAINER/
Lecture/ Live Demo: WORKFLOW IN DENTAL ORTHO SPLINT & SURGICAL
SYNERGY OF TRINIA WITH LABS GUIDE IN DENTAL LABS
CERAMAGE Speaker: Dr. Abhay Lamba Speaker: Dr. Raj Maurya/
Speaker: Mr. Madan Soman CDT/ 11:00 AM to 12:00 Noon Dr. Pratap Saini
Dr. G. Srinivas 12:00 Noon to 13:00 PM
10:00 AM to 11:00 AM Lecture/ Live Demo:
PRECISION ATTACHMENTS Lecture/ Live Demo:
LUNCH BREAK 13:00 PM TO 13:30 PM IN DENTAL LABS ROLE OF COMPOSITES
Speaker: Mr. Emanuel Melinotti MDT IN DENTAL LABS
Lecture/ Live Demo: 15:30 Noon to 16:30 PM Speaker: Dr. Ankur Gupta
LIFELIKE APPEARANCE MADE 16:30 PM to 17:30 PM
EASY – SR NEXCO
Speaker: Mr. Sumit Mahapatra, CDT
13:30 PM to 15:30 PM

CLOSING CEREMONY: 17:30 PM

WORKSHOPS DAY 1 WORKSHOPS DAY 2 WORKSHOP 2:
CLEAR ALIGNER/RETAINER/
WORKSHOP 1: WORKSHOP 2: WORKSHOP 1: ORTHO SPLINT & SURGICAL
3D PRINTING DIGITAL OPTIC FIBER IN DENTURE SYNERGY OF TRINIA GUIDE IN DENTAL LABS
DENTURES MAKING WITH CERAMAGE

Trainer:  Dr. Shiva Shankar Trainer: Mr. Balbir Singh CDT Trainers: Mr. Madan Soman CDT Trainer: Dr. Raj Maurya/
19th July 2020, 13:30 PM to 15:30 PM Dr. Pratap Saini
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