importance of enamel deproteinization in clinical dentistry: a review

Acid-etching employs dental etchants and is used frequently when bonding dental restoration to teeth. By dissolving minerals in enamel, the etchants remove the outer 10 micrometers on the enamel surface and make a porous layer 5-50 micrometers deep. This roughens the enamel microscopically and results in a greater surface area on which to bond. Acid etching with H3PO4 is not achieved over the entire adhesion surface of the tooth. Sodium Hypochlorite solutions have been used as wound and endodontic irrigant as early as 1920 due to its bactericidal and proteolytic properties. Irrigation of the root canals with sodium hypochiorite solutions is now widely accepted. Removing the organic content from the enamel surface with 5.2% sodium hypochiorite [NaOCl] as a deproteinizing agent prior to phosphoric acid etching has shown promising effect in improving the enamel surface area. However no relevant work has been done in Pakistan, so study must be conducted locally to find out the effect of sodium hypochiorite as a deproteinizing agent before acid etching

Bidirectional relationship between chronic kidney disease and periodontal disease

Non communicable diseases [NCDs] affect the life of an individual in terms of mortality, morbidity and financial crises. Main NCDs are diabetes mellitus [DM], cardiovascular diseases [CVD], pulmonary diseases, osteoporosis and chronic kidney diseases [CKD]. About 40% of the total deaths can be controlled by eliminating the risk factors for NCDs. Periodontitis have recently been labeled as an important potential risk factor for NCDs. CKD affect the oral health status of patients by inducing gingival hyperplasia, xerostomia, calcification of root canals and delayed eruption of teeth. Periodontitis increases systemic inflammatory burden leading to worsening of CKD which in turn has been has been found to negatively affect CKD of patients on hemodialysis therapy by altering their serum albumin and C-reactive protein levels. As hypoalbuminemia leads to increased mortality in CKD patients, it needs to be avoided by reducing systemic inflammatory burden in patients receiving HD therapy. Treating periodontal disease could be one factor that might decrease the systemic inflammatory burden and thereby improve quality of life of these patients. Data from descriptive, cross sectional and longitudinal studies published between 2000 and 2012 were included. Data searches based on human studies only. The key words, periodontitis, chronic kidney disease and hemodialysis, on MEDLINE, approximately 120 studies were identified. 35 of them were relevant to all three keywords. Most of them were cross sectional studies and total 7 clinical trials were identified regarding checking of serum levels after periodontal therapy with variable results. Patients with CKD have higher prevalence of periodontal disease while non-surgical periodontal therapy has been indicated to decrease the systemic inflammatory burden in patients with CKD specially those undergoing HD therapy

Oral health status of the elderly in Lahore district of Pakistan

Poor oral health among old aged people is an important public health issue and a growing burden to countries worldwide. In Pakistan, there is paucity of data available regarding the oral health status of the elderly. This study was aimed to describe oral health status of the elderly in Lahore district, by assessing the dental disease prevalence in the 60+ age group. The current study was conducted in Lahore district. The results of the study are based on 470 valid examination proformas. The mean age of the total sample was 66.71+6.39 falling in the range of 60-91 years. Extra and intra oral examination were carried out. All clinical findings were recorded on the standard World Health Organization [WHO] oral health assessment form. Prevalence of periodontal disease as observed by Community Periodontal Index [CPI] was almost 70% in the study population. Calculus, most frequent findings, was observed in 28% subjects, shallow pocketing in 23.25% whereas deep pocketing was reported in 18.75%. Mean Decayed Missing Filled [DMF] score for the sample was 16.3 with females scoring higher than males. Missing component constituted 86.5% of the DMF score. 80% of the subjects did not wear any prosthesis, while almost 11.85% wore either a bridge or a partial denture or both; and another 8.5% wore a complete denture. Temporomandibular joint [TMJ] symptoms were reported by 11.25% of the subjects whereas TMJ clicking was the most common sign observed in 38%. TMJ tenderness and reduced jaw mobility was observed in 11.1% and 1.4% of the subjects respectively. Results of the current study clearly indicate poor oral health status of the elderly in the study population of Lahore. The level of unmet needs is very high hence; more attention needs to be given towards is improving and maintaining the oral health status of the elderly

Improving quality of life of diabetic patients through non-surgical periodontal treatment

Improving the periodontal health leads to better glycemic control in type 2 diabetic patients. [6,7] The study included known type II diabetic patients registered with the Diabetic Out Patient Department of Shaikh Zayed Hospital Lahore and Oral examinations were carried out in the Department of Oral Health Sciences of Shaikh Zayed Medical Institute. 61 subjects, 31 treatment group 30 control group. All the patients were non smokers with at least 14 teeth and showed wild to severe level of periodontal disease. Age ranged from 45-65 years. HbA1c values varied from 5-8%. No history of systemic antibiotic administration in the past 3 months. Subjects with any change in oral glycemic drug or its dose altered renal medication or any antibiotics were not included in the study. Treatment group showed a statistically and clinical significant improvement of 16.25% in HbA1c values. The periodontal therapy improves quality of life of diabetic person by improving glycemic control and decreasing the patients' dosage of oral glycemic drugs. In review of this advantage periodontal therapy should be made an integral part of the regime to improve glycemic control

Transmission of streptococcus mutans from mother to child

Dental caries is the most infectious and communicable dental disease of all age groups, which effects overall health of an individual. Childhood caries is a multifactorial dental disease and if left untreated it leads to discomfort, pain and lack of interest in routine activities and ultimately destroys tooth structure and early loss of tooth. Steptococcus mutans [S.mutans] is the main cariogenic microorganism. S.mutans breaks down sugar for energy and produces acidic environment, which causes demineralization of superficial structures of tooth i.e. enamel and dentin resulting in dental caries. It can be transmitted horizontally and vertically. According to the recent studies vertical mode of transmission is more common in preschool children than horizontal. Mainly the transferred genotypes are responsible for the transmission of caries from mothers to their children. There is genotypic diversity in population to population. No such relevant study has been conducted on local population so there is a need to know the main cariogenic genotypes ofS. mutans and its transmission from mothers to their children in local population

Mixed dentition space analysis: a review

During mixed dentition period discrepancy between spaces available and required in the arch is predicted so that teeth can erupt freely with good alignment. Mixed dentition space analysis is done for this purpose in which size ofunerupted canine andpremolars is predicted. Accurate prediction is very important regarding correct orthodontic diagnosis and treatment planning. Prediction equation and or tables based on size of already erupted permanent teeth are the most widely used methods. Tooth size varies in different racial and ethnic groups and among genders so prediction equation and tables specific to each population for both male and female must be made. Mandibular incisors; combination ofmandibular incisors and mandibular 1[st] molars; and mandibular incisors and maxillary 1[st] molars have been used worldwide. Recent studies have reported that mandibular incisors are not the best predictors and sum ofmandibular incisors and maxillary 1[st] molars are even more accurate predictor for the estimation of size of unerupted teeth. In Pakistani population combination of mandibular incisors and maxillary 1[st] molar have not been employed so study must be conducted to estimate which combination of group of teeth is more accurate for the estimation of size of unerupted canine and premolars in local population

Oral health attitudes, knowledge, and behavior amongst high and low socioeconomic school going children in Lahore, Pakistan

This study was carried out to evaluate the knowledge, attitude and behavior of low and high socioeconomic school going children and the type of food available and consumed at school premises, as well as the dental health care facilities available at schools. It was a multi-centric study which analysed school going children [n=281] from grade 1 to grade 10 who attended private schools of both high and low income groups in Lahore, Pakistan. A questionnaire adapted from Peterson and Stenberg et al designed to assess children's behavior, knowledge and perception of their oral health and dental treatment along with the availability of healthy food in the school was used. Results showed that 54% of HSES students bought food from cafeteria as compared to only 11% of LSES School. 41% LSES children's parents did not observe their child while brushing. 54% of LSES and 41% of HSES visited the dentist only in pain. 39% of HSES but only 12%of LSES went for regular checkups. Reason for not visiting the dentist among HSES students was fear of drilling [40.3%] and 9.3% in LSES. It was concluded that there was a dire need of health education programs especially for low socio economic school children. This study provides baseline information about children's knowledge, their attitudes and behavior towards eating habits, maintaining oral hygiene, seeking dental treatment of low socio economic and high socio economic school children in Lahore

Micro-organisms in recurrent aphthous stomatitis

Recurrent aphthous stomatitis is an inflammatory disease of oral mucosa with unknown etiology. Many factors contribute in the pathogenesis of aphthae including stress, trauma, foods, allergy, hormonal and microbial factors. It has been observed by Hoover CI [1986] that microorganisms are the causative factor in the pathogenesis of aphthous ulcer. This study was conducted with the aim to observe presence or absence of gram positive and gram negative microorganism in the smears of the lesions compared with the scraping of controls. An Analytical cross-sectional study. It was carried out in Dental Out Patient Department of Shaikh Zayed Federal Postgraduate Medical Institute, Lahore. For a period of Six months First 60 subjects with active RAS during last six months were recruited for the study. Age and gender matched 60 subjects without ulcer during last six months were selected on the same day as control group. After taking informed consent, smears from RAS patients and scrapings from matched surfaces of the oralmucosa of controls was taken. Gram +ve and Gram -ve cocci and bacilli were the microorganisms frequently found in the smears of RAS subjects and Gram +ve cocci were observed in the scrapings of Controls. Presence of microorganisms in ulcers suggested that there is superimposed bacterial infection in these lesions

Dental caries and diabetes mellitus

Diabetes Mellitus has been linked with increased incidence of dental caries. Aim of this study was to compare caries incidence between control group and diabetic patients and to assess whether there is any association between dental caries and salivary glucose level and salivary calcium levels. Study was conducted on 60 subjects; 30 control and 30 diabetics. DFT [Decayed Filled Teeth Score] was assessed for both the groups clinically. Then un-stimulated whole saliva samples from diabetics and control group were collected, stored and frozen at -20C. Saliva samples were then defrosted, centrifuged and their supernatant portion were analyzed by Dimension Clinical Chemistry System for Salivary glucose and calcium levels. SPSS 16.0 was used for statistical analysis. Results showed that DFT score was higher among the diabetic patients [2.49] when compared with the control group [0.53]. It was also concluded that salivary glucose levels were higher and salivary calcium levels were lower in the diabetic patients as compared to control group

Healing and regeneration of tissues following periodontal treatment in menopausal women

Association of osteoporosis with the onset and progression of periodontal disease and declining estrogen level following onset of menopause has been linked to alveolar bone leading to tooth loss. Guided tissue regeneration has been accepted as evidence of periodontal regeneration in the evaluation of GTR procedures by resorbable membranes of bio-compatible nature, such as bovine or human collagen membrane in this study, the use of freeze dried, cross linked bovine collagen was evaluated in the guided tissue regeneration method of periodontal treatment in menopausal patients along with maintaining nutritional balance [Calcium Ig day with vitamin D 700 iu day] to assess and to control /reduce the bone loss in periodontitis. Clinical Measurements like PPD, PAL, PI, BI, bitewing radiographs and heel sonometry at baseline, 6 and 9 months were taken. Significant improvement was recorded in test groups as compared with control groups. Further research trial is necessary using other alternate bio-compatible natural cost effective materials

Prevalence of dental anxiety among university students in Islamabad, Pakistan

The aims of the current study were to find the prevalence of Dental Anxiety amongst Pakistani University Students and to determine the differences in relation to gender, education and level of dental anxiety. A questionnaire consisting Dental Anxiety Scale and Dental Fear Scale describing anxiety-provoking stimuli was constructed and presented to 385 university students. A convenient sample of 11 Universities students [n=385] of Islamabad, the capital of Pakistan was selected for the survey. The survey comprised different questions concerning demographic variables, first denial visit; last dental visit and reasons for avoidance of dental appointment and the level of dental anxiety. The methods of measurement of dental anxiety were 20 questions of Dental Fear Scale and 4 questions of the Corah Dental Anxiety Scale. The results indicated that waiting for the drill in Dental Anxiety Scale was highly prevalent while in Dental Fear Scale the most fear provoking stimuli for university students were items dealing with injection feeling and sighs of the needle males were significant more likely to report a high dental anxiety compared to males [p<0.05,]. The prevalence of high dental anxiety [Phobia] in the sample as measured by the Dental Fear Scale and Dental Anxiety Scale was 21.8% and 21.4% respectively. This study found a relativity high prevalence of dental anxiety and fear which confirm the scope of this problem facing dentists as well as patients. This problem should be addressed by the polify makers to improve the oral health of the population. The present findings support the need for assessment procedures using a broad spectrum of potentially anxiety-provoking stimuli in general population as well

Helicobacter pylori in dental plaque; is it related to brushing frequency, plaque load and oral health status?

To determine the relation between presence of H. pylori in supra-gingival dental plaque with oral hygiene habits and oral health status of patients suffering from symptomatic dyspepsia. Descriptive study. The Department of Oral Health Sciences, Shaikh Zayed FPGMI, Lahore, from September 2008 to August 2009. One hundred and fifty dyspeptic subjects with dental plaque were enrolled. After recording brushing frequency, oral health status and plaque load, the supra-gingival dental plaque samples were collected by sterile curettes. Helicobacter pylori were detected in dental plaque samples through PCR assay. Presence of H. pylori in dental plaque was found to be 37.5% in the sample. Most of the subjects brushed once daily, had plaque index score of 1 and had fair to poor oral hygiene status. Approximately 35% of the individuals who brushed once or twice a day harbored the bacterium in their dental plaque. There was no difference between bacterial detection rates among different categories of plaque index and oral health status of the study subjects. Presence of H. pylori in dental plaque was found to be associated with neither brushing frequency nor with the plaque load nor with the oral health status of individuals suffering from symptomatic dyspepsia

Is oral health status of children with beta-Thalassemia worse than that of their normal counterparts?

To determine the association, if any, of patients suffering from beta-Thalassema with dental caries, gingival condition and oral health status and compare it to their normal counterparts. A. total of 90 children suffering from beta-Thalassemia and 60 healthy controls [age range 6-15 years] were selected from similar socio-economic and parental education background. Oral hygiene status and gingival condition were examined using Oral hygiene Index-Simplified and Modified Gingival Index respectively. Dental caries was recorded using DMFT /dmft Index according to the criteria described by the World health Organisation. Dental caries status in both primary and permanent dentition was found similar in both the groups of children [p>0.5]. GI score of thalassemic children was 0.73 +/- 1.08 and of the healthy subjects was 0.85 +/- 0.95 [p>0.5], however oral health status of the two groups was found to be different [p<0.005] with a larger number of healthy group having [good] oral hygiene as compared to their thalassemic counterparts. There was no significant difference in the dental caries status and gingival condition of children with beta-Thalassemia as compared to their normal counterparts; however, oral hygiene status of the healthy children was significantly better than children suffering from beta-Thalassemia

Oral health related knowledge, attitude and practices among patients - a study

Objective of this study was to investigate oral health-related knowledge, attitude, and practices of patients visiting Khyber College of Dentistry, Peshawar, Pakistan. Five hundred and thirty patients in the college setting were approached, through second year students of Khyber College of Dentistry and self-reported questionnaires were filled. This study was conducted from September 2008 to August 2009. Response rate was 100%. Completely filled questionnaires were analyzed. Eighty six percent subjects brushed their teeth, and 12.1% showed twice a day frequency; 30% of male and 21.4% female patients changed brushes after 6 months period.81.3% had visited a dentist. Only 19.6% patients were smokers. Rich people were better in their oral health knowledge, attitude, and practices which were associated with education and socio-economic status

Infection control practices among dental practitioners of Lahore, Pakistan

To observe adoption of infection control measures among dental practitioners. A cross-sectional study based on a convenient sampling technique was conducted. Dental Practitioners in each subdivision [towns] of the Lahore, Pakistan were approached through 15 dental hygiene students to fill a close ended structured questionnaire. Study was conducted during 1[st] March-15 March 2005. Chi square test was applied with a significance level of p<0.05. Four hundred dental practices were visited and response rate of 83.25% was obtained. 62.76% surgeries were found being run by un-qualified dental practitioners and 37.23% by qualified dentists. 94.35% qualified practitioners used gloves as compared to only 28.2% of the un-qualified practitioners and a high percentage of qualified practitioners used gloves for every patients compared to their un-qualified counter parts [85.48% and 14.35%] respectively. 97.5% qualified practitioners and 80.3% of the un-qualified dentists used face masks. 85.1% of un-qualified and 98.3% of the qualified dental practitioners used fresh set of instruments for each patient. Use of sterilization methods including disinfectants, autoclaving of instruments was higher in qualified practitioners. Infection control measures among qualified and non-qualified practitioners were statistically significant. [p= 0.000] A poor level of infection control practice was observed in dental practices run by un-qualified practitioners. Majority of qualified dentists were observing infection control measures. There is need for further education and training for all the dental practitioners

Oral health related quality of life individuals with down syndrome

Down syndrome [DS] is the most common cause of mental and physical retardation in the world. Individuals with Ds have skeletal, dental and soft tissue anomalies which along with their mental retardation lead to poor level of oral health as compared to normal population. This in turn has a negative impact on their quality of life. Despite all the problems oral health is reported to be the greatest unattended need of the disabled. The present review highlights the dental and oral problems that are faced by individual with DS so that a strategy can be devised to handle these conditions in the dental office

Writing a research proposal

As researchers in dentistry, we have a quest to learn more, to look beyond what is written and to contribute a little to the field we plan to dedicate our lives to. For a beginner, writing a research proposal is probably one of the most challenging and arduous tasks, especially since research is a new area for the majority of Pakistani dentists. This article provides the necessary guidelines for the inexperienced potential researcher to produce a standard research protocol. It is outlined in a comprehensible, easy-to-grasp and systematic manner. Obtaining a grant for a research project generally determines the academic and administrative success of any project. Therefore the quality of a research protocol is of paramount importance for viable competition. Despite the uphill daunting task of producing a protocol of high quality, it is nonetheless one of the most interesting and satisfying part of research. Conquering this arena opens the door to an exciting unending world of knowledge yet to be discovered

role of essential oils in periodontal health: an appraisal of evidence

The objective of this search was to find out "Do essential oils as a therapeutic agent assist in maintenance of periodontal health?" The article is based on a search which was conducted on Medline to identify the studies related to the topic and published up to Sep 2008. Fifty nine articles were retrieved from the search. Four articles were in languages other than English which have not been included in the appraisal. Thirty two articles had information relevant to the search question. Based on the finding of the search it is concluded that essential oil when used as an adjunct to unsupervised oral hygiene can provide additional benefit in reduction of plaque and gingivitis

Self-reported oral health related knowledge, attitude and practices among medical doctors of Lahore, Pakistan- a pilot study

Objective of this study was to investigate oral health-related knowledge, attitude, and practices of medical doctors of Lahore, Pakistan. Three hundred sixty medical doctors were approached consecutively, through undergraduate students of a dental college, at their workplaces in Lahore, Pakistan and self-reported questionnaires were filled. Response rate was 100%. Eight four percent completely filled questionnaires' were analyzed. Ninety nine percent subjects brushed their teeth, 55% showed twice a day frequency; 82% used soft/medium textured brushed and 95% changed brushes in 4-6 months period, 98.7% subjects used toothpastes, 73.1% knew how to brush, 91.9% professionals did not complain of foul breath, 54% had dental hypersensitivity, 14.5% reported pain in teeth, 34.2% had bleeding gums and 76.1% had visited a dentist. Only 4.70% males were smokers. Significant association [p=0.05] was found for use of tooth brush, brushing frequency and timing of brushing, brush change, use of mouth wash with gender; complaint of bad breath with education; sensitivity of teeth with income groups; bleeding gums, and visit to a dentist with education and income; and smokers with gender, education and income group. All other variables showed no statistical significance with respect to gender, education and income levels. Medical doctors were better in their oral health knowledge, attitude, and practices which were associated with education and socio-economic status