Evaluation of Stress among Dental Undergraduates and Postgraduates Using Salivary Cortisol as a

Background: Stress is a non?specific response of the body to any demand. Professional education has a certain level of stress inherent in it. Dental students have been reported in the literature to experience more stress than medical students. Objective: To evaluate the stress levels of dental students: first?year undergraduates, house surgeons, and final?year postgraduates, using salivary cortisol as a stress biomarker. Materials and Methods: Dental students above 18 years of age and without any systemic illness were included in the study. Those students with a drug history of corticosteroids, anti?depressants, and oral contraceptives were excluded from the study. Female participants experiencing pre?menstrual symptoms, pregnancy, and familial stressor issues were excluded from the study. First?year undergraduates, house surgeons, and final?year postgraduates were enrolled in the study. Unstimulated whole saliva was collected in the morning and evening between 9:00 and 10:00 am and between 3:00 and 4:00 pm. Salivary cortisol levels were assessed by chemiluminescence immuno?assay (CLIA). Results: Paired sample t?test was used to compare the diurnal variation among morning and afternoon samples within the groups. The salivary cortisol levels were found to be significant within the groups. One?way ANOVA was used to compare the salivary cortisol levels between the groups. The salivary cortisol levels within the groups were not statistically significant. Conclusion: Salivary cortisol is a non?invasive biomarker of stress. Postgraduates had higher salivary cortisol levels than other study groups.

Niveles de estrés de endodoncistas de la India durante la pandemia COVID-19 / Stress Levels of Indian Endodontists during COVID-19 Pandemic

RESUMEN Introducción: La COVID-19 se propaga por vías respiratorias y aerosoles. La pandemia originada por esta enfermedad causa pánico, miedo y estrés en todos los estratos de la sociedad. Al igual que todas las demás profesiones médicas, los dentistas, particularmente los endodoncistas, que están muy expuestos a los aerosoles, pueden mostrar estrés. Objetivo: Encuestar a los endodoncistas indios para comprender mejor sus niveles de estrés psicológico durante el confinamiento de la India durante la pandemia de la COVID-19. Métodos: Del 8 de abril al 16 de abril de 2020 se realizó una encuesta cerrada en las redes sociales de endodoncia. Se utilizó la técnica de muestreo de bola de nieve. Asimismo, se recolectaron datos demográficos básicos, entorno de práctica y otras informaciones relevantes. El estrés psicológico y la angustia percibida se calcularon a través del índice de angustia peritraumática COVID-19 y la escala de estrés percibido. El análisis de regresión multinomial se realizó para estimar la tasa de riesgo relativo y p ≤ 0,05 se consideró significativo. Resultados: Este estudio tuvo 586 endodoncistas indios que completaron esta encuesta. De estos, 311 (53,07 por ciento) eran hombres, 325 (55 por ciento) en el grupo de edad de 25-35 años, 64 por ciento en áreas urbanas, 13,14 por ciento en prácticas individuales y un cuarto de ellos eran residentes. Las mujeres endodoncistas tenían un alto estrés percibido (RRR = 2,46, p = 0,01) en comparación con los hombres, medido por PSS. Los endodoncistas más jóvenes < 25 años (RRR = 9,75; p = 0,002) y 25-35 años (RRR = 4.60; p = 0,004) en comparación con el grupo de edad > 45 años tenían más angustia. Los consultores exclusivos tuvieron RRR = 2,90, p = 0,02, para la angustia leve a moderada en comparación con la normal. Se consideran los factores que impulsan este fenómeno. Conclusiones: Durante el cierre debido a la COVID-19, los endodoncistas indios 1-en-2 tuvieron angustia, según lo medido por CPDI y 4 de cada 5 percibieron estrés, según lo indicado por PSS. Nuestro modelo identificó ciertos factores que impulsan el (des)estrés, lo que ayudaría a los formuladores de políticas a iniciar una respuesta adecuada(AU)

ABSTRACT Background: The novel 2019 COVID-19 spreads by respiratory and aerosols. COVID-19 driven pandemic causes panic, fear and stress among all strata of society. Like all other medical professions, dentists, particularly endodontists, who are highly exposed to aerosols would be exposed to stress. Objective: To survey the Indian endodontists to better understand their levels of psychological stress during the Indian lockdown COVID-19 Pandemic. Methods: From 8th April to 16th April 2020, we conducted an online survey in closed endodontic social media using snowball sampling technique, collecting basic demographic data, practice setting and relevant data. Psychological stress and perceived distress were collected through COVID-19 Peri-traumatic Distress Index and Perceived stress scale. Multinomial regression analysis was performed to estimate relative risk rate and p ≤ 0.05 was considered significant. Results: This study had 586 Indian endodontists completing this survey across India. Of these, 311(53.07 percent) were males, 325(55 percent) in the age group of 25-35 years, 64 percent in urban areas, 13.14 percent in solo-practice and a fourth of them were residents. Female endodontists had high perceived stress (RRR = 2.46, p = 0.01) as compared to males, as measured by PSS. Younger endodontists < 25 years (RRR = 9.75; p = 0.002) and 25-35years (RRR = 4.60; p = 0.004) as compared with > 45 years age-group had more distress. Exclusive consultants had RRR = 2.90, p = 0.02, for mild-to-moderate distress as compared to normal. Factors driving this phenomenon are considered. Conclusions: During the lock down due to COVID-19, 1-in-2 Indian endodontists had distress, as measured by CPDI and 4-in-5 of them had perceived stress, as indicated by PSS. Our model identified certain factors driving the (dis)stress, which would help policy framers to initiate appropriate response(AU)

Areca nut use disorder: A dynamic model map

Problem: Areca nut (AN) chewing is common among Southeast Asian population. Use of AN products (with or without tobacco) have a multifaceted effect on physical health, especially on cardiovascular, nervous, gastrointestinal, metabolic, respiratory, and reproductive systems. AN is a known group 1 carcinogen and carries addictive potential. Varying degrees of AN-related substance use disorder (SUD) have been reported among AN chewers. There is a lacuna in awareness of the health risk of AN use, prevention, and cessation programs among AN users, particularly in those who have developed SUD. Existing Lacunae: The dynamic interaction of factors that promote AN use and later the risk of developing SUD at individual and community level has not been studied in depth. Understanding of the bio-psycho-socio-economic-cultural factors is necessary to identify the factors that prelude, promote, and reinforce AN usage. For managing AN-related conditions, including the several systemic disorders, there is a knowledge lacunae, among health care providers with respect to the pathophysiology of AN-related health issues, SUD, and nonavailability of structured, evidence-based cessation protocols. Solutions/Recommendations: This manuscript presents a model-map to study the dynamics of AN use and the impact of AN on health and health care system at individual as well as community level. The model proposed can help the health policymakers to create evidence-based awareness and cessation protocols for AN.

“Burden of the Triumph:” Burden of peri-implantitis in Indian population – A mathematical model

India suffers from a heavy burden of oral diseases. Dental implants (DIs) are prescribed widely by the dental practitioners to replace lost natural teeth. There is no estimate, however, to determine the number of DIs or the number of people with peri-implantitis or the failure of implants after placement. In this modeling study, we attempted to estimate the prevalence of adult Indians who would choose DI in the near future and to calculate the peri-implantitis and failure of DI. Materials and Methods: Using the Global Burden of Disease database (2016), the number of dental caries in permanent dentition, periodontal diseases, and edentulism was obtained. Empirical assumptions of patients with anodontia in urban and rural areas who opted for DI, percentage of implants placed, the affordability factors, and mathematical models for DI were formed and executed. Peri-implantitis and survival data from literary evidence were collated. Results: Based on assumptions, 909,643 Indians, (830,231–858,703) would choose DI. Estimated number of peri-implantitis would be 145,543–254,700 and estimated number of failures should be 50,940–79,412 in the near future. Conclusions: In spite of the high economic challenge and the risks or complications of peri-implantitis, DIs are gaining prominence. It is the dentists' burden to face the renewed challenges due to emerge and provide remedial measures.

Analysis of adverse events with use of orthodontic sequential aligners as reported in the manufacturer and user facility device experience database.

Background: Sequential aligners (SAs) introduced about a decade ago, changed the practice of orthodontics as we knew it but the adverse events and reactions (AER) associated with SA is not known. The Food and Drug Administration’s Manufacturer and User Facility Device Experience (MAUDE) database is a reliable database that has AERs reported. The manuscript attempts to review the AER associated with SA using the MAUDE database. Materials and Methods: The authors downloaded and reviewed the SA‑related AER from MAUDE for a period of 5 years. In‑depth analysis of the site and nature of intraoral and extraoral AERs were performed. We attempted to calculate the probability of pathologies being directly related to SA use, using Bayes’ theorem. Results: In the study period of 5 years, 175 cases of AER registered with MAUDE database owing to use of SA. Of the 175 cases, 129 (73.71%) instances were mandatory reports filed by the manufacturer. Of all AERs, 32 (18.29%) cases had been diagnosed/suspected to have an allergic reaction, 20 (11.43%) of them with anaphylactic reaction and 4 (2.29%) of them with angioedema. Lesions involving tongue, throat, and lip such as soreness, inflammation, and hives were more commonly reported. In addition, 12 cases (6.86%) reported of nausea, 11 (6.29%) of gastrointestinal issues (stomach upset, diarrhea, and vomiting), 13 (7.43%) of neuromuscular issues (muscle cramps, spasm, and pain), 13 (7.43%) of cough, 10 (5.71%) of persistent headache, 3 (1.71%) of fever, and 12 (6.86%) of cardiac‑related issues were identified. Conclusions: The AERs associated with SA has been described. Though the MAUDE database is not an exact, wholesome and reliable source to identify the potential AER, currently, it is the only available source of AERs associated with SA use. The nature of AERs with the use of SA and its potential pathogenesis and implications has been discussed.