Geriatric Depression in India; Causes and Solutions: An Ayurveda Perspective

Geriatric Depression (GD) prevalence rate is on the rise as is the geriatric population in India. It can be correlated to Kaphaja Unmada in Ayurveda based on its causes and symptoms. GD patients have symptoms like Mandavakchesta (slowing of speech and actions), Tushnibhava (depressed look), Anaannabhilasha (disinclination for food). GD has several causative factors like decreased physical agility, cognitive decline, lack of financial liberty, social isolation, long standing diseases and medicines etc. Following the surge of industrialization, urbanization like western countries after 1980s, the family systems and values in India have changed. Nuclear families are on rise and elderlies in families are considered as burden. Contrastingly, earlier elderlies were regarded as source of wisdom and guidance. This study is an attempt to go through all the possible literature offline and online to find out the causes and solutions of GD in India. Findings showed that along with the common causative factors related to the old age in elderlies, ignorance from younger family members is also equally important. GD is a psychosomatic disease, so treatments approach involving the body, mind, family dynamics and values using family psychotherapies and psychoeducation, Medhya rasayana and if needed modern psychiatric medication can address all types of GD and related mental health problems in India.

Review of Paediatric Typhoid Perforation Cases Managed at a Tertiary Care Centre

Background: Any criteria (clinical, pathologic, microbiological or histo-pathologic) attributing a case of Paediatric gastrointestinal perforation to Typhoid would be of help in reaching a proper diagnosis to guide appropriate management.Aims and Objectives: To review all cases of Typhoid perforation for their clinical, pathologic and intra-operative findings.Materials and Methods: A retrospective study was conducted on all cases of typhoid perforation (gastrointestinal perforation with positive Widal test) operated at a tertiary care centre from September 2015 to September 2018. Data regarding their clinical findings, investigation results, intraoperative findings, nature of thesurgical intervention, postoperative results and histopathological findings were collected from their records and analysed.Results: A total of 13 patients were operated during this period with positive Widal’s test at presentation. 6/13 had single ileal perforation; two patients had multiple ileal perforations; perforation at atypical sites were found in four patients (one each at gastric, duodenal, caecal and rectal); one patient presented with Meckel’s band obstruction with multiple ulcers –this patient was sick and died despite a diverting ileostomy in the postoperative period. While 8/13 patients had primary closure of the perforation site, diversion through ileostomy was performed in five patients. All patients did well in the post-operative period except one patient of multiple ulcers and obstructing Meckel’s band who died in the post-operative period. Conclusion: On encountering a gastrointestinal perforation, no definite symptomatology or its pattern, no clinical examination findings, no intraoperative characteristics of the perforation and no biopsy can definitively point towards Typhoid as the cause. Therefore, we still have to depend on serological tests in correlation with clinical features to reach a conclusive diagnosis. Cultures and PCR, although sensitive are either time-taking or expensive to guide management. Typhoid perforation can have vivid and atypical presentation depending on the number and site of perforation

Acidogenic and Erosive Potential of Paediatric Liquid Medications- A SEM Based Study

Background: Dental erosion is a complex pathology of multifactorial etiology in which chemical, biological and behavioural factors influence the erosive process. The etiology has been related to the regular use of products with low endogenous pH and high acidity including liquid medicaments. Aim: To investigate the endogenous erosive potential of commonly used pediatric liquid medicaments. Methods: Endogenous pH and titratable acidity of eight commonly used pediatric liquid medicaments were measured using a digital pHmeter. 54 exfoliated or extracted primary and permanent teeth without any carious lesion, maintained in pediatric liquid medicaments were observed under SEM after 1 minute and 10 minutes of time intervals. Results: Most of the medicaments showed etched prism pattern on primary teeth and crater formation whereas etched prism pattern was seen on all permanent enamel surfaces. Conclusion: Evidence of dental erosion was observed on both primary and permanent enamel.

Role of Periodontist in Screening Diabetes- A Correlation of Clinical and Biochemical Parameters

The increased prevalence and severity of periodontitis seen in patients with diabetes, especially those with poor metabolic control, has led to the designation of periodontal disease as the “sixth complication of diabetes” and successful periodontal therapy in diabetic patients entails the stabilization of blood glucose to a normal range. Hence, present study evaluates whether the noninvasive method of testing gingival blood glucose, is a reliable tool for screening diabetes in chronic periodontitis patients. Methods: The study sample comprised of 75 patients with probing pocket depth of > 4mm and clinical attachment loss of >3mm. Under aseptic measures and proper isolation, after gently probing the gingival sulcus the blood was drawn onto the glucometer strip and the readings were recorded. At the same visit blood was also collected from the index finger onto the glucometer strip. The statistical methods applied were Student's t-test (unpaired) to compare mean values between the two groups and Pearson's correlation for Means and Standard Deviation of the different parameters were calculated. Results: There is a positive correlation between GCBG and CFBG with all the clinical parameters. Fasting blood glucose level is negatively associated with age, plaque index and clinical attachment level (r=0.083, r=0.22 and p=0.042, respectively) whereas Post prandial blood glucose level is negatively associated with age, plaque index and probing pocket depth (r=0.117, r=0.099 and r=0.06, respectively). CFBG is slightly positively correlated with age, plaque index and clinical attachment whereas GCBG is strongly associated with probing pocket depth. Conclusion: The gingival crevicular blood glucose levels also found a positive correlation with the fasting blood glucose levels and post prandial blood glucose levels, suggesting the use of gingival crevicular blood as a screening marker for diabetes. Also a correlation was found between the gingival crevicular blood glucose levels and the clinical parameters suggesting that the treatment of periodontal disease can be considered as an important factor, which can help in improvement of the blood glucose levels in periodontitis subjects.

Evaluation of Dental CBCT in Assessing the Furcation Involvement in Mandibular Molars

Furcation involvement (FI) refers to the invasion of the bifurcation and trifurcation areas of multi-rooted teeth by periodontal disease. Diagnosis of FI by 2D radiographs can be overcome by the use of cone-beam computed tomography (CBCT) imaging technique. Objective: To compare the measurements of furcation depth by clinical method and CBCT in assessing the FI. Methods: The present study comprised of 60 furcation involved mandibular molars from 45 patients suffering from Chronic Generalized Severe Periodontitis. Teeth having probing pocket depth of ≥6mm were considered for the study. Clinical measurements of furcation depth were made on buccal or lingual sides of mandibular molars by using endodontic file with stopper which was done by two clinicians. The CBCT measurements were performed by measuring the deepest vertical and horizontal furcation defects at each furcation entrance. These measurements were then recorded, compiled and statistically analysed. Results: The comparison of furcation involvement clinically by clinician 1 and CBCT measurements in buccal side was statistically significant (p=0.0255*), while it was statistically not significant (p=0.3696 NS) on lingual side. Similarly, the comparison of furcation involvement clinically by clinician 2 and CBCT measurements in buccal side was statistically significant (p=0.0278*), while it was statistically not significant (p=0.4951 NS) on lingual side. Conclusion: CBCT technique can be considered a reliable tool for detecting FI as CBCT imaging showed high accuracy and moderate reproducibility in the assessment of furcation depth.

Association Between Middle Ear Infection and Dental Caries Amongst Children: A Hospital Based Study

Background: Otitis Media or infection of Middle Ear is a broadterm that encompasses all the inflammation of the middle earwithout any specific etiology or pathogenesis. The presentstudy was conducted with the aim to determine the incidenceof dental caries amongst the subjects with middle ear infection.Materials and Methods: Controls were subjects who didn’thad dental caries of ear infection. Children with any othermedical condition were excluded from the study. Children withinfection of middle ear were categorized according to age andgender. Group I subjects were having middle ear infection andGroup II were controls. Centrifugation was done for 10 minsand the deposits obtained were used for culturing. All the datathus obtained was arranged in a tabulated form and analyzedusing SPSS software. Probability value of less than 0.05 wasconsidered as significant.Results: The mean age of the subjects was 10.67+/-3.62years. The mean colony forming units in Group I was 5.7+/-9.65 and in Group II was 1.6+/-2.78. There were 5 children inGroup I and 30 children in Group II with very good health ofteeth. Good oral health was seen amongst 5 subjects in GroupI and 20 subjects in Group II. Majority of subjects in Group I(40) had average oral health. There was a significant differencein the Groups amongst oral health amongst the groups.Conclusion: There was an increased risk of early childhoodcaries amongst children with middle ear infection.

Nature Versus Nurture: A Case Report Comparing The Clinical And Cephalometric Pattern In Twins

Malocclusion is a manifestation of genetic and environmental interaction on the development of the orofacial region. Orthodontists may be interested in genetics to help understand why a patient has a particular occlusion. Orthodontists usually assume that the genetic factors are of major significance to the development of malocclusion. Studies of twin similarities have lent support to this concept. Twin study is one of the most effective methods available for investigating genetically determined variables of malocclusion. Discordancy is a frequent finding in dizygotic twins. However, discordancy in monozygotic (MZ) twins is a rare finding. Here, we report the case of MZ female twins aged 16 years and a comparison of the clinical and cephalometric pattern was done in both the twins. The present case shows discordancy between MZ female twins in relation to their extraoral and intraoral findings. The purpose of this study of MZ twins is to assess the genetic and environmental components of variation within the cranio-dento-facial complex.

Estimation of gingival blood glucose using a sensitive self-monitoring device in periodontitis patients

Background: Diabetes Mellitus is a complex disease with varying degree of systemic and oral complications. The prognosis is quite favorable if a disease is diagnosed in early stages. Since a large number of patients seek dental treatment routinely, screening procedures for early detection of subclinical cases can help in diagnosis of asymptomatic diabetes. Aim: The present study was undertaken to evaluate if gingival crevicular blood can be used for the estimation of blood glucose levels in periodontitis patients. Material and Methods: A prospective study was carried out comprising 150 patients Group A comprised of 75 subjects with gingivitis and group B comprised of 75 subjects with periodontitis. For gingival crevicular blood glucose (GCBG) level estimation, the blood was drawn onto the glucometer strip after gently probing the gingival sulcus and the readings were recorded. At the same time, blood Vijayendra Pandey, Akhilesh Chandra, Deepak Kumar, Anup Kumar Singh, Priyankesh, Alok Kumar Gupta. Estimation of gingival blood glucose using a sensitive self-monitoring device in periodontitis patients. IAIM, 2019; 6(6): 51-56. Page 52 was also collected from the index finger onto the glucometer strip for the capillary finger-prick blood glucose (CFBG) sample. Both the values were compared and statistical analysis of data was performed. Results: The mean GCBGL and CFBGL in group A was 98.43 mg/dl ± 18.62 and 103.48 mg/dl ± 13.90 respectively, while in group B it was 136.37 mg/dl ± 36.95 and 141.62 mg/dl ± 51.84, respectively. There was no statistically significant difference (p> 0.05) between the two values in both the groups. Conclusion: It can be concluded that GCBG levels are positively correlated with CFBG levels. Therefore, clearly indicating that gingival crevicular blood collected during diagnostic periodontal examination may be an excellent source of blood sample for glucometric analysis.

Assessment of Tooth Movement with Piezocision and Its Periodontal Transversal Effects in Class II Malocclusion Patients: A Clinical Study

Background: There are considerable amount of population suffering from malocclusion. An increasing number of patients are demanding orthodontic treatment for improved esthetics and a better mastication system. The present study was conducted to assess tooth movement with piezocision and its periodontal transversal effects in class II malocclusion patients. Methods: The present study was conducted in the department of Orthodontics. It comprised of 120 patients with class II malocclusion. Before canine distalization and after the alignment and leveling phases, piezocision was performed on experimental side (Group I). Tooth mobility and gingival index was assessed on both sides. Results: In group I, there was 3.56± 1. 4 months and in group II there was 5.61± 1.2 months for distalization. There was 1.54± 1.3 mm and 0.80± 1.1 mm distalization in group I and group II. The difference was significant (P< 0.05). The mobility score was 1.2 and 1.4 before and after distalization in group I and 1.3 and 1.5 before and after distalization in group II. The difference was non- significant. Gingival index score was 1.4 and 1.3 before and after distalization in group I and 1.5 and 1.6 before and after distalization in group II. The difference was non- significant (P> 0.05). Conclusion: Piezocision-assisted distalization accelerates tooth movement, decreases the anchorage loss for posterior teeth, and does not induce any maxillary transversal change. This technique does not have any adverse effects on periodontal health.

Sonographic Evaluation of Acute Appendicitis -A Study at a Tertiary Care Hospital of Tribal, Hilly, Wayanad in Kerala.

Background: Acute appendicitis (AA) is one of the most frequent causes of an acute abdomen requiring emergency surgery. Classically, the clinical findings consist of periumbilical pain migrating to the right lower quadrant, accompanied by fever and leukocytosis. However, the classic signs are not always present, and symptoms can be nonspecific and overlap with other causes of abdominal pain. While the clinical diagnosis may be straightforward in patients who present with classic signs and symptoms, atypical presentations may result in diagnostic confusion and delay in treatment. Among imaging methods, Ultrasound (US) is a valuable tool, which is widely available, can be performed at the bedside, does not use ionizing radiation, is relatively inexpensive, and may show evidence of other causes of abdominal pain. Methods: We evaluated the role of ultrasound in the diagnosis of AA, at a tertiary care hospital of tribal, hilly, Wayanad in Kerala, involving 224 patients from Jan 2015 to July 2016. Ultrasound findings were finally compared with surgical / pathological report of appendices removed at surgery. Results: The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of ultrasound in diagnosis of AA, in our study were found to be 99.2 %, 76.7 %, 87.2% , 98.5% and 90.6 % respectively. Conclusion: Although the sensitivity, specificity, and accuracy of sonography vary greatly in studies evaluating the imaging diagnosis of acute appendicitis, it should be the first imaging modality when there is clinical concern for acute appendicitis.

Singapore Neonatal Resuscitation Guidelines 2016

We present the revised Neonatal Resuscitation Guidelines for Singapore. The 2015 International Liaison Committee on Resuscitation Neonatal Task Force's consensus on science and treatment recommendations (2015), and guidelines from the American Heart Association and European Resuscitation Council were debated and discussed. The final recommendations of the National Resuscitation Council, Singapore, were derived after the task force had carefully reviewed the current available evidence in the literature and addressed their relevance to local clinical practice.

Hhip regulates tumor-stroma-mediated upregulation of tumor angiogenesis

Tumor growth is governed by the coordinated action of various types of cells that are present in the tumor environment. Fibroblasts, which constitute a major fraction of the stroma, participate actively in various signaling events and regulate tumor development and metastasis. The Hedgehog (Hh) pathway plays an important role in promoting tumor malignancy via fibroblasts; however, the role of hedgehog interacting protein (hhip; inhibitor of Hh pathway) in tumor growth is poorly understood. Here we implanted B16F10 tumors in hhip+/− mice to study the tumor growth characteristics and the vascular phenotype. Furthermore, the mechanism involved in the observed phenomena was explored to reveal the role of hhip in tumor growth. The tumors that were implanted in hhip+/− mice exhibited accelerated growth and increased tumor angiogenesis. Although we observed a decrease in hypoxia, blood vessels still had abnormal phenotype. We found that increased Hh signaling in tumor fibroblasts induced a high expression of vascular endothelial growth factor (VEGF), which subsequently resulted in an increased proliferation of endothelial cells. Thus, the heterozygous knockdown of hhip in mice could affect Hh signaling in tumor fibroblasts, which could cause the increased production of the growth factor VEGF. This signaling, via a paracrine effect on endothelial cells, increased tumor vascular density.

Evaluation of Correlation of Dental Fluorosis and Cognitive Status.

Background: Fluoride in groundwater is more common in crystalline igneous rocks and alkaline soils located in semiarid climate, which exist in the northwestern parts of the Jharkhand state in the district of Garhwa and Palamu. The present study was undertaken to evaluate the intelligent quotient among children affected with and without dental fluorosis visiting dental college in the Garhwa district. Methods: The present prospective study comprised of 30 subjects selected randomly in the age group of 6-12 years visiting Vananchal dental college & hospital, Garhwa. The study compared IQ levels of children of study and control groups by means of Seguin Form Board Test. Data so obtained was statistically analyzed using Student ‘t’ test with p value <0.05 as significant value. Results: Regarding drinking water source, 45% was drinking groundwater among study group. Mean scores for average timing category was found to be significantly higher (P<0.05) among children with dental fluorosis (29±2.87) than among children without dental fluorosis (27±3.02). Conclusion: The present study concludes that children with dental fluorosis have low Intelligence Quotient (IQ) than children without dental fluorosis. About half of the patients suffering from dental fluorosis were dependent on groundwater for drinking purposes. Fluoride water level of villages located in these regions should be selected in priority for application of defluoridation measures.

Assessment of Cytomorphometric Features of Oral Squames from Buccal Mucosa of Tobacco Users using Oral Brush Biopsy: An Exfoliative Cytological Study.

Background: Tobacco comprises of one of the most common addiction in the society. All the forms of the tobacco are harmful, causing alterations in the cellular parameters of the oral mucosal cells. A number of techniques and methods are available along with chair side examination for supplementing the diagnosis of tobacco induced premalignant lesions. Exfoliative cytology is one such technique, which is non-invasive and can be used for mass screening. Therefore, we evaluated the cytological and cytomorphometric changes in the oral squames using brush biopsy from buccal mucosa of tobacco users. Methods: A total of 300 patients with age group of 25 to 60 years were included in the study. Detailed history of the patients were taken to known the method (smoking, smokeless or both) and frequency of tobacco intake. Scrapings from the buccal mucosal scrape were obtained, smeared on slides and were subsequently stained with Hematoxylin and Eosin staining. Observation and analyses of the smears was done under microscope followed by analysis in the computer using software Dewinter Biowizard version 3.0. various cellular parameters were assessed and compared in between different groups. Patients were divided into two major groups- Habituers and Nonhabituers. The habituers were again divided into: Tobacco smokers, Tobacco chewers and patients having combined habit. Independent-Samples T Test and One-Way ANOVA were used to assess the level of significance. Results: Significant results were obtained while comparing nuclear parameter, cellular area, cellular perimeter, cell contour and nucleo-cytoplasmic ratio in between lesional group and tobacco smoking group. While comparing between tobacco smoking group and Non habituers group, significant results were obtained in all the parameters except for cell contour and N/C ratio. Significant results were obtained while comparing between lesions and combined habit groups. While comparing between habituers and non- habituers group, except for cell contour significant results were obtained in all other cellular parameters. Conclusion: Early changes detection in clinically normal oral mucosa of tobacco users is possible by using non-invasive, painless procedures like oral brush biopsy and cytomorphometry. Further studies recommended.

A Rare Cause for Sub-acute Small Bowel Obstruction: Distal Ileal Neuroendocrine Tumor.

Intestinal obstruction presents a unique challenge to the surgeon, with regard to making the correct diagnosis, deciding the optimal timing of intervention, and the appropriate therapy. Malignant tumors account for approximately 20% of the causes of small bowel obstruction. Small bowel neoplasms are exceedingly rare, despite the fact that the small bowel constitutes about 80% of the total length of the gastrointestinal tract and makes up more than 90% of the mucosal surface area. Only 5% of all gastrointestinal neoplasms and only 1-2% of all malignant tumors of the gastrointestinal tract occur in the small bowel. Neuroendocrine tumors (NETs) of small bowel presenting as sub-acute intestinal obstruction are very rare. The incidence rates of Jejuno-Ileal NETs are 0.28-0.8 per 100,000 population per year. We present here, a case of sub-acute intestinal obstruction due to a distal ileal stricture. The patient was evaluated and underwent laparotomy. Growth was noted in the distal ileum, which was resected and end to end anastomosis was done. Post-operative histopathology proved the growth to be a well-differentiated NET.

Level of Physical Exercise Capacity, Respiratory Muscle Strength and Peak Expiratory Flow Rate in Healthy Adolescents.

Introduction: The maturation of respiratory system in children leads to changes in value of respiratory parameters like peak expiratory flow rate (PEFR), maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), and 6-minute walk distance (6MWD). Accurate analysis and clinical decisionmaking in disease state require reference values for different ages. The current study was undertaken to study pulmonary function and exercise capacity in children and adolescents. Materials and methods: After obtaining Institutional Ethical approval and parental informed consent, 262 subjects aged 9 to 15 years were recruited for the study. They were divided into two age groups, i.e., preadolescent (9-12 years) and early adolescent (13-15 years). Demographic details including age, sex, height, weight, and body mass index (BMI) were noted. Physical activity rating (PAR) scale was used to denote physical activity levels. Peak expiratory flow rate was measured using standard Mini-bell peak flow meter (PFM). The parameters MIP and MEP was measured using micro respiratory pressure meter, and 6-minute walk test (6MWT) was performed as per American Thoracic Society (ATS) guidelines. Results: A significant difference was noted between the two groups in PEFR, MIP, MEP, and 6MWD (p = 0.00). Age showed a strong positive correlation with PEFR (r = 0.613, p = 0.000), MIP (r = 0.676, p = 0.000), and MEP (r = 0.658, p = 0.00) whereas showed a strong negative correlation with 6MWD (r = -0.605, p = 0.00). Height showed a strong positive correlation with MEP (r = 0.720, p = 0.000) whereas a strong negative correlation with 6MWD (r = -0.42, p = 0.00). Weight showed a weak negative correlation with 6MWD (r = -0.328, p = 0.00). Gender difference was noticeable in 6MWD and PEFR (p = 0.00) but not in MIP (p = 0.45) and MEP (p = 0.44). Almost 22.10% of early adolescents were overweight compared to only 7.7% seen in preadolescent group. Conclusion: PEFR and respiratory muscle strength was higher in early adolescents as compared to pre-adolescents. However, exercise capacity reflected by 6 MWD was found to be lower in early adolescents in comparison to pre-adolescents. These findings could be used while interpreting the outcome measures utilized while treating patients and for goal setting in cardiopulmonary rehabilitation in clinical practice.

A rare case of chronic suppurative otitis media with foreign body in external auditory canal and mastoid antrum.

Foreign bodies in External Auditory Canal (EAC) are common in both adults and children. Removal of foreign body requires skill but usually successfully performed in the ENT department. A 40 year old female patient presented with right ear discharge with decreased hearing. On examination, a pale, scanty, mucopurulent discharge, foul smelling with blood tinge, persisting even after medications. After aural toileting, tympanic membrane was perforated with granulation tissue in middle ear. Multiple broom sticks were found in the external auditory canal, mastoid antrum was removed via post auricular approach with excision of polyp with radical mastoid exploration. Removal of foreign body from EAC is an essential skill for ENT surgeon. Careful removal can prevent further trauma and complications. An aural polyp with ear discharge, never attempt to pull/avulsion.

Phenytoin induced toxic epidermal necrolysis: A case report.

Toxic Epidermal necrolysis (TEN) is a rare, life threatening dermatological disorder that is usually induced by medications. Anti-convulsants such as phenytoin, carbamazepine and phenobarbital have been enlisted as high risk drugs for causing TEN. A 25 year old man, a known case of epilepsy, who consumed inadvertently escalated daily dose of 600 mg/day of phenytoin for 10 days, developed TEN which involving more than 30% of body surface area with mucosal involvement. Rigorous treatment of 18 days using systemic and topical antibiotics along with glucocorticoids helped in complete recovery of the patient. Causality analysis of this Adverse Drug Reactions (ADR) showed a probable association on both World Health Organisation (WHO) – Uppsala Monitoring Centre (UMC) scale and Naranjo’s probability scale and Severity scale of 5 on Modified Hartwig and Siegel scale. Medication error is an important cause of such life threatening reactions which requires concern of all health care professionals.

Insights into the state of radiation protection among a subpopulation of Indian dental practitioners

PURPOSE: Radiographs is an integral part of patient management in dentistry, despite their detrimental effects. As the literature pertaining to radiation protection among Indian dental practitioners is sparse, exploring such protection is needed. MATERIALS AND METHODS: All private dental practitioners in Mangalore, India were included in the study. A structured, pre-tested, self-administered questionnaire was employed to assess the knowledge, attitudes, practices, previous training, perceptions towards the need to spread awareness, and willingness to gain and implement knowledge about radiation hazards and protection. Information regarding each respondent's age, gender, education, and type and duration of practice was collected. RESULTS: Overall, 87 out of 120 practitioners participated in the study. The mean knowledge, attitude, and practice scores were 9.54+/-2.54, 59.39+/-7.01, and 5.80+/-3.19, respectively. Overall, 25.3% of the respondents had undergone training in radiation protection, 98.9% perceived a need to spread awareness, and 94.3% were willing to improve their knowledge. Previous training showed a significant correlation with age, sex, and duration of practice; attitude was significantly correlated with education and type of practice; and knowledge scores showed a significant correlation with type of practice. CONCLUSION: Although the knowledge and practices of respondents were poor, they had a positive attitude and were willing to improve their knowledge. Age, sex, and duration of practice were associated with previous training; education and type of practice with attitude scores; and type of practice with knowledge scores. The findings of this study suggest a policy is needed to ensure the adherence of dental practitioners to radiation protection guidelines.