The Influence of Dissonance Induction and Assessment Reactivity in Improving Adherence to COVID-19 Precautionary Measures: A Cluster Randomised Controlled Trial.

BACKGROUND: During the coronavirus disease 2019 (COVID-19) pandemic, adherence to suggested precautionary measures has been emphasized as important in preventing and curtailing its spread. However, strict adherence to precautionary measures can be demanding. METHODS: This cluster randomised controlled trial done among 1517 undergraduate dental students tested the effectiveness of 'dissonance induction' (DI) and 'assessment reactivity' (AR) in improving adherence to World Health Organization (WHO) measures as compared to a control group. At baseline, participants in the DI group were tested for their knowledge of precautionary measures, immediately followed by assessment of their adherence to them. This methodology was adapted to systematically reveal the poor adherence of the participants in their self-held cognitions, should there be any. The magnitude of dissonance was measured as the proportion of such dissonant cognitions held by an individual. In the AR group, at baseline, participants were asked about their attitudes alone toward measures. The control group was neither assessed for knowledge and adherence nor for attitudes toward the measures at baseline. Two weeks after the administration of these interventions in the DI and AR groups, the 3 study groups were assessed for adherence. RESULTS: The follow-up adherence scores in the DI group were found to be significantly higher (15.11 ± 4.1) compared to the AR (13.13 ± 2.01) and control (12.87 ± 2.97) groups as analysed by Kruskal-Wallis analysis of variance (H = 243.5; P < .001). Wilcoxon signed-rank test showed that the adherence scores significantly improved in the DI group from baseline to follow-up (z = -8.84; P < .001). Magnitude of dissonance at baseline was found to be a significant predictor of follow-up adherence scores (R2 = 0.255). CONCLUSION: This study found that DI is an easy intervention to bring an immediate and significant change in adherence to precautionary measures.

Development and psychometric evaluation of COVID-19 Psychological Burden Scale for Indian Health Care Workers.

BACKGROUND: It is beyond doubt that the health care systems across the globe have been experiencing burdens of unprecedented magnitude in the coronavirus disease (COVID-19) era. However, no psychometric tools were validated in India to assess the impact of COVID-19 on the psychological well-being exclusively among health care workers, given their obvious risk for exposure. OBJECTIVES: This study was conducted to develop the first of its kind psychometric tool that measures the psychological burden posed by COVID-19 on Indian health care workers. MATERIALS AND METHODS: One hundred and sixty-nine health care workers attending COVID-19 duties in four different states of India took part in the study. The initial scale designed was tested for face and content validity. Exploratory factor analysis using direct oblimin rotation with Kaiser normalization was employed to determine the factor structure. Differential item functioning (DIF) analysis with ordinal regression based on the type of COVID-19 facility at which the participant is serving, educational background was done for identification of item bias. RESULTS: COVID-19 Psychological Burden Scale for Indian Health Care Workers (CPBS-IHCW), with 17 items loaded on four components, demonstrated good internal consistency reliability (Cronbach's Alpha 0.873). DIF revealed no item bias based on type of facility and educational background. Significant differences in CPBS-IHCW scores were noted between health care workers serving at different COVID-19 facilities and belonging to different educational backgrounds. CONCLUSION: CPBS-IHCW is a 17-item, rapidly administrable scale, demonstrating good internal consistency reliability, and temporal stability, which can be used in the assessment of psychological burden among health care professionals catering to the needs of the COVID-19 affected.

Dental x-ray exposure is not associated with risk of meningioma: a 2019 meta-analysis.

OBJECTIVE: To determine the risk of developing meningiomas after exposure to various types of dental ionizing radiation at diagnostic levels. METHOD AND MATERIALS: A literature review was conducted using databases such as PubMed, Scopus, Google Scholar, CINAHL, Clinical Key, and Web of Science. Data extracted from the studies were tabulated and a meta-analysis was performed using all relevant data. RESULTS: Twelve articles related to the topic that met the selection criteria were initially included in the systematic review. After evaluating the methodology and statistical analysis of each study, six were ultimately included in the meta-analysis. A forest plot created using RevMan v5.3 software (Cochrane Collaboration) produced a weighted odds ratio of 1.13 (95% confidence interval, 1.06 to 1.19) for meningioma risk. CONCLUSIONS: Studies in the recent past have found a positive association between exposure to ionizing radiation and risk of developing meningiomas. In this study, no association was found between dental x-ray exposure and the development of meningioma. The data were weighted heavily for one of the subgroups due to a larger patient pool as noted via the forest plot. Regardless of the weighting, the majority of the subgroups showed no significant association, further strengthening this conclusion.

Natural bioceramics: our experience with changing perspectives in the reconstruction of maxillofacial skeleton.

OBJECTIVES: Various bone graft substitute materials are used to enhance bone regeneration in the maxillofacial skeleton. In the recent past, synthetic graft materials have been produced using various synthetic and natural calcium precursors. Very recently, eggshell-derived hydroxyapatite (EHA) has been evaluated as a synthetic bone graft substitute. To assess bone regeneration using EHA in cystic and/or apicectomy defects of the jaws through clinical and radiographic evaluations. MATERIALS AND METHODS: A total of 20 patients were enrolled in the study protocol (CTRI/2014/12/005340) and were followed up at 4, 8, 12, and 24 weeks to assess the amount of osseous fill through digital radiographs/cone-beam computed tomography along with clinical parameters and complications. Wilcoxon matched pairs test, means, percentages and standard deviations were used for the statistical analysis. RESULTS: The sizes of the lesions in the study ranged from 1 to 4 cm and involved one to four teeth. The study showed significant changes in the formation of bone, the merging of material and the surgical site margins from the first week to the first month in all patients (age range, 15-50 years) irrespective of the size of the lesions and the number of teeth involved. Bone formation was statistically significant from the fourth to the eighth week, and the trabecular pattern was observed by the end of 12 weeks with uneventful wound healing. CONCLUSION: EHA showed enhancement of bone regeneration, and healing was complete by the end of 12 weeks with a trabecular pattern in all patients irrespective of the size of the lesion involved. The study showed enhancement of bone regeneration in the early bone formative stage within 12 weeks after grafting. EHA is cost effective and production is environment friendly with no disease transfer risks. Thus, natural bioceramics will play an important role in the reduction of costs involved in grafting and reconstruction.

Socket preservation using eggshell-derived nanohydroxyapatite with platelet-rich fibrin as a barrier membrane: a new technique.

OBJECTIVES: Socket grafting is vital to prevent bone resorption after tooth extraction. Several techniques to prevent resorption have been described, and various bone graft substitutes have been developed and used with varying success. We conducted this pilot study to evaluate the performance of nanohydroxyapatite (nHA) derived from chicken eggshells in socket preservation. MATERIALS AND METHODS: This was a prospective, single center, outcome assessor-blinded evaluation of 23 sockets (11 patients) grafted with nHA and covered with platelet-rich fibrin (PRF) membrane as a barrier. Bone width and radiographic bone density were measured using digital radiographs at 1, 12, and 24 weeks post-procedure. Postoperative histomorphometric and micro-computed tomography (CT) evaluation were performed. The study protocol was approved by the Institutional Ethics Committee. RESULTS: All patients had uneventful wound healing without graft material displacement or leaching despite partial exposure of the grafted socket. Tissue re-epithelialized with thick gingival biotype (>3 mm). Width of the bone was maintained and radiographic density increased significantly with a trabecular pattern (73.91% of sockets) within 12 weeks. Histomorphometric analysis showed 56.52% Grade 3 bone formation and micro-CT analysis revealed newly formed bone with interconnecting trabeculae. CONCLUSION: Use of a PRF membrane with nHA resulted in good bone regeneration in sockets. Use of a PRF membrane prevents periosteal-releasing incisions for primary closure, thereby facilitating the preservation of keratinized mucosa and gingival architecture. This technique, which uses eggshell-derived nHA and PRF membrane from the patient's own blood, is innovative and is free of disease transfer risks. nHA is a promising economic bone graft substitute for bone regeneration and reconstruction because of the abundant availability of eggshell waste as a raw material.

A Perioral Soft Tissue evaluation after Orthognathic Surgery Using Three-Dimensional Computed Tomography Scan.

BACKGROUND: Facial appearance is an important factor, affects social and psychological well-being. The ideal positioning of jaws and soft tissues is crucial during orthognathic surgery for a better outcome, but the response of facial soft tissues does not always reflect the exact movements of the underlying jaws in 1:1 ratio. So, soft tissue changes following orthognathic surgery require utmost attention during surgical correction to make successful treatment. AIMS AND OBJECTIVES: Evaluation of perioral soft tissue changes after orthognathic surgical procedures. The objectives of the study were to assess and compare pre and post-operative perioral soft tissue changes of lip width, nasolabial and mentolabial angle using Three Dimensional Computed Tomography scan (3DCT). PATIENT AND METHODS: The study involved ten patients for evaluation requiring orthognathic surgical procedures (maxillary or mandibular anteroposterior excess or deficiency, transverse deformities, vertical maxillary excess and facial asymmetry) presented to the department of oral and maxillofacial surgery during 2014-2016. Pre and post-operative 3DCT scan were taken after 12 months using iCT 256 slice whole body CT scanner and evaluated for changes using Dicom PMS D view. RESULTS: Significant changes were observed in nasolabial angle after maxillary advancement (1.81°) and maxillary setback procedure (2.73°). The mentolabial angle was significantly increased with mandibular setback procedures (3.27°). Mandibular advancement procedures showed both increase (3.6°) and decrease (7.6°) in mentolabial angle. CONCLUSION: 3DCT showed a significant difference in perioral soft tissue changes in nasolabial and mentolabial angle but no significant change was observed in lip width. 3DCT is a reliable tool for 3D assessment. The conventional thought of changes in Nasolabial angle after surgery is changing due to the underlying factors which should be considered for prediction.

An Evaluation of Use of Botulinum Toxin Type A in the Management of Dynamic Forehead Wrinkles - A Clinical Study.

INTRODUCTION: The pursuit of youth and beauty has undergone a resurgence of interest which is evidenced by increasing cosmetic procedures. Botulinum Toxin Type A (Botox) is one among the many procedures invented for facial rejuvenation which denervates certain muscles of facial expression responsible for facial wrinkles. It has been applied in the forehead, glabella, lateral canthal area and neck. In maxillofacial area hyperactive forehead wrinkles show sagging. AIM: This study was aimed to clinically evaluate the efficacy of Botox injection in the elimination of hyperdynamic forehead wrinkles and the objectives were to compare pre-operative and post-operative improvement in the number of wrinkles, photographic grading and patient satisfaction responses after 1st week, 4th week and 16th week. MATERIALS AND METHODS: A total of 10 patients were randomly included in the present study who were cooperative, motivated and aesthetically conscious with moderate to severe forehead wrinkles. Assessment was performed clinically, photographically (using standardized photographs) and patient satisfaction responses were recorded at 1st week, 4th week and 16th week. RESULTS: The study showed a significant difference in the elimination of wrinkles at rest and in action when assessed at 1st week and 4th week and it was consistent at 16th week. The patient showed positive satisfaction response without ptosis of the upper eyelid. CONCLUSION: Treatment with Botox is simple, safe and an effective modality for reduction of forehead wrinkles. It offers an alternative management in a cost-effective way when compared to surgical procedures.

The Effect of Ridge Expansion on Implant Stability in Narrow Partially Edentulous Ridges - A Preliminary Clinical Study.

INTRODUCTION: Currently, dental treatments with better aesthetic results and less treatment time is more acceptable by the patients. Inadequate amount of bone for implant placement at functionally and aesthetically most appropriate position is a common problem. AIM: To assess the effect of ridge expansion on implant stability in narrow partially edentulous ridges and to evaluate clinically and radiographically the success of dental implants, placed immediately following ridge expansion procedure. MATERIAL AND METHODS: Ten participants (nine males, one female, average age - 28 years) with partial edentulism associated with narrow atrophic alveolar ridges with adequate height and willing to participate in the study were included. The ridge expansion was performed using osteotomes and simultaneous implant placement was done. A total of 10 implants were placed. Stability, achieved ridge width and radiographic crestal bone loss were assessed three months post-operatively. RESULTS: Three months follow-up revealed stable implants both clinically and radiographically. All 10 implants were surrounded by adequate amount of bone required for successful functional rehabilitation. CONCLUSION: The study reveals that the technique of ridge expansion using osteotomes is successful in horizontal expansion, in cases of atrophic alveolar ridges thus, eliminating the need for more complex treatment as well as reduces the rehabilitation time along with improving the quality of bone support.

Anterior Ridge Extension Using Modified Kazanjian Technique in Mandible- A Clinical Study.

INTRODUCTION: Good alveolar ridge is a prerequisite for successful conventional/ implant supported partial/complete denture. Extensively resorbed ridges with shallow vestibule and high insertion of muscles in to the ridge crest, leads to failure of prosthesis. Success of prosthesis depends on surgical repositioning of mucosa and muscle insertions, which increases the depth of vestibule and denture flange area for retention. So, the study was planned to provide good attached gingiva with adequate vestibular depth using Modified Kazanjian Vestibuloplasty (MKV). AIM: To evaluate efficacy of MKV technique for increasing vestibular depth in anterior mandible so that successful prosthesis can be delivered. Efficacy of the technique was evaluated through operating time required, vestibular depth achieved, scarring or relapse and any postoperative complications associated with the healing. MATERIALS AND METHODS: Total of 10 patients were included in the study, who had minimum 20mm of bone height and less than 5mm of vestibular depth for MKV procedure. The results were tabulated and statistical analysis was carried out to assess vestibular depth achieved i.e. from crest of the ridge to junction of attached mucosa both pre and postoperatively. The study results were compared with existing literature. RESULTS: Healing of raw surface was uneventful with satisfactory achievement of vestibular depth. The average gain in vestibular depth was 11 mm. The patients had good satisfaction index for prosthesis. CONCLUSION: Even in the era of implant prosthesis Modified Kazanjian technique is worth to practice to achieve good results and overcorrection is not required as that of standard Kazanjian technique. It provides adequate attached gingiva for successful prosthesis. Extension of vestibular depth enables fabrication of better denture flange with improved oral hygiene. This technique does not require hospitalization and additional surgery for grafts.

Eggshell-Derived Hydroxyapatite: A New Era in Bone Regeneration.

BACKGROUND: Defects of maxillofacial skeleton lead to personal (functional and aesthetic), social and behavioral problems; which make the person to isolate from the main stream of society. So, bone regeneration is the need for proper structure, function, and aesthetics following cyst enucleation, trauma, and tumor ablative surgery; which helps for overall health of the individual. AIM AND OBJECTIVES: The preliminary study is planned to evaluate and compare the efficacy of eggshell-derived hydroxyapatite (EHA) and synthetic hydroxyapatite (SHA) following cystectomy. MATERIAL AND METHODS: Microwave-processed calcium deficient EHA and commercially available SHA are used for grafting. Total 20 patients enrolled in this study, consisting 10 in each group between 20 and 45 years of age. All the patients were evaluated for bone regeneration at first, second, third, and sixth month's interval, postsurgically, using radiovisiograph and clinical parameters. RESULTS: The bone formation characteristics vary at second month when compared to SHA. This difference may be because of the kinetics involved in the regeneration pattern. The pattern of bone healing was trabecular after third month, indicating complete bone formation. The study showed constant raise of density and remained same at the end of study period. CONCLUSIONS: Both EHA and SHA graft materials are equally efficient in early bone regeneration. Within the limitations of this study the EHA showed promising results. Which indicates the eggshell waste-bio mineral is worthwhile raw material for the production of HA and is a Go Green procedure. Eggshell-derived hydroxyapatite is economic, compared with SHA.

Disaster Management and the Role of Oral Maxillofacial Surgeons.

"Disaster" the word itself suggests an event resulting in great loss and misfortune. In this developing world, India is becoming more powerful and is shining across the world. But we are still left to deal with various disasters, so that no harm comes to mankind. India has the occasional national disaster to which we have to promptly respond. Like the rest of the world, India has become a terror prone nation and recent attacks since the last decades affected not only the function but also it made citizens insecure. As we are in a large nation so, no matter how large a disaster it may be; we have to overcome it. The oral and maxillofacial region in a human body is very delicate with complicated anatomy, which decides the life of a human being. The management of disaster is a multitask approach, in which maxillofacial surgeon plays an important role. It is a very difficult task to operate in disaster zone. It is essential for a surgeon to make quick and important decisions under stressful conditions. Usually the surgeries are performed in a well-equipped hospital but, when it comes to disaster zone the surgeon have to treat the patient with a minimal armamentarium available within a fraction of time. The surgical competence in a disaster field is an alarming situation. Disaster management itself is not an alarming situation but the time management is important for better outcomes. A surgeon however should be trained, so that he should not miss injuries for better outcomes along with personal safety. The article discusses about disaster management strategy and guidelines for both oral maxillofacial surgeons and the statuary body to make maxillofacial surgeon as part of disaster management team for better outcomes.

Evaluation of knowledge and experience among oral and maxillofacial surgeons about cardiopulmonary resuscitation.

OBJECTIVE: This study was undertaken to assess the level knowledge and experience about CPR among oral and maxillofacial surgeons. MATERIALS AND METHODS: In a cross-sectional study, a total of 96 professionals (31-PGs, 65-MDS staff) were surveyed using a self-administered structured questionnaire pretested through a pilot survey. The data was analyzed using the SPSS version 15.0. The Student's t-test and ANOVA test were used as test of significance. The level of significance was set at p ≤ 0.05. RESULTS: In the present study, 78% of oral surgeons had received training about CPR but only 52.0% have proper practical knowledge of performing it. As there were some cases due to CPA in dental practice even then half of the participants take history of patients regarding this. A significant difference was found according to designation with PGs having lower mean scores. A positive linear correlation was found between years of experience and knowledge about CPR (Pearson's correlation, r = 0.613, p = 0.00). CLINICAL SIGNIFICANCE: The present findings showed that practical knowledge of performing CPR is still low and half of them still do not take history regarding this. So there is need for more knowledge about CPR through CDE programs.