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Introduction: The primary health centers and community health centers (CHCs) offer an opportunity for early diagnosis and treatment, dental health education, and institution of preventive measures in the remote areas. Aim: To assess the level of utilization of dental health care services and to determine barriers that prevent utilization of dental health-care services among the patients visiting CHCs in Nellore District, Andhra Pradesh. Materials and Methods: A cross-sectional study was carried out among 600 patients aged 20 years and above visiting the randomly selected 10 CHCs during May 2015 in Nellore District. A multistage sampling method was followed. The source of data was primary in nature and it was obtained through self-administered questionnaire. Data was entered and analyzed using a software program IBM SPSS Statistics version 22 (Armonk, NY: IBM Corp) (P < 0.05). Results: Only 36% of patients had visited the dentist in the last 12 months. Males (54%) visited dentist more frequently than females (46%). The most common reported reasons for the last dental visit were pain or a dental emergency (71%), followed by restorative treatment (17%) and other reasons (12%). The most commonly reported reasons for not seeking dental care were “Not needed unless having pain” by 360 (60%), “I do not think dental diseases are very serious” by 304 (51%), “I have fear of dental procedures” by 290 (48.6%),“Lack of time” by 235 (45.6%), “Dental treatment is expensive” by 200 (33.3%), and “The dentist is at a long distance” by 158 (26.8%). Conclusions: Our findings suggest that only a small portion of population visited a dentist in previous year. Most of them believe that visiting dentist is necessary only for pain relief.

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Introduction: Oral health status has witnessed marked advances in many industrialized countries. However, dental caries is consistently increasing in developing countries, and periodontal diseases are among most common afflictions to humankind. Approach best suited for developing countries is to focus on the prevention with innovative strategies. Hence, evolution of novel, innovative strategies to prevent dental caries and periodontal diseases is need of hour. Objective: To determine minimum inhibitory concentration (MIC) of combinations of Acacia nilotica, Murraya koenigii L. Sprengel, Eucalyptus hybrid, and Psidium guajava against dental caries and plaque microorganisms and to qualitatively identify various phytochemical constituents in individual plant extracts and their quadruple combinations. Materials and Methods: MIC of the combinations of A. nilotica, M. koenigii L. Sprengel, Eucalyptus hybrid, and P. guajava on Streptococcus mutans, Lactobacillus acidophilus (dental caries bacteria), Streptococcus sanguis, Streptococcus salivarius (primary plaque colonizers), Fusobacterium nucleatum (secondary plaque colonizer), and Porphyromonas gingivalis (tertiary plaque colonizer) was determined using broth dilution method. Series of dilutions of quadruple combinations ranging from 0.05% to 1.5% were prepared. 100 μL of each serial dilution of quadruple combinations was added to each tube containing bacterial culture. The optical density was noted after incubation in each tube to estimate the MIC for each bacterium. Results: MIC of the polyherbal combinations on S. mutans, S. sanguis, S. salivarius, L. acidophilus, F. nucleatum, and P. gingivalis was found to be 0.25%, 0.05%, 0.05%, 0.1%, 0.25%, and 0.25%, respectively. Conclusion: The quadruple combinations of these four plant extracts could be considered in the evolution of an indigenous polyherbal mouth rinse as the formulation inhibited all the bacteria tested in the present study at low concentrations.

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Introduction: Dental health-care professionals are expected to provide a wide range of dental care contributing to the quality of their patient's day-to-day lives, for which they are trained clinically during undergraduate (UG) course. Owing to scarcity of literature pertaining to challenges faced by dental UGs during their clinical training, research was conducted. Aim: The aim of this study was to assess challenges faced by dental UGs during the first patient encounter with patients in clinical posting. Materials and Methods: Four focused group discussions (FGDs) were conducted among 34 dental UGs using an FGD guide to facilitate the discussion process. A phenomenological approach was used to explore the lived experience of UGs. The recorded data were transcribed, translated, anonymized, and coded using Qualitative Data Analysis Miner software. Results: UGs were facing challenges related to communication, professionalism, and ethics every other day while treating patients. FGD conducted was able to explore the challenges faced by UGs during clinical posting such as language barrier, optimum utilization of material, and uphold confidentiality. Conclusions: Improving current state of UGs by taking care of all the mentioned challenges will help them become professionals with good communication skills.

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Introduction: Dental caries is seen across all age groups and in all populations. Several sociobehavioral factors existing in a broader cultural and environmental context can affect caries prevalence. Aims: To determine the prevalence and severity of caries across gender, age, and educational levels and to study the association between oral hygiene behaviors, daily habits, and caries. Materials and Methods: The cross-sectional study recruited participants ≥18 years from Ramgarh, Chhindwara district in Madhya Pradesh, India. Information was collected on demographics, oral hygiene behaviors, and daily habits. Overall caries experience was quantified using decayed, missing, filled tooth index through intraoral examinations. Results: Use of toothbrushes, (P < 0.001) toothpastes (P < 0.001), and fluoridated toothpastes (P = 0.01) was significantly higher in younger participants aged 18–34 years than in older adults. Brushing twice daily (P = 0.05), use of toothbrushes (P < 0.001), toothpaste (P < 0.001), and fluoridated toothpaste (P < 0.001) was significantly higher among participants with ≥8 years education than participants with no formal education or ≤8 years of education. Use of tobacco was significantly more common among people with no education, people with ≤8 years of education (P = 0.02), and males (P < 0.001). Participants ≥45 years had 3.2 times higher odds of having decayed, missing, filled teeth scores ≥1 than the younger age groups. Conclusions: Poor oral hygiene behaviors among older adults, males, and participants with ≤8 years of education were associated with higher caries experience and missing teeth as a result of caries.

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Introduction: The relationship between oral health and tooth retention is complex. Dental caries and periodontal diseases are the main reasons for tooth loss; the contribution of other modifying factors such as cultural beliefs, socioeconomic characteristics, access to dental care, and dental practitioner's philosophy of treatment may also influence the decision to extract teeth. Aim: The aim of this study is to assess the prevalence and risk indicators of tooth loss in an adult population visiting community health centers (CHCs), Nellore district. Materials and Methods: A cross-sectional study was conducted among adult patients visiting the outpatient wards of 10 CHCs which were selected by multistage random sampling. A total of 450 patients in the age range of 35–74 years were surveyed using a structured questionnaire followed by clinical examination. Questionnaire was regarding age, sex, socioeconomic status (SES), smoking habits, dental visiting patterns, and oral hygiene practices. Clinical examination was performed using dentition status from the WHO pro forma and loss of attachment (LOA) with LOA Index. Results: Overall prevalence of tooth loss was 50.39%. The highest prevalence of tooth loss was reported in 65–74 years old age group (96.18%) and upper lower class. Males had highest tooth loss prevalence (64.29%) with mean tooth loss of 3.08 ± 3.59. Multiple logistic regression done to assess the impact of various independent variables on tooth loss revealed that age, gender, SES, habits of cleaning teeth, frequency of brushing teeth, time of brushing, dietary habits, visit to dentist, dental caries, and LOA had a significant impact on tooth loss. Conclusion: Age, gender, SES, habits of cleaning teeth, frequency of brushing teeth, time of brushing, dietary habits, visit to dentist, dental caries, and LOA were identified as risk indicators for tooth loss among adult people visiting community health centers in Andhra Pradesh.

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Introduction: Tobacco use continues to be the leading global cause of preventable death. Dental health professionals play a significant role in the intervention of the tobacco-related epidemic. Aim: The aim of this study was to compare the effectiveness of health education (HE) alone and HE with cognitive behavior therapy (CBT) at a dental tertiary referral unit of South India. Materials and Methods: Self-reported quit attempt was assessed and the sample size was estimated at 194. Tobacco users who met the inclusion criteria were randomly assigned to one of the two groups - HE only and HE with CBT. Age, sex, socioeconomic status, form of tobacco usage, alcohol usage, addiction and stage of motivation, knowledge, attitude, and behavior regarding tobacco use, and ill effects were assessed at baseline. Follow-up was for 6 months (2^nd, 6^th, 12^th, and 24^th weeks) to assess reduced use, quit attempt, point prevalence abstinence, continuous abstinence, lapse, relapse, and attrition rates in each visit. The self-reported quit rates were validated using the standardized cotinine test. Pearson's Chi-square test was used to determine the effectiveness of intervention. Results: Continuous abstinence was significantly high in CBT. Reduced use and point prevalence abstinence were significantly higher in HE. Quit attempt in both the groups was equal showing no statistical significance. Attrition was significantly higher in HE compared to CBT. Conclusion: CBT plays a vital role in achieving continuous abstinence, overcoming social factors, and reducing lapse among the tobacco users.

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Introduction: Dental caries is the most prevalent oral disease among childhood. Dental caries in primary dentition is often neglected since they exfoliate, and its treatment is considered as economic burden among lower socioeconomic families. Aim: To assess the prevalence of dental caries in the primary teeth of 3–6–year-old preschool Anganwadi children in Mudhol town of Karnataka. Materials and Methods: A cross-sectional study was conducted over 758 children, aged 3–6 years studying in 15 Anganwadis of Mudhol. Type III WHO method of examination was followed, and decayed, missing, filled teeth (dmft) index was recorded according to the WHO criteria. The data were analyzed by Z-test and Chi-square test using SPSS version 17 software. Results: Among the study population, 62.14% were found to be affected by dental caries. The prevalence of dental caries increased with increase in age. No significant difference was found with respect to gender. The mean dmft was 2.34. The filled component was nonexistent among these children. Second primary molars were the teeth most affected by caries followed by first molars and central incisors. Conclusion: Dental caries prevalence of 62.14% and mean dmft of 2.34 among Anganwadi children of Mudhol town is a cause for concern. The nonexisting filled component among these children indicates high unmet restorative treatment needs. Dental health services should be made available in the peripheral areas to meet the needs of young children.

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Introduction: Oral cavity ecosystem represents a dynamic pattern. An effective plaque control measure should target plaque formation before the mature plaque is formed. Various types of chemotherapeutic agents are coming up with different antimicrobial agents in them. Hence, this study has been undertaken to know whether these antimicrobial agents are effective on common microorganisms of oral cavity which directly and indirectly contributes to plaque formation Aim: The aim of this study was to determine antimicrobial efficacy of different mouthrinses against the oral pathogens in vitro. Materials and Methods: A total of seven mouthrinses were tested for their antimicrobial activity against three oral pathogens, namely, Streptococcus mutans (MTCC 890), Escherichia coli (ATCC 25922), and Candida albicans (ATCC 10231) by well agar diffusion assay. Statistical analysis was performed using Kruskal–Wallis test. The level of significance used was P< 0.05. Results: Mouthrinse with chlorhexidine (CHX) gluconate, triclosan as main ingredients showed maximum zone of inhibition (P = 0.003) against streptococcal mutans and E. coli at 1:16 dilution and mouthrinse with CHX gluconate and zinc chloride showed maximum zone of inhibition at 1:16 dilution against Candida among seven mouthrinses used in the present study. It was also observed that zone of inhibition of all the mouthrinses decreased with the increase in dilution. Conclusion: Among mouthrinses formulations, CHX combined with other active ingredients was found to be more effective.

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Introduction: Pediatricians play a pivotal role in the provision of primary care following dental trauma, especially for population with limited access to dental care. The criticality of time and knowledge is very important in the success of dental trauma management. Objective: The objective of this study was to evaluate the knowledge and experience of pediatricians in the primary management of dental trauma. Materials and Methods: A questionnaire-based cross-sectional survey was conducted among 261 pediatricians from various regions of India who attended the National Pediatric Conference, Mysore 2015. The survey addressed demographic- and knowledge-related data concerned to dental trauma, experience in treating and witnessing dental trauma, diagnosis, preliminary management, and attitude of the pediatricians toward the same. The collected data were analyzed using the SPSS version 17. Results: Among 261 respondents analyzed, 65.5% of them had encountered dental trauma in their practice. Avulsed tooth can be saved as opined by 67.8% of pediatricians. A higher percentage of the pediatricians, 94.3% knew the significance of time lapse. Saline was preferred medium of transport by 90.8%, followed by ice-cold water (78.2%). A fair awareness of the emergency treatment protocol of the avulsed teeth was observed among 59.8% of the pediatricians. Conclusion: Among pediatricians, the knowledge regarding handling of avulsed tooth, medium of transportation, and significance of time lapse between avulsion and reimplantation were found to be at a good level. The knowledge regarding the type of tooth to be reimplanted, method of cleaning the tooth was lacking.

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Introduction: Tobacco smoking exerts a harmful effect on the periodontal tissues manifested by periodontal pockets, attachment loss, and periodontal bone loss. Various factors contribute to the deleterious periodontal effects of smoking, including alteration of both microbial and host response factors. Moreover, smoking may exert effects throughout the cytokine network. Aims: The aim of this study was to evaluate the influence of smoking on periodontal biomarkers possibly related to the development of periodontitis including inflammatory mediators and pro-inflammatory cytokines in saliva. Materials and Methods: A total of sixty subjects aged 30–55 years were included in the study and divided into three groups: systemically and periodontally healthy individuals (Group 1), subjects with pocket probing depth (PPD) ≥5 mm and clinical attachment loss (CAL) of ≥2 mm (Group 2), and a subjects smoking (≥10 cigarettes a day) with periodontal parameters of Group 2 (Group 3). Periodontal parameters of PPD, CAL, gingival index (GI), and plaque index were measured using standard indices and criteria. Three milliliters of unstimulated saliva was taken, and salivary tumor necrosis factor-alpha (TNF-α) and matrix metalloproteinase-8 (MMP-8) were determined using ELISA technique. Results: The mean GI was lowest for Group 3, but the mean probing depth of Group 3 (4.93 ± 0.41) was highest. The mean TNF-α level of Group 3 was significantly different and higher as compared to Group 1 and Group 2 (24.32 ± 8.32 ng/ml vs. 6.43 ± 2.65 ng/ml, q = 16.14; P< 0.001). Similarly, the mean MMP-8 level of Group 3 (461.71 ± 58.01 ng/ml) was significantly different (P < 0.001) and higher as compared to Group 1 (192.96 ± 134.89 ng/ml) and Group 2 (347.83 ± 206.72 ng/ml). Both markers showed positive and significant correlation with their periodontal status. Conclusion: Our study clearly indicates a profound effect of smoking on salivary markers of periodontal disease (TNF-α and MMP-8) in chronic periodontitis subjects in comparison to healthy controls.

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Introduction: Every dental health professional should have the essential knowledge to identify, assess and manage a potentially life-threatening situation. Aim: To assess the experience, awareness, and perceptions about medical emergencies among dental interns in Chennai city, India. Materials and Methods: A cross-sectional study carried out in four randomly selected dental colleges of Chennai city. Data were collected using a self-administered, structured, closed-ended 20-item questionnaire. It consists of questions on experience of medical emergencies encountered by interns during their graduation, awareness of the essential drugs and equipment, the amount of medical emergencies training undertaken by participants, preparedness of interns in handling medical emergencies. Descriptive statistics, independent sample t-test, were used. Results: Out of 335 interns, 157 (47%) said that syncope was the most common medical emergency event encountered by the interns. Regarding awareness about essential drugs, about 161 (48%) study participants answered oxygen, epinephrine, nitroglycerin, antihistamine, salbutamol, and aspirin as emergency drugs. About half of the study participants, 187 (56%) were aware that pressure should be given to the affected site, with or without suturing if the greater palatine artery is inadvertently cut. The majority of the interns (93%) preferred to have a specified training on the handling of medical emergencies in dental practice. Conclusions: Syncope was the most common medical emergency event. Awareness about the essential drugs, equipment, and preparedness of dental interns in handling medical emergencies was low.

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Introduction: Dental caries is a common disease of the childhood affecting the quality of life (QoL). Studies have focused on oral health including caries experience in underprivileged children. However, information concerning relationship between caries experience and QoL of orphanage children is scarce. Objective: To assess caries experience and its relationship with oral health-related QoL (OHRQoL) among orphanage children in Bengaluru city. Materials and Methods: A cross-sectional study was conducted among 200 orphanage children aged 7–18 years from six randomly selected orphanages in Bengaluru city. Demographic data were obtained through self-designed questionnaire while OHRQoL was assessed using prevalidated Child Oral Health Impact Profile-Short Form questionnaire (COHIP-SF). Caries experience was determined using decayed, missing, filled teeth/Decayed, Missing, Filled Teeth (dmft/DMFT) indices. Descriptive statistics and Spearman's correlation were performed using SPSS-16. P< 0.05 was considered statistically significant. Results: Among study participants, caries experience in primary and permanent dentition was 40.5% and 38%, respectively, while mean dmft and DMFT were 1.26 ± 2.00 and 0.96 ± 1.49, respectively. Mean COHIP-SF was 56.83 ± 11.10. COHIP-SF positively correlated with DMFT (rho = 0.21, P = 0.002) and negatively correlated with dmft (rho = −0.26, P = 0.001). Conclusions: Dental caries experience was similar in primary and permanent dentition among orphanage children. Higher COHIP-SF scores indicate positive OHRQoL. Dental caries significantly correlated with their OHRQoL. Innovative oral health promotion program through the help of public–private partnership could enhance their OHRQoL.

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Introduction: Psychological disturbances in clinical dental students and teachers remain largely unknown. Aim: To describe the psychological health of clinical dental students and their trainers in an institution in India. Materials and Methods: A cross-sectional, questionnaire-based study was conducted among clinical dental students and faculty of an Indian dental college in November 2014. The questionnaire consisted of depression anxiety stress scales-21 (DASS 21), a short version of the original 42-item DASS. Data were compiled on SPSS version 21. Group comparisons were done and P values were obtained. All tests were two-tailed with significance set at P< 0.05. Results: Stress scores were found to be higher in students as compared to trainers (P = 0.040), with the highest scores for undergraduate students. Statistically, significant difference was seen in stress scores between graduate and postgraduate trainers (P = 0.015), undergraduates and postgraduate trainers (P = 0.005), and postgraduate trainers and students (P = 0.029). A significant difference was also observed between depression scores in graduate and postgraduate trainers (P = 0.006) as well as postgraduate trainers and students (P = 0.041). Females had significantly higher level of stress (P = 0.007) and anxiety (P = 0.003) scores as compared to males. Conclusion: Stress, anxiety, and depression scores in dental students are higher than trainers. Undergraduate students among all showed the highest scores for all three parameters. Different approaches to reduce them should be further investigated and utilized at the earliest.

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Introduction: Among all innovative technologies, net is one among the recent and also the most innovative media by that one will keep connected with the remainder of the planet. This facility provides huge volume of oral health consciousness at the side of oral health info to net users who eventually have an effect on the dentist–patient relationship. Aim: The aim of this study is to evaluate the attitude of patients and dentists for the treatment of oral diseases after the use of internet by the patient. Materials and Methods: In a cross-sectional study, data were collected from 153 dentists and 449 patients. The data from the dentists were collected from hospitals and private practices. Data from the patients were collected in urban area. The questions asked to dentists and patients were such that each respective question in both the questionnaires gave the same conclusion. Results: Dentists (56.2%) agreed changes in patients thinking after the usage of internet. Within 21–40 years, 40.4% of dentists agreed that internet represents a threat to dentist–patient relationship. Conclusion: The usage of internet by the patients had brought about changes in patients thinking and the dentists had modified or guided patients in the use of oral health information obtained from the internet.

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Introduction: Dental erosion is tooth surface loss caused by chemical processes without bacterial involvement, which can affect children because of various dietary and other lifestyle factors. Aims: The aim of this study was to assess the prevalence of dental erosion in 12-year-old schoolchildren in Lucknow city. Materials and Methods: A total of 212 schoolchildren were selected through multistage cluster random sampling method. A pretested self-administered pro forma was used to record demographic data, medical history, and dietary habits. The clinical examination was done to evaluate dental erosion of children using dental erosion index by O'Sullivan. Descriptive analytical tests were used including distribution of erosion, its extent and severity. The findings were compared across the study participants using Chi-square test. Results: The overall prevalence of dental erosion was 34.12% with no significant sex difference. Dental erosion was significantly related to the frequency of consumption of fruit juices (67.07%) followed by carbonated drinks (64.47%). In most of the cases, more than half of their surfaces were diagnosed as affected by erosion (26.25% central incisors, 4.83% lateral incisors). Conclusions: Dental erosion among the study group was found to be 34.12%, providing evidence that dental erosion is becoming a significant problem in Lucknow schoolchildren.

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Introduction: More than one-third of the tobacco consumed in India is of smokeless form. While the smokeless tobacco (ST) products have been strongly associated with oral cancer, the association between ST and periodontal disease is less clear. The present study was conducted on industrial workers because in premises, there is a ban on smoking tobacco and hence workers tend to consume more of ST products. Aim: The aim of this study is to assess periodontal status in ST chewers and nonchewers among industrial workers in North Bengaluru. Materials and Methods: A cross-sectional analytical study was conducted on 800 industrial workers (400 ST chewers and 400 nonchewers) of North Bengaluru. Information regarding ST habits was obtained using the Global Adult Tobacco Survey questionnaire, followed by clinical examination to assess periodontal status using the community periodontal index and attachment loss. The comparison between chewers and nonchewers was done using Pearson's Chi-square test. Logistic regression analysis was used to estimate the difference of periodontal status and loss of attachment (LOA) between chewers and nonchewers. Results: ST chewing habit was observed the maximum (46.5%) among age group 25–44 years. Most of male chewers had habit of chewing gutkha followed by khaini, and majority of the female chewers were using khaini followed by betel nut quid. A significantly higher prevalence of bleeding on probing and calculus was found among nonchewers. ST chewers had 2.06 (95% confidence interval [CI]: 1.55–2.75) times more risk of developing periodontal pockets and 2.23 (95% CI: 1.68–2.98) times more risk of having LOA when compared with nonchewers. Conclusions: ST has deleterious effects on the periodontium. Hence, it is one of the important risk factors for periodontal disease.

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Introduction: Social reward is a result of human interactions that motivates and gives happiness. In this study, an attempt was made to understand various domains of the social reward of dental staff. Aim: The aim of this study was to examine the individual differences in the value of social reward among dental staff working in teaching health-care institutions. Materials and Methods: A questionnaire-based study was conducted on dental staff working in teaching health-care institutions. Demographic data were collected. The social reward was assessed using Social Reward Questionnaire on a seven-point Likert scale. The mean value of each domain was calculated and compared based on the academic experience of the staff. The significance difference was tested using one-way ANOVA. Results: A total of 290 dental staff members of a mean age of 33.4 ± 6.2 years participated in the study. Those with academic experience of <1 year had a highest mean value with regard to domains such as admiration and sociability. The staff members of >11 years of experience had the highest mean value with regard to pro-social interaction. Conclusion: Understanding the individual differences in valuing social reward is useful to organizations in promoting a better work environment, contributes for pro-social behaviors among staff, helps in sustaining the worth, and contributes for positive human interactions.

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