Swami Devi Dyal Hospital & Dental College
Village Golpura, Teh. Barwala, Dist. Panchkula (Haryana) Tel No. 01734-258195 Fax No. 01734 - 258195 Mobile No. 09988889035 Email:
[email protected]
The Journal of the Indian Association of Public Health Dentistry(JIAPHD), Vol. 2011, Supplement III, Issue: 18
With Best Compliments from
Vol. 2011
SUPPLEMENT III
ISSUE : 18
ESTD 1993
THE INDIAN ASSOCIATION OF PUBLIC HEALTH DENTISTRY (IAPHD) Registered under the Registrar of Societies, Bangalore, No. 777/93-94 H.O : 32, 100 Feet Road, 3rd Phase 6th Block Banashankari, Bangalore - 560 085. Founder Members Dr. R.K.Bali Dr. M.R.Shankar Aradhya Dr. Shaik Hyderali Dr. Ganesh Shenoy Panchmal Dr. K.V.V. Prasad Dr. M.B.Aswath Narayanan Dr. BK Srivatsava Dr. H L Jayakumar Dr. Yellappa Dr. Karim Virjee Dr. N Vijay Kumar Dr. Gopal Raje Urs Dr. S S Hiremath President: Dr. R K Bali Padmashree Awardee Adviser: Dr. M R Shankar Aradhya Vice Presidents: Dr. M Arunadevi Dr. Vijay Kumar Hon.Gen. Secretary: Dr. S S Hiremath Joint Secretary: Dr. Joseph John Treasurer: Dr. V Gopikrishna Editor: Dr. M B Aswathnarayanan E C Members Dr. B K Srivastava Dr. Md Shakeel Dr. Manjunath P Puranik Dr. Arun Doddamani Dr. P D Madan Kumar Dr. S R Uma
Co-opted Members Dr. Ganesh Shenoy Panchmal Dr. Ajit Krishnan Dr. Sahana Hegde Dr. Pankaj Goel Dr. Sabyasachi Saha Dr. Shashidar Acharya Dr. Chaitanya Reddy Editorial Board Dr. C Dileep Dr. N Anup Dr. M Pramila Dr. Padma Rajkumar Dr. M Senthil Dr. Tanupriya Gupta Central Committee Dr. Md Shafiulla Dr. C V K Reddy Dr. D P Narayan Dr. Karim Virjee Dr. M Shivakumar Dr. Ashok Kumar Mohapatra Dr. Parthasarthy Dr. Anil Ankola Scientific committee Coordinators Dr. Nusrath Fareed Dr. S Pushpanjali Dr. J Chandrashekar Website Coordinators Dr. Manjunath P Puranik Dr. M Naganandini Dr. Namita Shanbhag
Members Dr. M Shivakumar Dr. G N Chandu Dr. Jitesh Jain
E STD 1993
JOURNAL OF THE INDIAN ASSOCIATION OF PUBLIC HEALTH DENTISTRY VOL: 2011 ISSUE: 18 SUPPL. III
Contents Supplement III 168. Dentistry in News: An Analysis of Newspapers and Magazines in Uttar Pradesh Dr. Ravishankar T.L, Dr. Chaitra T.R., Dr. Naveen Kumar B.
925
169. Is Mouthwash an Eyewash? A Review Dr. Suvarna Patil, Dr. Laxmi Hombal, Dr. Sheetal Sanikop, Dr. Mamata Hebbal
928
170. Endodontics by Emerging Dentists Dr. Gayathri Sundari Jethwani, Dr. Kavita Verma, Dr. Sultana S Sayed, Dr. Jitendra Jethwani
934
171. Prevalence and Prevention of Dental Caries and Gingivitis in Patients undergoing Orthodontic Treatment Dr. S. Venkateswaran, Dr. Ashwin Mathew George, Dr. A. Shree Mankinda Prabhu, Dr. M.K. Anand, Dr. N.R. Krishnaswamy
939
172. H1N1 Flu (Swine Flu) Precautions for Dental Professionals Dr. Amit Vanka, Dr. G. Shanthi, Dr. Ajay Bhambal, Dr. Vrinda Saxena, Dr Sahana, Dr. Sudhanshu Saxena
942
173. A Greater Focus on the Knowledge and Attitude on the Management of Children with Special Needs among Primary Dental Care Providers Dr. Punithavathy, Dr. Esther Nalini, Dr. Geetha Priya Dr. Rachuri Narendra Kumar, Dr. Joe Louis
945
174. Oil Pulling Therapy on Streptococcus mutans Count in Plaque and Saliva - A Randomized Controlled Trial Dr. Sharath Asokan, Dr. Jeevarathan J, Dr. Shakeer A, Dr. Pamela Emmadi, Dr. Raghuraman R
948
175. Multidisciplinary Management of Complicated crown - Root Fractures of maxillary lateral Incisor and Canine - A Case Report Dr. Shah Dipali, Dr. Garde Janardan, Dr. Vora Reena, Dr. Vijaykumar L
953
176. Prevalence of Dental Fluorosis in Permanent teeth at varying degree of Fluoride levels A Cross sectional Survey Dr. T. Mahantesh, Dr. H.G. Raju, Dr. (Mrs.) Uma B Dixit, Dr. Ramesh P Nayakar
957
177. Socio-Demographic factors and Tooth loss Dr Dipanjit Singh, Dr Shanmukha G, Dr Jasheena Singh, Dr Ashish Chowdhary, Dr Dildeep Bali
963
178. Assessment of Gingival and Dental Caries Status among 12 and 15 years old School going Children of Ahmedabad City - A Pilot Study Dr. Patel Dhaval R., Dr. Parkar Sujal M.
967
(i)
E STD 1993
JOURNAL OF THE INDIAN ASSOCIATION OF PUBLIC HEALTH DENTISTRY VOL: 2011 ISSUE: 18 SUPPL. III
179. Impact of Orthodontic Treatment and Socioeconomic Status on Daily performances in Indian School Children: A Two Centre Study Dr. Mehta S, Dr. Malviya N, Dr. Sivakumar A, Dr. Valiathan A, Dr. Nayak Krishna U.S
972
180. Modern Dentistry: The Economic aspect Dr. Abhinav Kumar, Dr. Priyanka Sethi Kumar, Dr. Stutee Bali Grewal, Dr. Mandeep Grewal, Dr. Dildeep Bali
978
181. Health Care Waste Management : A Biosafety Issue Dr. Sadaf Nishat, Dr. Shweta Bali, Dr. Priyanka Chopra, Dr. M. Siddarth
979
182. Cultural Practices involving Teeth and Oro-facial Soft Tissues - A Review Dr. Neeraj Singh Chauhan, Dr. G Shanthi, Dr. Vikram Singh, Dr. Arpan Shrivastav, Dr. Sumit Khare
984
183. Gerodontology - Orodental Care for Elderly - A Review Dr. Luthra R.P., Dr. Bhardwaj V. K., Dr. Sharma K.R., Dr. Jhingta P.
989
184. Various Methods of Gingival Pigmentation: A Case Report Dr. Parvati Malhotra, Dr. K. Padmavathi, Dr. Abhishek Kandwal
995
185. Prevalence of Malocclusion and its correlation with Incidence of Caries and Periodontal Disease Dr. Saravana Kumar S, Dr. Anita V, Dr. Divya Loganathan, Dr. Shanmugam M, Dr. Shivakumar V
999
186. Non Invasive Esthetic management of Congenitally Missing Central Incisor tooth using a Condition Specific Custom Made Matrix Dr. Shanmugam Jaikailash, Dr. Mahendran Kavitha, Dr. Disha Thareja
1004
187. Comparision of Effectiveness of Mini Implants vs Conventional Implant supported Overdentures - A Review of Literature Dr Ashish Choudhary, Dr. Ekta Choudhary, Dr. Jay Vikram, Dr. Dipanjit Singh, Dr. Kuldeep
1007
188. Oral Health Status of Children with Cardiac Disease and the Awareness, Attitude and Knowledge of their Parents Dr. Madhavan. V, Dr. M. Jayanthi, Dr. Elizabeth Joseph, Dr. D.Senthil
1012
189. Evidence Based Dentistry - The Need for Better Clinical Practice Dr. Pavan Kumar K.R, Dr. Nandeeshwar D.B.
1019
190. Teaching Medical and Dental Doctors through Non-technical Skills - A View Dr Vinay Kumar Gupta, Dr Seema Malhotra, Dr Mohit Mohan Singh, Dr Sandeep Kumar
1024
191. Implications of Socio-economic factors in Complete Denture Treatment in Bhopal an Epidemiological Survey Dr. J. Varsha Murthy, Dr. Naveen S. Yadav, Dr. Vrinda Saxena, Dr. Yuvaraj V, Dr. Akash Krishna
1028
(ii)
E STD 1993
JOURNAL OF THE INDIAN ASSOCIATION OF PUBLIC HEALTH DENTISTRY VOL: 2011 ISSUE: 18 SUPPL. III
192. Cross Infection control in Impression making Procedures - A Pilot Survey Dr. Murali S, Dr. Shankar S, Dr. Kruthika M, Dr. Vishnudev P.V, Dr. Mythili Merunalavathi S
1031
193. Communication Proficiency in Dentistry - A Stepladder to Success!. Dr. Gaurav Beohar, Dr. Utkarsh Katare, Dr. Swapnil Parlani, Dr. Surendar Agrawal, Dr. Sudhanshu Saxena
1036
194. Caries Prevalence among 5-12 years School Children residing in Rural Chennai Dr. M. Senthil Kumar, Dr. S. Bala Gopal, Dr. Sridhar Reddy, Dr. A. Venkatesh
1040
195. Head and Neck Radiotherapy - Consequences and its Management Dr. Nidhi Gupta, Dr. Mohit Bansal, Dr. Shelja Vashisth, Dr. Nanak Chand Rao
1044
196. Prevalence of Gingival Recession in Lucknow, Northern India - A Cross Sectional Survey Dr. Ranjana Mohan, Dr. Mohan Gundappa
1049
197. Management of Grossly Mutilated Central incisor using Biological Post and Crown: A Case Report Dr. Mahendran Kavitha, Dr. Shanmugam Jaikailash, Dr. Kannan Gokul
1057
198. Antibiotic Resistance - Current Issues and Implications Dr. Elizabeth Joseph, Dr. M. Jayanthi
1062
199. Oral Hygiene Status of 7-12 year old School Children in Rural and Urban population of Nellore District Dr. M.S. Minor Babu, Dr. SVSG Nirmala, Dr. N. Sivakumar
1075
200. Systemic Lupus Erythematosus - A Rare Case Report with Review of Literature Dr. P.E. Chandra Mouli, Dr. (Capt).S.Manoj Kumar Dr. B. Anand, Dr. P.D. Madan Kumar, Dr. S. Shanmugam
1081
201. Occlusion in Complete Denture: A Review Dr. Utkarsh Katare, Dr. Gaurav Beohar, Dr. Anup Mangal, Dr. Swapnil Parlani, Dr. Sudhanshu Saxena
1086
202. Oral Lesions commonly associated with HIV Infection in South Indian Population. Reports of few cases with Literature Review Dr. Nalini Aswath
1091
203. Dental Distraction - A Case Study Dr. R. Saravanan, Dr. N. Raj Vikram, Dr. Swati Acharya
1095
204. A New Nomenclature for the number of Roots in Maxillary Permanent Molar Teeth Dr. A.V. Rajesh Ebenezar, Dr. Ajit George Mohan
1098
205. Assessment of Knowledge and Practices Regarding Infant Oral Health Care in Chandigarh Population Dr. Manjot Kaur, Dr. Ashima Goyal
1102
(iii)
E STD 1993
JOURNAL OF THE INDIAN ASSOCIATION OF PUBLIC HEALTH DENTISTRY VOL: 2011 ISSUE: 18 SUPPL. III
206. Chelioscopy: Determination of Sex and Blood Group Dr. Vidya GD, Dr. Sreeshyla HS, Dr. Usha Hegde, Dr. Shivananda S
1109
207. Dental Survey of Deaf and Dumb Children in a Special School from Pune Dr. Mamatha GS, Dr. Kakodkar P, Dr. Deshpande T
1114
208. The Remineralization Potential of CPP-ACP (GC Tooth Mousse) and TCP with 0.21% W/W Sodium Fluoride Anti-cavity Paste (Clinpro Tooth Crème) on Artificial Caries -like Subsurface Lesions in Primary and Permanent Teeth - An in-vitro Study Dr. Arun Prasad. R, Dr. M. Jayanthi, Dr. Elizabeth Joseph, Dr. D. Senthil
1118
209. A Cross-sectional Survey of Quality assurance in Endodontic Practice amongst Indian Endodontists Dr. Mohan Gundappa, Dr. (Mrs.) Ranjana Mohan, Dr. Neeraj Kumar
1125
210. Maxillary Necrosis by Rhino-maxillo Cerebral Mucormycosis. A rare Case Report and Literature Review Dr. (Capt).S. Manoj Kumar, Dr. P.E. Chandra Mouli, Dr. B. Anand, Dr. P.D. Madan Kumar, Dr. S. Shanmugam
1134
211. A Cross Sectional Study on the Prevalence and Determinants of Dental Caries among School Children of Padur Dr. V. Shivakumar, Dr. V. Gopinath, Dr. R. Saravanakumar, Dr. V. Anitha, Dr. M. Shanmugam
1138
212. Molars with Single Root and Single Canals Dr. Ajit George Mohan, Dr. A.V. Rajesh Ebenezar, Dr. A. Vinita Mary
1144
213. Attitude and Awareness toward Periodontal Therapy in North Indian Population: A Questionnaire Survey Dr. Archana Bhatia, Dr. M.P. Singh, Dr. Rohit Chopra
1148
214. A Randomized Controlled Trial of Lycopene in Oral Submucous Fibrosis Dr. Revant H. Chole, Dr. Swati V. Balsaraf, Dr. B.S Dangi, Dr. Shailesh Gondivkar, Dr. Amol Gadbail, Dr. Satish Balwani, Dr. Mugdha Gadbail, Dr. Rima Parikh
1156
215. A Maxillary First Molar with Six Canals: A Case Report Dr. A. V. Rajesh Ebenezar, Dr. A. Vinita Mary
1160
216. Periodontal Treatment of Multi - Rooted Teeth Dr. D. Jayanthi, Dr. M.B. Aswath Narayanan, Dr .S.G. Ramesh Kumar
1164
217. Integrating Bleaching with different Treatment Modalities: A Review Dr. Dildeep Bali, Dr. Deepika Thosre Chandhok, Dr. Dipanjit Singh, Dr. Ashish Chowdhary, Dr. Shweta Bali, Dr. Pryanka Thakural, Dr. Ekta Chowdhary
1169
218. Vascular Leiomyoma of the Gingiva - A Rare Case Report Dr. M.P. Singh, Dr. Archana Bhatia, Dr. Rose Kanwaljeet Kaur
1174
219. Adult Orthodontics - A Boon for the Periodontal Patients Dr. Rohini Mali, Dr. Vishakha, Dr. Amita Mali, Dr. Priya Lele, Dr. Darshana Dalaya
1178
(iv)
JOURNAL OF THE INDIAN ASSOCIATION OF PUBLIC HEALTH DENTISTRY Vol:2011 ISSUE:18 SUPPL. III
Dentistry in News: An Analysis of Newspapers and Magazines in Uttar Pradesh Dr. Ravishankar T.L1, Dr.Chaitra T.R.2, Dr.Naveen Kumar B.3 ABSTRACT The public pays attention to health in media, and it could be a positive influence on the nations thinking about health. So an effort is made to analyse the newspaper and magazine reports in Uttar Pradesh print media. We retrospectively searched the three newspapers and four weekly magazines circulated in Uttar Pradesh for relevant health related articles. 262 articles were identified in newspapers, out of which only 3.43% are related to dental science. From the result it is evident that dentistry and research findings in this field were regarded as insignificant and not worth mentioning by Indian journalist. Dentists, dental policy makers and dental researchers should provide the editor with significant dental information, and convince them that this information is of considerable news value. Key words: Newspaper coverage, Magazines, Print media, Dental information. INTRODUCTION
much information would reach the general public through the mass media. So an effort is made to analyse the number of articles relating to dentistry /health care published in mass media.
The news media are a major source of information about health issues for both the public and for the health professionals and can have an influence on decision making about treatment choice and medical care.1 The public pays attention to health in media; over half of the US adults report that they follow health news closely 2. Thus the press is well positioned to educate the public about health and health risks. In short the press could be a positive influence on the nation’s thinking about health. A Cochrane review identified 5 studies that evaluated health care utilisation before and after media coverage of specific events1. Favourable publicity was associated with higher use; unfavourable publicity was associated with lower use.
MATERIAL AND METHOD
We retrospectively searched the three largest circulated daily newspapers in state of Uttar Pradesh (India), The newspaper included “Times of India” published in English language which had an annual readership of 133.32 lakhs people; other two newspapers were “Danik Jagaran” and “Amar Ujala” published in Hindi, national and also the local language of the area with an annual readership 557.45 lakhs and 293.80 lakhs respectively according to Indian readership survey (2008)4. Newspapers were searched from 1st Jan 2009 to 31st Dec 2009. Along with this, one General weekly published magazine published in English language and three weekly magazines (one general and two women’s magazines) published in Hindi language were also searched from Jan 2007 to Dec 2009, for a period of three years. The search was aimed to identify relevant articles published in Indian magazines and major daily newspapers and their Sunday equivalent. To be eligible for inclusion article had to/must have at least 5 sentences about health care/dental sciences, which may include topics related to health policy issues, scientific topics, forensic, topics related to prevention, topics of dental health education, oral diseases and dental treatments. Promotional and
As far as the authors know, the media coverage of dental care is seldom been studied in dentistry. Although in the dental research community the transfer of scientific knowledge to the public is seen as highly important and necessary 3.The purpose of this study was therefore to analyse dental/health information provided by the press. As it is practically impossible to study this issue in whole of India, the state of Uttar Pradesh which has seen a big spurt in the number of dental/medical colleges and dental/health fraternities from 2000 onwards was selected. In the view of widespread and interesting activities in the dentistry and health field, it was expected that 1
Reader, Dept. of Public Health Dentistry, 2Senior Lecturer, Dept. of Pedodontics and Preventive Dentistry, Kothiwal Dental College and Research Centre, Moradabad (U.P) 3Reader, Dept. of Public Health Dentistry, St.Joseph Dental College, Duggirala, Eluru, (A.P).
925
JOURNAL OF THE INDIAN ASSOCIATION OF PUBLIC HEALTH DENTISTRY Vol:2011 ISSUE:18 SUPPL. III
(2007)7,8 and thousands of students perusing dental education in this state, the interest and effort shown by them is dismal. It is also evident that dentistry and research finding during this period at least were regarded as insignificant and not worth mentioning by the Indian Journalist. This is regrettable since the public could benefit from increased concern of dentist and their endeavour to inform them in every possible ways.
commercial advertisements are excluded from the analysis. Articles that focused on the financial performance of companies associated with the drug were also excluded from the analysis. Decision about the inclusion of the article were made by one researcher and checked by another. For newspapers, search was done physically/manually by checking all newspaper every day and their additional supplements on Sunday and Saturday, for the magazine searches was done manually as well on their websites as the complete data of the magazine was available on the websites and which was very feasible.
Possibly the reason was due to the lack of selection of dental information by editors. Obviously they attach little attention to dentistry and for them there is hardly any news worth publishing in this field. On the other hand it could be that dental policy makers and dental researchers are not able to provide the editor with significant dental information, and convince them that this information is of considerable news value.
RESULT
Our search identified 507 potentially relevant newspaper articles, of which 98% had a total agreement between the two authors. Among 414 relevant articles identified in weekly magazines, no disagreement was seen between the authors. A breakdown of all included articles by newspaper, magazines and year’s is presented in table1
Table 1: Source of Press Release Screened General Health Articles
Dental Health Articles
Times of India (English)
253
09
Amar Ujala (Hindi)
125
05
Dainik Jagran (Hindi)
113
02
India Today 2009
21
01
(English) 2008
08
00
2007
07
00
Outlook 2009
24
02
(Hindi) 2008
15
01
2007
11
00
Source Newspapers
Times of India, English daily newspaper has the most coverage’s with 262 articles. But only 3.43% of the articles are related to dentistry. The English newspaper covered more health related articles than the hindi newspaper. Among magazines, which include two general weekly magazines and two women magazines, search was done for 3 consecutive years. More number of health related articles are published in women magazines than general weekly magazines. Of the total number of articles published 88.16% of the articles are general health related and only 11.74% of the articles are related to dentistry.
General Magazines
DISCUSSION
Women’s Magazines
There has been much discussion and debate surrounding the role of media influence in the dissemination of health/dental science knowledge to public. This paper presents the first effort and assessment of newspapers and magazines coverage about dental science. Considering the fact that survey samples contain only 3 newspaper and 4 magazines. It is not an exaggeration to conclude that the information about dentistry in the Uttar Pradesh (India) news paper was almost non-existing during the period Jan 2009 to Dec 2009. Similar studies were also reported from Netherland, and US5,6.
Meri Saheli 2009
40
08
(Hindi) 2008
32
05
2007
22
02
Grahshobha 2009
64
10
(Hindi) 2008
70
12
2007
51
08
CONCLUSION
The media can and do play key role in shaping our understanding of medicine and generally about the ways by which decisions are made. But this is not to say that if our understanding is clouded it is the fault of the
Considering the presence of 31 dental colleges and 4637 registered dental personnel as per DCI 926
JOURNAL OF THE INDIAN ASSOCIATION OF PUBLIC HEALTH DENTISTRY Vol:2011 ISSUE:18 SUPPL. III
media. The media are prone to external influences and the action of researcher, clinician, government and industry all can undo influence the way news is reported. If we have to truly inform debate about health science news, we need to be less enthusiastic and more questioning about what we read and of the motives of those who seek to set news agenda.
3. Genco R J. The trust and the agenda: science transfer. J Dent Res 1991; 70:1102-1105.
REFERENCES
6. Frazier P J., Jenny J J., Otsman R. and Frenick C. Quality information in mass media: barrier to the dental health education of the public. J Public Health Dent 1974; 34: 244-257.
4. www.npes.in/others_news.asp (Accessed on 2010 July 28). 5. Eijkman M.A.J., Hoebergen N. and Moltzer. The transmission of knowledge from dentistry and dental science to the press during the period 1981-1990. International dental journal. 1994; 44:360-361.
1. Grilli R., Ramsay C. and Minozzi S. Mass media interventions: effects on health services utilization. Cochrane Database of Systematic Reviews 2002; 1. CD000389.
7. http://www.upeducation.net/Dental/index.aspx. (Accessed on 28Jan 2011).
2. Lisa M. Schwartz and Steven Woloshin. The Media Matter: A Call for Straightforward Medical Reporting. Ann Intern Med. 2004; 140: 226-228.
8. http://www.indiaonapage.com/india/Uttar Pradesh. (Accessed on 2011 Jan28).
927
JOURNAL OF THE INDIAN ASSOCIATION OF PUBLIC HEALTH DENTISTRY Vol:2011 ISSUE:18 SUPPL. III
Is Mouthwash an Eyewash??? A Review Dr. Suvarna Patil1, Dr. Laxmi Hombal2, Dr. Sheetal Sanikop3, Dr. Mamata Hebbal4 ABSTRACT Oral care products comprise a broad range of formulations and devices produced primarily to benefit oral and dental health. A mouthwash may be recommended to treat infection, reduce inflammation, relieve pain, reduce halitosis or to deliver fluoride locally for caries prevention. The well-known and often-reviewed benefits of oral hygiene products on oral and dental conditions and diseases are well established. Indeed, through their role in the prevention and treatment of gingival and periodontal disease, there is the potential for benefits of oral hygiene products in the prevention of systemic disease and conditions. Despite this, perhaps, as with all agents, drugs and devices designed to maintain or improve human wellbeing, there is the possibility of harmful adverse effects occurring as a result of the use of oral hygiene products. The aim of this review is to debate the potential for oral hygiene products to cause oral, dental and systemic harm to the user. Keywords: Mouthwash, oral hygiene, periodontitis, local adverse effects, systemic adverse effects INTRODUCTION
equivocal success, as therapy for candida infections, and for alleviating the pain and discomfort of inflammatory conditions of the mouth.
Plaque is a major etiologic factor in most forms of periodontal diseases, a significant relation between the accumulation of bacterial plaque on the teeth and the development of gingivitis and periodontitis has been well established through clinical and epidemiological research. Complete removal of bacterial plaque is necessary for attaining and maintaining healthy gingival condition. Plaque control refers to all the measures taken by both the patients and the dental team to prevent accumulation of bacterial plaque and other deposits on the tooth and the adjacent gingival surfaces. Till date the most dependable mode of plaque control is mechanical cleaning of teeth
Several ill effects of improper oral hygiene procedures have been documented3. The potential for harm or other side-effects from mouth rinses is real and quite well documented. At present, an International Standards Organization considers general aspects of mouth rinse safety in a manner similar to toothpastes. It would appear that potential risks /side-effects from mouth rinses come from three sources, namely4 1. The physico-chemical properties of the rinse (such as pH and titratable acidity),
Over a period of nearly four decades there has been quite intense interest in the use of chemical agents to control supragingival plaque and thereby gingivitis. The number and variation of chemical agents evaluated are quite large but most have antiseptic or antimicrobial actions and success has been extremely variable1. The mouthwash may be used for preventive or therapeutic purposes. The preventive use mainly to control dental caries and the therapeutic use is to inhibit or reduce plaqueassociated bacteria and as prophylaxis after periodontal surgery. In cases in which patients are unable to perform oral hygiene, mouth rinsing with antimicrobial agents often becomes the only feasible solution2. Oral rinses have been used for symptomatic treatment of aphthous ulcers with
2. The active (s) ingredients in the products and 3. Other ingredients (such as alcohol) The adverse effects of mouthwash may be divided into local and systemic effects5 Local adverse effects of mouthwash use:
The pH of mouth rinses is set below 10.4 and clearly, in the acidic range below 5.4-5.5, there is the potential for erosion of enamel and, more particularly, dentine. The titratable acidity and / or buffering capacity of acidic products can be measured. Although data on acidic beverages indicate that the higher the titratable acidity of a rinse the greater the risk for erosion. Evidence that
1
Professor and Head, Dept. of Periodontics, 2P.G. student, Dept. of Periodontics, 3Associate Professor, Dept. of Periodontics, Reader, Dept. of Public Health Dentistry, KLE’s V.K. Institute of Dental Sciences, Belgaum
4
928
JOURNAL OF THE INDIAN ASSOCIATION OF PUBLIC HEALTH DENTISTRY Vol:2011 ISSUE:18 SUPPL. III
acidic mouth rinses can erode enamel and dentine comes from tests both in vitro and in situ. The few proprietary products tested do reveal erosion of enamel and dentine, but to a level considerably below that of a soft drink control. The only concern from a study in vitro may lie with the removal of the dentine smear layer to initiate a lesion of dentine hypersensitivity6. The issue with acidic rinses must relate to the duration of use relative to erosivity. Thus, for example, acidified sodium chlorite was shown to be as effective against plaque as chlorhexidine7, but caused enamel erosion similar to orange juice (pH 3.5)8. Although never marketed, such an agent may have only been recommended, as with chlorhexidine, for short-term use and therefore erosion would not be clinically significant.
explanation is not available. The extrinsic staining, which is quite difficult to remove because it tends to calcify quickly, a dark yellow or brown stain is often present. The same mechanism explains the tooth and tongue discolouration by polyvalent metal ions such as tin, iron and copper. The mechanisms proposed for chlorhexidine staining can be debated (Eriksen et al 1985, Addy & Moran 1995, Walts & Addy 2001)10,11,14 but have been proposed as.
Side-effects from active ingredients contained in the mouthwash have been reported and for the most part these problems have been local.
Nonenzymatic browning reactions (Maillard reactions) catalyzed by chlorhexidine are a theoretical possibility; however, evidence is indirect, circumstantial or inconclusive. The theory does not consider the fact that other antiseptics and metals such as tin, iron and copper also produce dental staining.
Degradation of chlorhexidine molecules to release parachloraniline appears not to occur on storage or as a result of metabolic processes. Also, Alexidine, a related bisbiguanide, does not have parachloraniline groups, yet causes staining identical to that of chlorhexidine.
Chlorhexidine mouth rinses are perhaps most studied and effective antiseptic for plaque inhibition and the prevention of gingivitis. Chlorhexidine is a bisbiguanide antiseptic, a compound of a strong base and dicationic at pH levels above 3.5. Chlorhexidine mouth rinses are studied in greatest detail for local side-effects; systemic safety is well established because of its polar nature and lack of absorption into the systemic circulation. Chlorhexidine rinses at 0.2% concentration were reported causing taste disturbance, mucosal desquamation, increased formation of supragingival calculus, unilateral or bilateral parotid swelling and the extrinsic staining of teeth1
Protein denaturation produced by chlorhexidine with the interaction of exposed sulphide radicals with metal ions is also theoretically possible but there is no direct evidence to support this concept Precipitation of anionic dietary chromogens by cationic antiseptic, including chlorhexidine and polyvalent metal ions as an explanation for the phenomenon of staining by these substances, is supported by a number of well controlled laboratory and clinical studies11. Thus, the locally bound antiseptics or metal ions on mucosa or teeth can react with polyphenols in dietary substances to produce staining. Beverages such as tea, coffee and red wine are particularly chromogenic, but other foods and beverages will interact to produce various coloured stains.
Taste disturbance is thought to be caused by chlorhexidine interfering with taste bud activity with a preferential effect on salt taste: foods tending to have a bland taste9. Chlorhexidine also has bitter taste. Mucosal desquamation appears to be an idiosyncratic reaction in a very small proportion of chlorhexidine rinse users. The reaction is probably concentration dependent in that it was rarely reported with 0.12% rinses and anectdotal reports of dilution of 0.2% rinses 50:50 with water usually permitted continued use. Increased formation of supragingival calculus, the chlorhexidine mechanism in this process is not clear but could increase pellicle thickness by precipitating salivary proteins and / or precipitating phosphate, and thereby calcium, onto / into the pellicle. Reversibly, unilateral/bilateral parotid swelling is an extremely rare occurrence and an
The other side effect are: Neurosensory deafness can occur if chlorhexidine is introduced into the middle ear and the antiseptic should not be placed in the outer ear in cases if the eardrum is perforated Phenols and Essential oils: These have been used in mouth rinses and lozenges for many years. This mouth rinse product may reduce gingivitis via both a plaque inhibitory action and an anti-inflammatory action possibly due to an anti-oxidative activity. Nevertheless, the pH of the product is low (pH 4.3) and has been shown in 929
JOURNAL OF THE INDIAN ASSOCIATION OF PUBLIC HEALTH DENTISTRY Vol:2011 ISSUE:18 SUPPL. III
such as acute ulcerative gingivitis18. Povidine iodine is largely without side effects but as a rinse has potential to affect thyroid function adversely. Prolonged excess intake of iodides can lead to thyroid gland dysfunction including hypo- or hyperthyroidism, thyroid gland hyperplasia (enlargement), thyroid adenoma, goiter, autoimmunity, and elevated thyroid stimulating hormone (TSH) levels. Individuals with autoimmune thyroid disease (AITD) may have increased sensitivity to adverse effects of iodine. Those with previous iodine deficiency or nodular goiter may be particularly susceptible.
vitro and in situ to cause erosion of dentine and enamel respectively, albeit to a considerably less degree than orange juice1 and also has the strong taste unacceptable. Amine alcohols like Delmopinol: Morpholinoethenol derivatives, octopinol was the first to be shown effective as an antiplaque agent but was withdrawn for toxiologic reasons. Delmopinol at 0.1-0.2% causes transient tingling of the tongue, which is a form of numbness rather than taste disturbance12. The duration of the tongue effect is considerably shorter than that of chlorhexidine. Delmopinol also causes extrinsic tooth staining, but the incidence is less as is the severity when compared with chlorhexidine. Interestingly, the staining is reported to be easily removed.
The long-term use of Povidine-iodine for gargling should be avoided by (a) people with a high risk of developing thyroid dysfunction due to the excessive intake of iodine, (b) pregnant women and (c) breast-feeding mothers.
Fluoride rinses: have the potential for both systemic toxicity and dental fluorosis. Dental staining occurs with stannous formulations and appears to occur by the same mechanism as for chlorhexidine and other cationic antiseptics involving interaction with dietary chromogens13
Systemic adverse effects of mouthwash use
In a susceptible host, mouthwashes have also been shown to produce allergic reactions, triggered by a variety of ingredients. Fischer19 in 1974, identified antiseptics such as benzalkonium chloride, antibiotic agents, essential oils used as flavours, alcohol, sodium perborate, zinc chloride, borax, menthol, thymol, phenol, iodine, methyl salicylate, boric acid, cresols and surfactants as potential allergens.
Other mouth rinse actives reported to cause local side effects are: Cetylpyridinium chloride: which can cause extrinsic tooth staining by a mechanism similar to that of chlorhexidine14. The staining relates to frequency of use and is much less than chlorhexidine when used twice daily, but similar when used four times a day, an effect that probably reflects the reduced substantivity of cetylpyridinium chloride compared with chlorhexidine (15).
The term allergic reactions is used to indicate type I and type IV hypersensitivity reactions. Type I hypersensitivity of oral mucosa is manifested usually by urticaria, edema and erythema in the affected areas. Vesicle formation may also be noted. Type I hypersensitivity or anaphylactic type hypersensitivity is mediated by antibodies of immunoglobulin (Ig E) type. The symptoms usually develop within minutes of exposure in persons previously sensitized to the allergen and may take the form of a local or systemic reaction depending on the portal of entry. In some cases, anaphylactic shock may also develop.
Hexetidine: A saturated pyrimidine, at 0.1% was shown to have limited plaque-inhibitory action and no evidence for antiplaque activity when used as an adjunct for oral hygiene. Side effects was reported commonly to cause mucosal erosion if used above the concentration of 0.1%16. Hexetidine also has a slight tendency to stain teeth. Sanguinarine: a plant extract, was used in mouth rinses, usually combined with zinc salts. Importantly and very recently, sanguinarine containing mouthrinses have been shown to increase the likelihood of oral precancerous lesions almost ten-fold even after cessation of mouthrinse use 17
Type IV or delayed type hypersensitivity reactions are responsible for contact dermatitis in the skin and it is postulated that the same mechanism may cause contact stomatitis in the oral mucosa. In the oral mucosa, it manifests clinically as erythema, ulceration and epithelial peeling. The onset of symptoms may occur as late as 24 to 48 hours after contact with the allergen.
Povidone-iodine: lacks appreciable plaqueinhibitory activity or action in acute infections
Allergic reactions triggered by mouthrinses have been reported in the literature. Mathias et 930
JOURNAL OF THE INDIAN ASSOCIATION OF PUBLIC HEALTH DENTISTRY Vol:2011 ISSUE:18 SUPPL. III
Mouthwashes and oral cancer
al20 reported a case of contact urticaria that developed after use of a cinnamic aldehyde containing mouthwash in which lip swelling occurred. Fisher19 reported a case of allergic contact dermatitis caused by thymol that was used for the treatment of paronychia (abscess formation of apocrine gland regions in the nail bed), no oral lesions were reported. Lim et al21 reported perioral and mucosal edema caused by contact allergy to proflavine (an antiseptic) in an acriflavine (a proflavine derivative) mouthwash. In another case report, benzydamine mouthwash use was shown to provoke a maculopapular rash on the trunk and limbs of a patient. Moghadam et al22 reported a chlorhexidine mouthwash-induced fixed drug eruption. This reaction may represent either immediate-type or delayed-type hypersensitivity reactions. It should also be noted that chlorhexidine has been associated with other harmful effects such as ototoxicity, conjunctivitis, colitis. Ohtoshi et al23 reported more than 30 cases of anaphylactic shock after the topical application of chlorhexidine. In these cases a specific IgE antibody against chlorhexidine was shown to be a mediator of the reaction. Chlorhexidine should be given with caution to atopic patients, especially those with a history of multiple drug reactions
The association of oral cancer with tobacco and alcohol use has been well established. Alcohol is used in mouthwashes principally as a solvent for other ingredients. The high alcohol content of several mouthwashes and the fact that they are held in the oral cavity for a longer period of time than alcoholic beverages led Weaver et al27 to ask whether the oral rinses had a carcinogenic effect on the oral mucosa. Although the number of patients studied was too small to allow any conclusion. In 1991, Winn et al reported that regular users of mouthwashes containing concentrations of alcohol greater than 25% had a greater risk of oral and pharyngeal cancer and that the excess risk was greater in women, but no stronger among those who abstained from tobacco and alcohol. In 2008, McCullough and Farah concluded that there is "sufficient evidence" that "alcohol-containing mouthwashes contribute to the increased risk of development of oral cancer"28. It has been found that ethanol in mouthwash helps substances such as nicotine to permeate the mouth lining. Squier et al29 showed that alcohol has the capacity to eliminate the lipid component of the barrier present in the oral cavity that surrounds the granules of the epithelial spinous layer, and short-term exposure to 15% alcohol increased the permeability of human ventral tongue mucosa. It also can produce a substance called acetaldehyde which is a well known human carcinogen. Oral bacteria like Streptococcus salivarius, S. intermedius and S. mitis produce high amounts of acetaldehyde. Oral streptococci may contribute significantly to the normal individual variation of salivary acetaldehyde levels after alcohol drinking and thereby also to the risk of oral cancer. This may in fact be the mechanism that explains the observed phenomena that individuals with poor oral hygiene have an increased risk of developing oral cancer. The authors also state that the risk of acquiring cancer rises almost five times in alcohol-containing mouthwash users who neither smoke nor drink (with a higher rate of increase in those who do). Alcohol rinses may also adversely affect the surface hardness of restorations.
Systemic hypersensitivity reactions to oral rinses have also been reported. Tal and Dekel24 presented a case report of erythema multiforme caused by mouthwash containing iodine and Bickers et al25 reported an exacerbation of hereditary hepatic porphyria in a patient who ingested a mouthwash solution. The eucalyptol in the mouthwash was shown to be capable of inducing clinical manifestations of the disease in patients with acute intermittent porphyrin heme pathway. Although allergic reactions to mouthwashes are relatively uncommon. Mouthwashes are easily accessible, high-ethanol products marketed without child resistant packaging. Mouthwashes nowadays have an alcohol content that varies from 6% to 26.9%. cases of mouthwash induced hypoglycaemia from ingestion of the solution and fatal mouthwash poisoning have been reported. Weller Fahy et al26 remarked that mouthwashes are permitted to contain alcohol in relatively high concentration because they are classified as cosmetics and consequently the Food and Drug Administration does not require a specification of their alcohol content
Recently, Warnakulasuriya et al. undertook an immunohistochemistry study that for the first time assessed specific alcohol-induced changes to the oral epithelium in patients with both oral cancer and dysplasia. This study assessed the generation and sub-cellular distribution of ethanol-induced 931
JOURNAL OF THE INDIAN ASSOCIATION OF PUBLIC HEALTH DENTISTRY Vol:2011 ISSUE:18 SUPPL. III 4. Martin Addy. Oral hygiene products: Potential for harm to oral and systemic health? Periodontology 2000, Vol. 48, 2008, 54!65
DNA-protein alteration, particularly the presence of covalently bound intra-cellular proteins with acetaldehyde, the first metabolite of ethanol, as well as the end products of lipid peroxidation, and showed strong evidence of ethanol-induced carcinogenesis.
5. Eleni Gagari, Sadru Kabani. Adverse effects of mouthwash use. A review. Oral surg oral med oral pathol oral radiol endod 1995;80:432-9 6. Addy M, Loyn T, Adams D. Dentine hypersensitivity: effects of some proprietary mouthwashes on the dentine smear layer. An S.E.M. study. J Dent 1991: 19: 148!152.
In addition to the above mentioned effects on mucosal permeability and metabolic production of acetaldehyde, studies have shown that high concentrations of alcohol in mouthrinses may have detrimental oral effects such as epithelial detachment, keratosis, mucosal ulceration, gingivitis, petechiae and oral pain. Bernstein et al reported the presence of diffuse white oral mucosal lesions with long-term use of an alcohol-containing mouthwash.
7. Yates R, Moran J, Addy M, Mullan PJ, Wade W, Newcombe R. The comparative effect of acidified sodium chlorite and chlorhexidine mouthrinses on plaque regrowth and salivary bacterial counts. J Clin Periodontol 1997: 24: 603!609. 8. Pontefract H, Hughes J, Kemp K, Yates R, Newcombe RG, Addy M. Erosive effects of some mouthrinses on enamel. A study in situ. J Clin Periodontol 2001: 28: 319!324.
CONCLUSION
9. Lang, N.P., Catalanotto, F.A., Knopfl i, R.U. & Antczak, A.A. Quality specifi c taste impairment following the application of chlorhexidine gluconate mouthrinses. Journal of Clinical Periodontology 1998, 15, 43!48.
Mouthwashes are used as a supplemental aid in the daily oral hygiene regimen. The dentist and the consumer should both be aware that mouthwashes may cause adverse effects. Allergic reactions, both local and systemic, have been reported and so have incidents of alcohol intoxication in children from ingestion of mouthrinses. In recent years, investigators have studied the possibility that the high alcohol content in several of the oral rinses might play a role in the cause of oral cancer. There is a significant number of indications for the use of mouthwash in preventive dentistry, most of which rely on the antimicrobial properties of the antiseptic and its duration of action. Its use should be for short duration when mechanical tooth cleaning is difficult or inadequate and during which time local side effects are likely to be minimized. Guidelines should be followed cautiously before prescribing a mouthwash to the patients. The mouthwash is more effective as a preventive rather than a therapeutic agent.
10. Eriksen, H.M., Nordbo, H., Kantanen, H. & Ellingsen, J.E. Chemical plaque control and extrinsic tooth discoloration. A review of possible mechanisms. Journal of Clinical Periodontology 1985,12, 345!350. 11. Addy, M. & Moran, J.M. Mechanisms of stain formation on teeth, in particular associated with metal ions and antiseptics. Advances in Dental Research 9,1995, 450!456. 12. Claydon N, Hunter L, Moran J, Wade W, Kelty E, Movert R, Addy M. A 6-month home-usage trial of 0.1%and 0.2% delmopinol mouthwashes. 1. Effects on plaque, gingivitis, supragingival calculus and tooth staining. J Clin Periodontol 1996: 23: 220!228. 13. Addy, M., Mahdavi, S.A. & Loyn, T. Dietary staining in vitro by mouthrinses as a comparative measure of antiseptic activity and predictor of staining in vivo. Journal of Dentistry 1995: 22, 95!99. 14. Watts A, Addy M. Tooth discolouration and staining: a review of the literature. Br Dent J 2001: 190: 309!316 15. Roberts WR, Addy M. Comparison of in vitro and in vivo antibacterial properties of antiseptic mouthrinses containing chlorhexidine, alexidine, CPC and hexetidine. Relevance to mode of action.J ClinPeriodontol 1981: 8: 295!310.
REFERENCES 1. Martin Addy & John Moran, Chemical supragingival plaque control, Jan Lindhe, Clinical periodontology and implant dentistry, 5th edition, Blackwell Publishing company, 2008: 734-65 2. Cannel JS. The use of antimicrobials in the mouth. J Int Med Res 1981;9:277-82.
16. Bergenholtz A, Hanstrom L. The plaque inhibitory effect of hexetidine (Oraldene) mouthwash compared to that of chlorhexidine. Comm Dent Oral Epidemiol 1974: 2:70!74.
3. Gillete WB, van House RL. Ill effects of improper oral hygiene procedure. JAnn Dent Assoc 1980;101:476-80
17. Mascarenhas AK, Allen CM, Loudon J. The association between Viadent use and oral leukoplakia. Epidemiology 2001: 12: 741!743. 932
JOURNAL OF THE INDIAN ASSOCIATION OF PUBLIC HEALTH DENTISTRY Vol:2011 ISSUE:18 SUPPL. III 24. Tal H, Dekel A. Oral mouthwash and erythema multiforme. J Oral Med 1986;42:147-8
18. Addy, M., Griffiths, C. & Isaac, R. The effect of povidone iodine on plaque and salivary bacteria. A double blind crossover trial. Journal of Periodontology 1977: 48, 730!732. 19. Fisher AA. Contact stomatitis, glossitis, and cheilitis. Otolaryngol Clin North Am 1974;7: 827-43
25. Bickers DR, Miller L, Kappas A. Exacerbation of hereditary hepatic porphyria by surreptitious ingestion of unusual provocative agent: a mouthwash preparation. Medical Intelligence 1986;292:115
20. Mathias CG, Chappler RR, Maibach HI. Contact urticaria from cinnamic aldehyde. Arch Dermatol 1980;116:74-6
26. Weller- Fahy ET, Berger LR, Troutman WG. Mouthwash: a source of acute ethanol intoxication. Pediatrics 1980;66:302-5
21. Lim J, Goh CL, Lee CT. Perioral and mucosal edema due to contact allergy to proflavine. Contact Dermatitis 1991;25:195-6
27. Weaver A, Fleming SM, Smith DB. Mouthwash and oral cancer: carcinogen or coincidence? J Oral Surg 1979;374:250-3
22. Moghadam BK, Drisko CL, Gier RE. Chlorhexidine mouthwash-induced fixed drug eruption: case report and review of literature. Oral surg oral med oral pathol 1991;71:431-4
28. MJ McCullough ,CS Farah. The role of alcohol in oral carcinogenesis with particular reference to alcohol-containing mouthwashes. Australian Dental Journal, Volume 53, Issue 4 pages 302!305, December 2008
23. Ohtoshi T, Yamauchi N, Tadokoro K, et al. IgE antibody-mediated shock reaction caused by topical application of chlorhexidine. Clin Allergy 1986;16:155-61
29. Squier CA, Cox P, Hall BK. Enhanced penetration of nitrosonornicotine across oral mucosa in the presence of ethanol. J Oral Pathol 1986;15:276!279.
933
JOURNAL OF THE INDIAN ASSOCIATION OF PUBLIC HEALTH DENTISTRY Vol:2011 ISSUE:18 SUPPL. III
Endodontics by Emerging Dentists Dr. Gayathri Sundari Jethwani1, Dr. Kavita Verma2, Dr. Sultana S Sayed3, Dr. Jitendra Jethwani4 ABSTRACT Aim: To evaluate the technical quality of root fillings performed by undergraduate students at a dental teaching institute in Lucknow, Uttar Pradesh, India. Methodology: A random sample of 812 records of patients who received dental treatment performed by the undergraduate students and interns at the Department of Conservative Dentistry and Endodontics at Career Post Graduate Institute of Dental Sciences and Hospital, Lucknow, India between 2006 to 2009 was investigated. The accuracy of length of root fillings, their radiodensity and the presence of voids/discrepancies in the root filling or between root filling and root canal walls were recorded and scored. The results were statistically analysed to determine statistically differences between the technical quality of root fillings and type of tooth treated. Results: Of the 594 teeth included in the study, only 33.7% of teeth fulfilled the criteria of showing a dense root filling without voids and of adequate length while 67% had an adequate length of root filling and 26% had dense root filling without voids. The relationship between the technical quality of root fillings and tooth type was statistically significant (P < 0.001) .The highest percentage of adequate root fillings occuring in single-rooted teeth. The highest percentage of inadequate root fillings according to the criteria of root filling length and lateral adaptation was found in molar teeth. Conclusion: The assessment revealed that the technical quality of root fillings performed by undergraduate students needs to be improved. INTRODUCTION
2005, Er et al. 2006. Correct RCT consists of radiographic evidence of a prepared root canal homogenously filled and without space(s) between canal filling and canal walls. Furthermore, the root canal filling should be placed within 0.5–2 mm of the radiographic apex to prevent recurrent disease.(5)
A 3-dimensionally hermetic obturation of the root canal system complex is of prime clinical importance for the success of endodontic treatment. Hence, one of the objectives of endodontic treatment is to completely fill the root canal complex after it has been thoroughly chemically cleaned and mechanically shaped. The technical superiority of the root filling highly influences the outcome of root canal treatment (RCT) as demonstrated by epidemiological studies which report a high prevalence of apical pathosis associated with root filled teeth, particularly when the root filling was inadequate. (Helminen et al. 2000, Kirkevang et al. 2000, Lupi-Pegurier et al. 2002, Dugas et al. 2003). There is substantial evidence that the technical quality of root canal treatment has a significant impact on the outcome of the procedure and its durability.(3) Thus a methodical assesment of the quality of root fillings is essential for clinicians to estimate prognosis(5).
Recent epidemiological endodontic studies performed in different population groups have reported a percentage of adequate root fillings ranging from 26.5% to 55.3% (Kirkevang et al. 2000, Chueh et al. 2003, Dugas et al. 2003, Barrieshi-Nusair et al. 2004, Eleftheriadis & Lambrianidis 2005, Er et al. 2006). In France, epidemiological studies on endodontic treatments investigated the quality of root fillings undertaken by general practitioners (Boucher et al. 2002, Lupi-Pegurier et al. 2002, Basmadjian-Charles et al. 2004) which showed only 20.8–31.2% of adequate fillings. To date, no appraisal of the quality of root fillings performed by Indian undergraduate students are available. Thus, the aim of this study was to evaluate the technical quality of root fillings using radiographs of teeth treated by undergraduate students and interns at the Department of Conservative Dentistry and
One of the methods used to determine the clinical outcome of RCTs is based on radiographical evaluation as seen in the studies by Eleftheriadis & Lambrianidis 2005, Tsuneishi et al. 1
Professor and Head, 2,3P.G. Student, Dept. of Conservative Dentistry and Endodontics, 4Professor, Dept. of Prosthodontics, Career Post Graduate Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh.
934
JOURNAL OF THE INDIAN ASSOCIATION OF PUBLIC HEALTH DENTISTRY Vol:2011 ISSUE:18 SUPPL. III
tooth). The scores of each parameter were added up to obtain a final score allowing the assessment of the technical quality of the root filling. The final score 0 corresponded to a root filling deemed adequate, whereas a final score of 4 corresponded to an under-or over-filled canal. Chi-square analysis was performed to determine statistically significant differences between the technical quality of RCTs according to the tooth type.
Endodontics at a teaching hospital in Lucknow between the years 2006 to 2009. MATERIALS AND METHOD
The records of 812 patients who had received RCT at the Department of Conservative Dentistry and Endodontics a teaching hospital in Lucknow between the years 2006 to 2009 were randomly scrutinized in this study. Records of patients younger than 19-year-old were excluded. Records that did not include preoperative and postoperative periapical radiographs with at least 2 mm of periapical region were excluded. The final sample consisted of 594 obturated teeth. All RCTs were carried out by the interns and final year BDS students posted in the deparment using K- file hand instruments by the step back technique and a lateral compaction filling technique. The irrigants used were sodium hypochlorite and EDTA. The sealer used was Zinc Oxide Eugenol. For each root filled tooth, preoperative, working length determination and postoperative radiographs were examined. The radiographs were independently examined under even illumination in a dark room at × 3.5 magnification by two investigators. The results were compared and a final consensus was agreed upon. In case of disagreement, a third investigator was asked to read the radiograph and a final agreement was reached. Parameters used to assess radiographical quality of root fillings are listed as follows:
RESULTS
The final scores for the 594 root filled teeth are summarized in Table 1. The score 0 corresponding to an ‘acceptable’ filling was rated in 200 (33.7%) teeth. The score 4 corresponding to the combination of an incorrect length and density of the root filling was rated in 3 (0.5%) teeth. Table 1. Distribution of the final scores according to the evaluated radiographical parameters
1. Presence or absence of a low density of root canal filling.
Final Scores
Number of Teeth
Percentage (%)
0
200
33.7
1
155
26.1
2
157
26.4
3
79
13.3
4
3
0.5
TOTAL
594
100
Table 2 shows the distribution of the teeth according to the parameters evaluated by the investigators. The length of the root fillings was adequate in 399 (67%) teeth, 22 (4%) teeth were classified as being ‘over-filled’ and 173 (29%) teeth were evaluated as being ‘under-filled’. A poor density of root filling was observed in 273 (46%) teeth and the presence of voids in the root filling was present in 231 (39%) teeth. A root filling could present both an inadequate density and voids. To evaluate the overall quality of the root filling, the density of the root filling was related with the presence of voids. In this way, 95 root fillings (16%) were not dense and contained voids; 51 root canal fillings (9%) were evaluated as being dense with voids; 90 root canal fillings (15%) were not dense without voids and 156 root fillings (26%) were dense without voids.
2. Presence or absence of voids in the root filling or between root filling and root canal walls. 3. Presence or absence of an ‘underfilling’: where the root canal filling material is > 2 mm short of the radiographic apex. 4. Presence or absence of an ‘overfilling’: where the root canal filling material is extruded beyond the radiographic apex. Each parameter was scored as previously described by Matysiak et al. 2003. Briefly, each parameter cited above was scored with 0 = absence (criterion not observed on the radiographs) or 1 = presence (criterion observed on the radiographs). For a multi-rooted tooth, each root canal was independently evaluated, scored, and then an overall score was attributed (e.g. when the same parameter was observed on several root canals, the score ‘1’ was attributed only once for the entire 935
JOURNAL OF THE INDIAN ASSOCIATION OF PUBLIC HEALTH DENTISTRY Vol:2011 ISSUE:18 SUPPL. III Table 3. Distribution of the radiographic criteria according to the tooth type
Table 2. Percentages of the evaluated teeth according to the radiographical criteria
No. of radiographs evaluated
Percentage of radiographs evaluated
Low density of RC filling
273
46
Voids between RC filling or RC wall
231
39
Low density with voids
95
16
Voids with adequate density
51
9
Low density without voids
90
15
Adequate density without Voids
156
26
Underfilling
173
29
Overfilling
22
4
Radiographical criteria
S. Characteristi No. cs
Single rooted teeth (n = 282)
Multi-rooted teeth (n = 312)
No.
%
No.
%
X2
P
1
Voids
92
32.6
139
44.5
8.86
