Clinical governance as a vital strategy is important for quality improvement in health-care services while protecting staff, patients, and the public. Similarly, such strategies are widely applicable to dental health care and services. In general, clinical governance is a structure in which establishments are responsible for continues improvement of their services using the best standards of care available. The main objective of this study was to conduct an extensive review of literature to identify the efficacy status of clinical governance implementations in general dentistry. A comprehensive review of literature in English language was conducted using PubMed and Emerald databases from 1997 to 2017. Clinical governance, dental services, quality assurance, dental practice, and dental care were used as principal selected keywords. All identified papers were fully assessed and critically evaluated. Evidently, data were very scarce. Eleven relevant articles were selected for data extraction and summary production. Some studies reported a lack of understanding and awareness about how clinical governance can be implemented and how it can influence the dental practice. In response to such concern, others emphasized the importance of professional development through mentorship for successful learning method by dental practitioners. This method has a great potential for improving the quality of dental care and is crucial for the enhancement of dental practice. Excellence in dental clinical practice is best possible by continually improving standards of care through clinical governance. However, supports of dental health educators are immensely required to use mentoring strategies. This would enhance knowledge and confidence in the implementation of clinical governance while dental providers are in clinical practice.

Aims: The missing teeth should ideally be replaced to anticipate some serious consequences. The most obvious effect of that is esthetics, but something like migration and rotation of teeth, chewing inefficiencies, temporomandibular joint disorders, and speech disorders can also affect function and health. Based on preliminary research, almost all elders who live in nursing homes in Surabaya lose their teeth, partially or completely, and they leave without replacing them with dentures for several reasons. This research intended to study the demands of patients for dentures in the elderly group so that future trends in health and management strategies can be improved. Materials and Methods: A cross-sectional study was conducted among 80 elderly individuals with multistage random sampling. The design was a descriptive analytical study. The instrument of this study was a validated questionnaire about the demand of dentures. Data analysis method used in this study was descriptive method, and data calculation was presented in percentage form by using software SPSS 16.0. Results: Most of the participants (45 people) presented low level of demand toward dentures (56.2%), with the rest of 35 people having high demand on dentures (43.8%). Conclusions: The demand for low dentures can result in poor oral health, so it is highly recommended that public health programs cover the oral health population, especially the elderly, so that future trends in health and management strategies can be improved.

Aim: The aim of this in vitro study was to evaluate the antibacterial activity of gypsum-based biomaterial with different concentrations of chitosan (GP/CT) and to compare with the commercial dental materials, Dycal and glass ionomer cement (GIC) against the Streptococcus mutans. Materials and Methods: GP/CT was prepared with different concentrations of CT to GP of 0%, 10%, 20%, 40%, and 80% (w/w). The antibacterial study was carried out using agar diffusion method on Mueller-Hinton agar (MHA) against S. mutans. Uniform wells were prepared at equidistant points in the base layer of MHA. The wells were filled with the materials immediately after manipulation and preincubated for 2 h and then incubated. The means of inhibition zones were measured at 48 and 72 h. Results: The results revealed that higher means of inhibition zone were observed in a dose-dependent manner with higher concentrations of CT. GP/80%CT showed more effective antibacterial effect than GP/20%CT and GP/10%CT with significant degree and also with GP/40%CT with no significant result (P < 0.05), while GP/0%CT showed no inhibition of bacterial growth. GP/80%CT showed no statistically significant difference with GIC and Dycal on day 3. In addition, no significant bacterial growth inhibition was observed between GP/40%CT and GIC. Conclusion: Gypsum-based biomaterial has potent antibacterial activity against S. mutans when CT added. Higher antibacterial activity of GP/CT biomaterial was observed in a dose-dependent manner with higher concentrations of CT. GP/80%CT exhibits the antibacterial effect similar to that of Dycal and GIC.

Background: Zinc oxide–turmeric dressing was known to have better anti-inflammatory properties than zinc oxide–eugenol dressing, but the optimal application duration is yet to be discovered. Aims: This study aimed to determine the optimal application duration of zinc oxide–turmeric dressing through molecular observation of neovascularization and expression of MAC387 and cyclooxygenase-2 (COX-2) during wound healing process in rat model. Materials and Methods: Twenty male Wistar rats were randomly divided into four groups (n = 5), Full-thickness excision of 6x6 mm was made on the dorsal area of all subjects and following the excision: the control (C) group was left undressed, while treatment groups was dresed with zinc oxide turmeric dressing for 3 days (T3 group), 5 days (T5 groups), and 7 days (T7 groups) prior to being sacrificed on day 7. All subjects were sacrificed on day 7. Hematoxylin-eosin staining and immunohistochemistry staining were performed to identify the neovascularization and MAC387 and COX-2 expressions. Data obtained were analyzed with analysis of variance and least significant difference test. Results: There was a significant higher neovascular number, higher MAC387 expression, and lower COX-2 expression in T5 and T7 groups compared to the C group (P < 0.05). Conclusions: The application of zinc oxide–turmeric wound dressing for 5 and 7 days could increase both neovascularization and MAC387 expression and also decrease COX-2 expression on the observation day in day 7. The optimal application duration is 5 days.

Aim: The aim of this study was to investigate the stress distribution in models of maxillary central incisors restored with different post and core systems. Materials and Methods: A finite-element model of a maxillary central incisor was simulated in four different configurations – model 1: an intact tooth, Model 2: received gold cast metallic post and core, Model 3: received a fiberglass post and core, and Model 4: had a fiberglass post and the composite resin core. The restored tooth models were assumed to receive a ceramic crown simulating a clinical situation. After the preparation, the geometric models were exported in mesh to the analysis software (ANSYS 10.0, ANSYS Inc., Houston, USA). A 100 N static force at a 130° angle with respect to the longitudinal axis of the tooth was applied to the palatine surface of the model along equally distributed on the element nodes. The values and stress distribution were analyzed. Results: The stress distribution in the radicular structure of the models restored with three different post and core systems was like each other, but the gold cast metallic post and core system slightly improved the pattern of the stress distribution. Conclusions: The placement of post changes the stress distribution behavior, and the material with the highest elastic modulus showed the best performance in the stress distribution.

Aims: The study aimed to evaluate the reliability and validity of the Thai version of Rapid Estimate of Adult Literacy in Dentistry (ThREALD-30). Materials and Methods: The Rapid Estimate of Adult Literacy in Dentistry-30 items (REALD-30) was translated to Thai language and back-translation process to English version of REALD-30 by experts of dentistry and linguistics. This cross-sectional study was conducted with a sample of 1110 patients from the five provinces in Northeast of Thailand. All variables were performed by descriptive statistics. The quality of the development tool of ThREALD-30 was tested internal consistency, reliability, and validity from construct validity and predictive validity correlated with Thai Oral Health Impact Profile 14 items (Thai OHIP-14) and Oral health status, respectively. The statistics were analyzed using STATA version 10. Results: A total of 1110 adult patients with a mean age was 51.11 + 6.63 years old. The reliability of ThREALD-30 was excellent (α = 0.950; intraclass correlation coefficient = 0.970, 95% confidence interval: 0.939–1.000). The construct validity was evaluated to indicate the subscales of ThREALD-30 being trustable by showing the correlation coefficient with their own dimension between 0.345 and 0.773, and predictive validity from Spearman's with Thai OHIP-14 (r_rho= −0.688, P < 0.001) and oral health status; decayed, missing, and filled teeth (r_rho = −0.283, P < 0.001); Oral Hygiene Index Simplified (r_rho = −0.432, P < 0.001); and clinical attachment loss (r_rho= −0.470, P < 0.001), supporting the construct and criterion validity. Conclusion: ThREALD-30 is an oral health literacy tool that worked well in the Thai population. It offers a valid and reliable instrument for measuring oral health outcome of the individual in community settings.

Aim: The prevalence of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients worldwide continue increasing annually, thus it has become a global health problem and burden. An oral manifestation can be used as the clinical biomarkers in people living with HIV/AIDS (PLWHA) using the pathognomonic periodontal manifestation, such as Necrotizing Ulcerative Gingivitis (NUG) and Necrotizing Ulcerative Periodontitis (NUP). This study aims to investigate the prevalence and correlation of pathognomonic periodontal manifestations with Cluster of Differentiation 4 (CD4⁺) level in PLWHA in a tertiary hospital, Surabaya, Indonesia. Materials and Methods: It presents an observational analytical study with a cross-sectional and total sampling method conducted from July to August 2014 in Dr. Soetomo General Tertiary Hospital. There were 88 HIV-seropositive patients who have not received any antiretroviral therapy yet who were recruited for this study. The patients and their guardians were explained about the study aims and participation approval which was obtained by the written informed consents. The diagnosis of NUP and NUG in PLWHA was based on its clinical features. The CD4⁺ level the latest 6 months was obtained from medical record as a retrospective data. The correlation between low CD4⁺ levels with pathognomonic periodontal manifestation in PLWHA was analyzed by Spearman's correlation test. Results: There are 9 (10.23%) PLWHA with pathognomonic periodontal manifestation, 7 (77.7%) with NUG, and 2 (22.3%) with NUP. All PLWHA (100%) have low CD4⁺ level (<200 cell/mm³). The Spearman's correlation shows that there are a correlation between pathognomonic periodontal manifestation with CD4⁺ level in PLWHA (r = −0.464) (P = 0.03; P < 0.05). Conclusion: NUG and NUP are pathognomonic periodontal manifestation found in Indonesian PLWHA which are associated with low CD4+ level reflecting the immune suppression level, and it can be used to predict HIV/AIDS stage of progression.

Background: The use of systemic antibiotics in complement of the periodontal debridement in the treatment of aggressive periodontitis is supported by evidence published in the literature. The appropriate use of antibiotics allow to avoid practices that may enhance microbial resistance. Aims: The objective of this study is to evaluate the knowledge, attitudes, and practices of a population of dental practitioners in Morocco regarding antibiotics prescribing for patients with aggressive periodontitis. Materials and Methods: This cross-sectional study was carried among practitioners from cities of Casablanca, Rabat, Sale, Fez, Kenitra, and Temara from January to April 2016. The data collected were analyzed through the Statistical Package for Social Sciences software (SPSS version 13.0). Results: A total of 750 replies were received giving a response rate of 75%. Nearly 63.7% of the participants were female and 68% had <10 years' practice experience. The present study showed that dental practitioners had good knowledge regarding antibiotic use. The median score of knowledge was 3 (maximum possible score of 4). The results of attitudes and practices toward prescribing antibiotics were poor. Four hundred and twenty-two (67.5%) choose inappropriate dose of systemic metronidazole combined with amoxicillin. Gender, age, duration of practice, graduation, and continuing education in periodontology were significantly associated with the prescription of correct dose and duration of antibiotic treatment. Conclusion: This study lends support that scientific basis for prescribing antibiotics for aggressive periodontitis was not respected by the majority of the participants in this Moroccan population of dental practitioners. The attitude towards the prescription of antibiotics should therefore be modified. Also, it adds to the evidence the needed to designing periodontal national guidelines for studied dental practitioners.

Aims: Suture materials are used routinely in periodontal and oral surgical procedures. Strength of the sutures depends on many factors such as tensile strength, compressive strength, and knot configuration. The aim of this in vitro study was to compare herbal rinses and chlorhexidine mouthwashes on the tensile strengths of the commonly used absorbable suture materials. Materials and Methods: Three commonly used absorbable suture materials polyglactin 910 (PLG 910), poliglecaprone (PGCL), and catgut were selected. A total of 15 samples for each suture material for a combined total of 45 were used. The sutures were tested for pre- and post-immersion tensile strength after being placed in three different solutions. Tensile strength was determined by a testing machine with a load set at 50 N. Results: Wilcoxon sign-rank test was used for quantitative data evaluation and Kruskal–Wallis test for intragroup comparison. From the experiment, it is evident that PLG 910 is superior in comparison to other suture materials, with a mean of 600.8 N/mm² compared to PGCL (422.6 N/mm²) and chromic catgut (229.2 N/mm²). Among the herbal rinses, frankincense showed a statistical significant value in terms of stabilizing tensile strengths of the suture materials. Conclusions: Although PLG 910 was better against the three suture materials, more studies need to be done using varied variables and other media to see the effect in tensile strengths.

Aims: A good compliance with oral hygiene practices depends on the level of awareness and source of information. The present study attempts to evaluate and compare the level of awareness of oral health and its hygiene practice among rural and urban schoolchildren in Al Qassim Region, Saudi Arabia. Materials and Methods: The study included 228 boys in the age group of 6–7 and 12–13 years from three schools each in the rural and urban area in Al Qassim, Saudi Arabia. Data on oral health knowledge and practices were collected by means of a self-administered questionnaire. Statistical Analysis: Data were represented in percentages. Comparison of response between rural-urban and age groups of schoolchildren was done using Chi-square test, with a confidence interval at 95% (P < 0.05). Results: Children residing in urban areas found to prefer professionals (P < 0.001) as their source for acquiring knowledge about oral health and hygiene practices. They also outscored in translating knowledge in terms of vertical technique (P < 0.001) and frequency (P < 0.05) of brushing. Professionals were found to be the source for majority of children of elder group (P < 0.001), whereas younger were dependent on parents for the same. Elder group also showed to have better practice in terms of frequency (P < 0.001) and choice of medium for brushing (P < 0.01). Conclusion: Wider availability of healthcare services in the urban areas has improved the awareness for oral health. By large, younger group of children has considered parents as their role model and approach them to seek advice on health issues.

Background: Sometimes, a combination of mechanical and chemical treatment provides good recovery such as metronidazole (MTZ) and hyaluronic acid (HA) topically that have recently been recognized as an adjunct therapeutic measure for periodontitis. Aims and Objectives: The objective is to estimate and compare the potential benefits of the effect of MTZ and HA gels on the clinical periodontal parameters. Materials and Methods: Chronic periodontitis patients were volunteered to partake in this research. They classified into three groups; 10 patients received root surface debridement (RSD) and 0.2% HA gel was additionally applied subgingival in test sites as the first group, the second group (10 patients) received RSD and MTZ gel was also added subgingival in test sites, and the last group consisting of 10-patient management with RSD alone. At the first visit, plaque index, gingival index, and periodontal pocket depth (PI, GI, and PPD) were recorded subsequently, and this represents 1^st record which was done before periodontal treatment, while the 2^nd record for indices was taken after 7 days. Results: Intragroup analysis of all the clinical periodontal parameters showed high significant (HS) results between baseline and 1 week at P < 0.01. In addition, on intergroup analysis, the results were significant at a second visit for GI and HS for PPD and not significant for PI. Conclusion: Local applications of MTZ and (0.2%) HA gels as an auxiliary to conventional periodontal therapy have a useful impact on clinical periodontal parameter during 7 days in chronic periodontitis patient.