Odontomas are among the most frequent odontogenic tumors of the jaws that generally appear as single or multiple teeth-like radiopaque lesions. As reported in the literature, they often interfere with tooth eruption and are usually discovered by routine panoramic radiographs. This case report shows a compound odontoma and the associated impaction of the underlying mandibular permanent right cuspid in an ASA II 10-year-old male Caucasian patient. Treatment plan involved surgical excision with histopathological analysis. No signs and symptoms were observed over 6 months of follow-up.

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Introduction: Use of rotary instrumentation for pulpectomy is a recent emerging concept in the field of pedodontics. The objective of this study was to evaluate the knowledge and practice of NiTi rotary instruments' usage in primary teeth by the Indian dentists. Materials and Methods: A self-administrated questionnaire was prepared and pretested and was given to the private practitioners. A total of 100 completed questionnaires were obtained. The data were entered and analyzed for frequency and percentages using Statistical Package for the Social Sciences (SPSS) software version 17. Results: In the present study, about 50% of the practitioners used rotary instrumentation of root canals in primary teeth, of which majority were postgraduates. ProTaper was the commonly used rotary system in primary teeth. The practitioners felt both taper and length of the existing rotary file to be the limitation for its use in primary teeth. Conclusion: From the present study, it is concluded that there is a need for comprehensive education programs to be conducted to increase the awareness and use of rotary files for pulpectomy in primary teeth. In addition, there is a need for an exclusive pediatric rotary system for convenience in using it in children.

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Aim: The aim of this study was to investigate attitude and practice of infection control among senior dental students of the College of Dentistry, King Khalid University, Abha. Materials and Methods: The study sample comprised of 191 students of the College of Dentistry, King Khalid University, Abha. A standardized self-administered questionnaire was developed with 25 open- and closed-ended questions related to barrier techniques, vaccination status, infection control practices, and awareness. These questionnaires were distributed among the senior dental students after obtaining the consent form. Each questionnaire was coded to ensure the confidentiality of the response. Results: The compliance with the use of protective barriers was high with the exception of protective eyewear, utilized by only 22% of students. There was a significant difference between 5^th-year, 6^th-year students and interns' attitudes (P < 0.05) regarding the treatment of patients with infectious diseases. About 59% of interns and 27.8% of 6^th-year and 56.2% of 5^th-year students suffered from percutaneous injury (P < 0.05), and needlestick injury was the most common source of accidental exposure. Conclusion: Efforts are needed to improve the attitude and motivate students in the correct and routine use of infection control measures. With all infection control protocols already implemented in dental schools, the challenge remains on improving compliance with infection control recommendations.

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Aims: Probiotics have been proven to be beneficial for general and systemic health. Many in vitro and in vivo studies have investigated the use of probiotics for the prevention or treatment of dental caries and gingival diseases. Lactobacillus reuteri is believed to possess anti-microbial and anti-inflammatory properties. The aim of our randomized controlled trial was to evaluate the effect of chewing gums containing probiotics and xylitol on the salivary Streptococcus mutans counts, plaque, and gingival scores after the intervention. Materials and Methods: In our 3-week, short-term trial, 40 healthy 7–12-year-old children consumed two commercially available chewing gums; Group 1 (BioGaia™ ProDentis) and Group 2 (Orbit^®Gum, Wrigley's). Individuals consumed three chewing gums daily, immediately after major meals for 20 min each. The probiotic gum contained two strains of L. reuteri (ATCC 55730 and ATCC PTA 5282) along with artificial sweetener, sorbitol, and the xylitol gum consisted of both xylitol and sorbitol. Pre- and post-intervention whole unstimulated saliva samples were collected and cultured on Mitis Salivarius Bacitracin agar plates to check for colony forming units/ml of Streptococcus mutans. Plaque and gingival scores were also recorded at pre- and post-intervention appointments. Results: Following the intervention, the salivary Streptococcus mutans counts decreased in both groups. There was a significant reduction in plaque and gingival scores at postintervention examination. Conclusion: Probiotics can be used as an alternative to xylitol in the preventive regimen for dental caries or control in case of high caries risk.

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This literature review was done to estimate the uses and effectiveness of carbon monoxide (CO) breath analyzers in identifying smokers and evaluating the role it can play in tobacco cessation programs. A web-based research on PubMed and Scopus from date of inception till 2016 was done for collecting data for the review. Our inquiry was limited to relevant articles with specific keywords. During the web search title and abstracts, 118 articles were screened for content and quality and 66 articles were selected to get an update on the desired information. As on date, there is enough evidence to prove the reasonably high sensitivity and specificity of CO analyzers in distinguishing smokers and nonsmokers. It also correlates well with smoking status. Its primary application is in validating smoking abstinence and as a motivational tool in smoking cessation programs. Due to its advantages over other biochemical assays, it is used in screening large population, in developing countries and in research. It can also detect pregnant women who are smokers and victims of passive tobacco exposure. However, it does possess limitations which have to be taken into account when using it. It can be concluded that CO analyzers are proven to have great potential and can be used as an adjunct in achieving the goal of combating tobacco addiction. It is cheap, noninvasive, gives immediate results, easy to use, and it can be self-administered by individuals. It should henceforth be considered as an invaluable tool for tobacco cessation programs.

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Traumatic head injuries (THIs) associated with maxillofacial fractures (MFFs) are large public health concern worldwide, especially among adult-aged males. The MF injuries accompanied with THI involve serious esthetic and functional problems that lead to various consequential complications; therefore, early detection of associated THI in patients with MFF is the urgent need for initial assessment and treatment planning because it can reduce morbidity and mortality and enhance the outcome of treatment in those patients. The present review provides current updates for THI associated with MFF among different countries considering the prevalence, age, sex, etiology, and types of MFF in patients with THI throughout the world. The young adult males in the age group of 20–39 years were the most sustained THI associated with MFF. Road traffic accident (RTA) was the most common etiology of injury followed by assault, fall, and the other causes represent very low percentages. The types of MFF (orbital, zygoma, maxilla, and mandible) were associated with THI in MFF patients. Within the limits of the reviewed THI associated with MFF literature, it was concluded that civilization, culture, adult age group, male gender, RTA, and assault were the major factors that determine the trends of THI-related MFF. In this study, we recommend improving public awareness by applying road traffic regulations, encouraging the rules for compulsory use of seat belts and helmet, avoiding risky driving, and enhancing road quality.

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Background: To evaluate the effectiveness of passive ultrasonic on the cleanliness of dentinal tubules in curved root canals during endodontic retreatment with and without solvents using scanning electron microscope (SEM). Materials and Methods: A total of 36 extracted maxillary molars were obturated with gutta-percha and AH Plus sealer. Retreatment was done with or without using solvent. Time was also recorded. Passive ultrasonic irrigation was done in one group. The roots were split longitudinally and observed under an SEM at ×2000. All the specimens were evaluated for a total number of dentinal tubules and the number of those either completely or partially filled. The data were analyzed by one-way ANOVA followed by Tukey's post-hoc was used for intergroup comparison. Results: It was observed that more open tubules were present in Group IV followed by Group III, Group II, and Group I, respectively, and this difference was statistically significant (P < 0.05) hence, endodontic retreatment without using any solvent showed more cleanliness of dentinal tubules when compared with the groups using Endosolv-R solvent. However, cleanliness was better in the group where ultrasonic irrigation was done. Conclusion: The use of solvent in this study did not hasten the removal of gutta-percha and AH Plus sealer. Use of passive ultrasonic irrigation after gutta-percha and sealer removal in non-surgical endodontic retreatment enhances the cleanliness of dentinal tubules.

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Orthodontic mini-implants use has been increased. The purpose of this review was to analyze the factors related to the clinical application of orthodontic mini-implants. For the present study, the electronic databases PubMed, MEDLINE, Cochrane, and Google Scholar were searched for available data. The literature search was performed on the articles published from 2003 up to 2017. International peer-reviewed journal articles related to factors which are associated with the clinical application of orthodontic mini-implants were searched. Successful application of mini-implants depends on proper selection of insertion site, proper selection of mini-implant (length, diameter, tapering), proper insertion (site, predrilling, angle, primary stability, injury, and absence of adjacent anatomic structures), absence of inflammation, and proper orthodontic loading. Insertion site and mini-implant characteristics are selected based mainly on cortical bone thickness, bone density, available bone, adjacent anatomic structures, and soft-tissue thickness. Sites of high cortical bone thickness, high cancellous bone density, sufficient available bone, and thin attached gingiva are ideal for mini-implant insertion. Extremely thick cortical bone requires attention. In thick cortical bone, shorter mini-implants can be selected. For sites of low cortical bone thickness and low cancellous bone density, longer and wider mini-implants are indicated. Very thin cortical bone and very low cancellous bone density negatively affect the prognosis of mini-implants. Very narrow implants entail fracture risk. Predrilling is preferred at high bone quality sites, whereas it is used with caution or even be avoided at low bone quality sites. Angled placement might be considered to increase bone-to-implant contact and reduce root injury risk. Loading time depends on insertion torque. Successful application of mini-implants is based on proper insertion site and mini-implant characteristics selection, proper insertion, absence of inflammation, and proper orthodontic loading. Careful assessment of all the factors that might compromise mini-implant success is important for their clinical application.

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Aims: Altered sella turcica morphology, sella turcica bridging, or calcification of the interclinoidal ligament (ICL) of the sella turcica has been associated with various dental anomalies. To investigate whether impacted canines or the presence of hyperdontia (supernumerary teeth) is associated with sellar bridging, a retrospective study was done. The aim of the study was to check the frequency of sella turcica bridging in participants with impacted canines and hyperdontia compared with a control group. Material and Methods: Determination of the extent of sella turcica bridging was carried out using lateral cephalometric radiographs from 39 patients with impacted canines and 23 patients with hyperdontia or supernumerary teeth. The extent of the sella turcica bridging on each lateral cephalogram was assessed based on a standardized scoring scale (Type I, II, and III) and then compared with those of the control group consisting of 36 patients. Results: The frequency of complete calcification of ICL (Type III bridging) in patients with impacted canines and hyperdontia was 17.9% and 21.7%, whereas 5.6% was found in the control group. A partially calcified ICL (Type II bridging) was observed in 43.6% and 21.7% of patients with impacted canines and hyperdontia compared with 19.7% in the control group. P < 0.05 was considered statistically significant according to Chi-square statistics which proved the frequency of sella turcica bridging in patients with dental anomalies is increased. Conclusion: The frequency of sella turcica bridging is positively associated and increased in patients with impacted canines and hyperdontia when compared to a control group. Sella turcica bridging can be used as a diagnostic marker of underlying dental anomalies such as impacted canines and hyperdontia.

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Aim: The aim of this study was to assess the knowledge, attitude, and awareness of the outpatients regarding dental implants. Objective: The objective of this study was to determine the reasons deterring a patient from choosing dental implants as a treatment modality inspite of its success rate and great clinical longevity. Materials and Methods: A self-administered questionnaire-based survey of 168 patients visiting the Clinic for replacement of teeth. The statistical analysis was done by the Chi-square test. Results: Females and volunteers of the age group of 15–30 years had the best oral hygiene. Lack of awareness followed by high cost was the main reason for not choosing dental implants. A significant number did not opt for implants because of its long waiting period. The dentist was the main source of knowledge, and most of the volunteers expected more information from the dentist. Conclusion: Based on the maintenance of oral hygiene, dental implants should be recommended to the age group of 15–30 years. Waiting period, high cost, and surgical procedures involved were all deterring factors for not choosing implant prosthesis. New developments should be made in the field of dental implants to eradicate these reasons. Electronic media should be used more effectively to improve awareness regarding dental implants.

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Aims: The survival of oral squamous-cell carcinoma (OSCC) patients remains poor despite recent treatment advances. A sensitive and specific biomarker is important in screening high-risk patients. The present study was undertaken to test a hypothesis whether salivary tumor necrosis factor-alpha (TNF-α) can be used as a biomarker for OSCC. The study aimed to assess salivary TNF-α in OSCC, leukoplakia, and whether it can be used as a biomarker for the early diagnosis of OSCC. The objectives are as follows: (1) To evaluate salivary TNF-α and compare with histological grades of OSCC. (2) To evaluate salivary TNF-α in leukoplakia and compare with different grades of dysplasia. (3) To compare TNF-α levels in the saliva of oral cancer patients with leukoplakia patients and with healthy control group. Materials and Methods: The study was conducted in 90 participants, of which 30 healthy individuals, 30 leukoplakia, and 30 OSCC patients. Whole unstimulated saliva was collected and analyzed using an ELISA test. Results: TNF-α was significantly elevated in leukoplakia, further elevated in OSCC as compared to controls. There was a significant difference in TNF-α between the different histopathological grades of OSCC and leukoplakia (P ≤ 0.01). There were also statistically significant differences in TNF-α level between different clinical stages in OSCC (P ≤ 0.05). ROC curve analysis and area under curve values showed high specificity and sensitivity in differentiating OSCC from leukoplakia and healthy controls. Conclusion: The present study shows that salivary TNF-α can be used as a marker for predicting leukoplakia and oral cancer. The study also showed a significant correlation between clinical staging and histopathological grading of OSCC and TNF-α level.

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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.

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Aim: Periodontal diseases remain a challenging clinical condition and hence existing literature showed no consensus on the best treatment option for disease control. The aim of this review was to provide a comprehensive overview of exciting clinical evidence on the effect of photodynamic therapy (PDT) in the treatment of periodontal diseases. Materials and Method: A literature review was performed using MEDLINE, PubMed, Wiley, ScienceDirect, and Scopus using the terms PDT, periodontal disease, laser, scaling and root planning, chronic periodontitis, and aggressive periodontitis. Results: Of a total of 149 articles appeared from various sources, 147 articles were screened and 36 were related to the research objective. Adjunctive therapy with PDT may promote additional clinical and microbiological outcomes. Conclusion: Little information is available with regard to PDT photosensitizers, wavelength, number of sessions, and duration. Therefore, large randomized control trials with longer follow-up are needed to assess the potential of PDT in the treatment of periodontal disease.

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Coronavirus disease 19 (COVID-19) is a recent infectious disease that is rapidly spreading worldwide and targets human angiotensin-converting enzyme 2 receptors. A recent study found that COVID-19 induces immune responses resulting in periodontal manifestation. The purpose of this study was to investigate the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on periodontal tissue. Periodontal bacteria are implicated in systemic inflammation, bacteremia, and pneumonia. Moreover, it has been shown that 80% of patients with severe COVID-19 had high bacterial load. It has also been reported that the severity of COVID-19 in patients associates with increased levels of inflammatory markers such as interleukin and bacterial invasion. Systemic increase in the inflammatory response reveals the similarity with cytokine storm in COVID-19 patients. These conditions revealed that elevated levels of cytokines detected in locally inflamed gingival tissue through saliva analysis could expand to the systemic circulation, resulting in systemic inflammation and vice versa. It is suggested that there is a possibility of periodontitis due to increased inflammatory responses in host as an impact of SARS-CoV-2 infection. Periodontal impact was seen in COVID-19 patients as localized erythema in margins of gingiva leading to desquamative gingivitis and oral pain. Although COVID-19 might manifest in periodontal tissues, presence of periodontal pathogen could pose a risk of superinfection, and periodontal pocket could be a favorable anatomical niche for the virus, the literature is still lacking to conclude that COVID-19 has an impact on periodontal tissues and more studies are needed.

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Background: SOX 2 and OCT 4 are cancer stem cell (CSC) markers required for the maintenance of pluripotency and self-renewal of stem cells. They have been found to play a role in tumorigenesis. This study was conducted to detect and compare the expression of CSC markers OCT 4 and SOX 2 in ameloblastoma and keratocystic odontogenic tumor (KCOT) and to evaluate which marker better stains the stem cell population in the above-mentioned entities. Materials and Methods: Paraffin sections of 15 KCOT's and 15 solid multicystic ameloblastomas were obtained from the archives. Immunohistochemical staining for OCT 4 and SOX 2 was performed using monoclonal rabbit antibodies (PathnSitu Biotechnologies Pvt. Ltd). Immunopositivity was determined on the basis of dark brown staining of nucleus and a total of 1000 cells were counted in five representative areas at a magnification of ×400. Results: No OCT 4 positivity was found in ameloblastoma or KCOT. Ameloblastoma showed SOX 2 negativity while high SOX 2 expression was found in KCOT. Conclusion: SOX 2 is a more reliable marker for identifying stem cell population in KCOT. High expression pattern of SOX 2 in KCOT may also explain the aggressive nature of lesion and account for the presence of numerous daughter cysts responsible for its high recurrence rate, and hence, may be helpful to justify its reclassification as a tumor. Targeted therapies may be designed against these CSC populations to render more effective treatment, prevent recurrence, and reduce morbidity of the patients.

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Aims and Objectives: Osseointegrated implants are used in replacement of missing teeth. Survival rate of implant depends on many factors including oral hygiene, implant material used, bone quality, and personal oral habit such as smoking. The present retrospective research was conducted to assess the effect of smoking on survival of dental implant. Materials and Methods: The study participants were selected from all the patients who underwent for dental implant in implant center from 2005 to 2015. For each patient, various information regarding implant characteristics and smoking habits were recorded. The readings were statistically evaluated by SPSS statistical software by IBM version 21 and using Chi-square test at P ≤ 0.01. Results: In our study, the age range of patients was between 30 and 54 years. There were 2142 (57.2%) male and 1579 (42.4%) female participants, in that 72.2% were nonsmokers and 27.7% were smokers. Implant placed more in mandible (2312, 62%) than in maxillary region (1409, 37.8%). From 3721 patients, 3600 were successful and 121 failures. Success of implant was considerably more in nonsmokers than smokers. Implant failure rate was more in smokers with increased frequency and duration of cigarette smoking habit, but it was statistically not significant. In the present study, we have observed 0.049% mobility in smokers compared to 0.007% in nonsmokers. Conclusion: The present study showed that higher risk of implant failure was associated with long term and increased frequency of smoking due to bone resorption.

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Aims: The purpose of this study was to assess the knowledge of oral health of community pharmacists (CPs) in Plateau State, Northern Nigeria, serving as a template upon which they can be engaged as a medium to improve oral health care among the people. Materials and Methods: A quantitative cross-sectional study on CPs spanning the entire State. Results: CPs (113) were recruited as participants. A one-sample t-test showed good knowledge of oral health by the CPs: mean = 17.2, standard deviation (SD) = 2.44, t (112) = 5.14, P < 0.001. Independent sample t-test showed statistically significant differences in mean oral health knowledge of CPs who stock oral health-care products (mean = 17.3, SD = 2.4) than those who did not: (mean) = 13, (SD) = 1.41, t (111) = 2.50, P = 0.014. A multiple regression analysis also showed stocking oral health products as the only statistically significant predictor of knowledge score. Organizing workshops and seminars on oral health (63%) were the most common suggestion by the CPs on how knowledge of oral health can be improved among them. Conclusion: CPs may be effectively employed in oral health promotion because patients frequently contact them and regularly ask for their advice on both general and oral health-care. It would be beneficial to empower them through trainings and access to oral health information so as to help them take a more active and integrated role as part of a multidisciplinary health-care team attending to the oral health concerns of the people.

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Aims: Dental hygiene and oral health status are essential components of health throughout life. The purpose of the study was to investigate the oral health-related behaviors and experienced teeth pain, as well as their correlates, among male schoolchildren in Saudi Arabia. Material and Methods: A cross-sectional study was conducted recruiting 10 elementary schools, Saudi Arabia. The total sample size was 725 schoolchildren (aged 7–12 years). Pretested structured questionnaire was used to collect the data using a multistage stratified-random sampling procedure. Univariate and multivariate regression analyses were used to examine the association between variables. Results: All of the children (100%) did not have the habit of using tooth flossing regularly. The majority (62.5%) of the children did not have the habit of daily brushing, and only 11.8% brushed their teeth twice or more daily. About 56% missed/skipped visiting dentists in the past 12 months and 34.5% of the children complained a frequent toothache. Daily teeth brushing was significantly associated with young age (odds ratio [OR] = 0.5; P < 0.001), consuming fruits daily (OR = 2.3; P < 0.001) consuming vegetables daily (OR = 2.1; P < 0.001), and visit to dentist in the past 12 months (OR = 1.6; P = 0.010). The frequent toothache was positively associated with daily consumption of carbonated drinks (OR = 1.6; P = 0.005), sweets (OR = 1.8; P = 0.009), and visit to dentist (OR = 1.5; P = 0.010), and inversely associated with daily dairy products consumption (OR = 0.7; P = 0.020). Conclusions: Children's oral hygiene and oral health status were found to be poor and associated with their dietary habits. Preventive school health programs are required for better adaption of oral health behaviors and to maintain good oral health status among children.

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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.

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Aims and Objectives: This study was undertaken to investigate the referral patterns and treatment needs of patients managed by the special care dentistry (SCD) clinic specialists at a Malaysian teaching dental hospital, in preparation for improved oral health services for this patient population. Materials and Methods: The dental records of patients who attended the SCD clinic between January and December 2017, were reviewed for information, including sociodemographic characteristics, sources and reasons for referral, dental treatment needs, and medical profile. Quantitative data were analyzed via the Statistical Package for the Social Sciences version (chi-squared test, P < 0.01). Results: A total of 182 patients were managed in 2017, consisting mostly of Malays (89.6%) and with a majority being males (63.2%) in the 0–20 years age group (69.8%). A slight prevalence of adolescent/adult patients (52.2%) was reported as compared with that of pediatric patients (47.8%), with no significant difference between the genders. Many of the patients were encountered within the mobile dental service program (53.8%) and mostly first presented for routine checkups (66.5%). Treatment needs included periodontal therapy (76.9%), restoration (47.3%), exodontia (28.0%), and dentures (12.1%). The patient study sample additionally boasted physical impairments (58.8%), complex medical conditions (32.4%), psychiatric disorders (8.8%), and intellectual disabilities (8.2%). Systemic health issues included cardiovascular (18.7%), respiratory (9.9%), and endocrine (7.7%) disorders. Significant differences in the numbers of patients with physical disabilities and complex medical conditions were observed across age groups. Conclusion: This study provides important information for the future development of SCD services at the institutional and national levels.

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Background: Thailand has been facing maldistribution of dentists for decades despite its continuous increase in total numbers. Aims: The objective of this study was to analyze spatial inequality of dentist distribution patterns in Thailand. Materials and Methods: Data on dentist in public sector profiles between 2007 and 2015 were retrieved from the Ministry of Public Health, Thailand, to analyze the distribution patterns and spatial relationships. The distribution of dentists was visualized on a map using Quantum Geographic Information System. Global Moran I and local indicators of spatial association were analyzed using GeoDa software to determine the distribution of spatial relationship. Results: The total number of dentists has been increased annually from 2007 to 2015. Initially, the high–high (population-to-dentist ratio) spatial clusters were common in the Northeast (NE) region, whereas there were many low–low spatial clusters in Central region. In 2015, the high–high spatial clusters persisted in the NE region, but the low–low spatial clusters were hardly found in the Central region. Conclusions: Unequal geographical distribution of dentist still existed in Thailand, especially in the NE region. Both supply side concerning administrative factors related to resource allocation, and demand side of socioeconomic development and population changes from migration had influences on inequality in dentist distribution.

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Aim and Objectives: The objective of this study was to illustrate the link between periodontitis (PO) and endothelial dysfunction in hypertensive patients. Materials and Methods: This cross-sectional study involved 53 hypertensive patients with or without PO compared with 28 healthy controls. On the basis of the study protocol, the participants were divided into three groups: Group (1): 24 patients with hypertension only, Group (2): 29 patients with hypertension and PO, and Group (3): 28 healthy controls. Lipid profile, endothelin-1 (ET-1), and high-sensitivity C-reactive protein (hs-CRP) were measured. Blood pressure and body mass index (BMI) were evaluated. Diagnostic criteria of severe PO periodontal indices including plaque index, gingival index, and community periodontal index were estimated. Data collected during the study were analyzed using analysis of variance followed by Bonferroni post hoc test and unpaired t-test (IBM SPSS Statistics for Windows, version 20.0, 2014, IBM, Armonk, NY). Results: BMI was not differed in both groups, P = 0.08. Systolic blood pressure and diastolic blood pressure were high in hypertensive patients with PO compared with hypertensive patients only, P = 0.04 and P = 0.03, respectively. Moreover, hypertensive patients with PO showed significant dyslipidemic status compared with hypertensive patients only (P < 0.05). Biomarker of endothelial dysfunction (ET-1) was elevated in patients with PO (67.54 ± 13.56 pg/mL) compared with hypertensive patients only (23.67 ± 9.63 pg/mL), P = 0.0001. hs-CRP serum level was increased patients with PO compared with hypertensive patients only, P = 0.002. PO indices were high in patients with PO compared with hypertensive patients only, P < 0.01. Conclusion: ET-1 serum level is elevated in hypertensive patients with severe PO and correlated with cardio-metabolic complications, mainly endothelial dysfunction. Therefore, ET-1 serum level is regarded as a surrogate biomarker link PO with risk of endothelial dysfunction.

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Aims and Objectives: Temporomandibular joint (TMJ) clicking has been considered as the most important clinical features of many TMJ disorders, so that the early diagnosis of TMJ clicking could be considered an important value for early treatment. The knowledge and study of the factors that have an adverse effect on the TMJ are necessary for the proper diagnosis, treatment, and prognosis of TMJ disorders. This aim of this study was to observe whether there was a relationship between the presence of impacted third molars and the development of TMJ clicking. Materials and Methods: The study was undertaken on 189 patients with bilateral maxillary and mandibular impacted third molars aged between 18 and 25 years, in regardless of genders that were referred to the radiology department of some dental centers in Baghdad for taking orthopantomograms (OPGs) from June 2017 to December 2018. The patients were examined clinically for detecting the temporomandibular clicking by using a stethoscope for hearing clicking sounds during mouth opening and mandibular excursion. Results: The statistical analysis showed that there was no significant relationship between the presence of impacted third molars and development of TMJ clicking (χ² = 1.04; P = 0.3). Conclusion: According to this study, impacted third molars were not considered to be an effective factor in the occurrence or development of TMJ clicking or sound.

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Glass ionomer cements (GIC) were first introduced to dentistry in the late 1960s and since have proven to be useful in various areas of dental science, particularly restorative dentistry. As an aqueous polyelectrolyte system, GICs are known for their relative ease of use, chemical bond to the tooth, fluoride release and recharge, low coefficient of thermal expansion, and acceptable esthetic quality. However, clinical usage of GICs is still limited due to their relatively inferior mechanical properties and sensitivity to initial desiccation and moisture. Years of extensive research on enhancing the chemistry of the basic glasses have yielded improved formulations with enhanced mechanical properties and reduced moisture sensitivity. A comprehensive review of the available literature has revealed that not all modifications in glass powder have resulted in the desirable strengthening of GICs. There is a shift of focus toward studies on nanoscale particles and bioactive glass. Recent research has proven that incorporation of nanoceramics such as hydroxyapatite (HA), fluorapatite, silica, and zirconia (ZrO₂) have resulted in improved mechanical properties of GICs due to their ability to release fluoride, high surface area, and better particle size distribution. More work should thus, be undertaken to optimize techniques for enhancing the physicomechanical properties of GICs by incorporation of nanophases of ZrO₂, HA, and metallic nanofillers.

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