Programmed cell death or apoptosis is considered a vital component of various processes including normal cell turnover, proper development and functioning of the immune system, hormone-dependent atrophy, embryonic development, and chemical-induced cell death. Inappropriate apoptosis (either too little or too much) is a factor in many human conditions including neurodegenerative diseases, ischemic damage, autoimmune disorders, and many types of cancers. The process of apoptosis is generally characterized by distinct morphological characteristics and energy-dependent biochemical mechanisms. An understanding of its role in the pathophysiology of oral tissues is pertinent to the development of novel therapeutic approaches. The developing tooth passes through the various morphologic stages and apoptosis is observed selectively in certain locations. This review focuses on the current knowledge of apoptosis emphasizing its role in normal oral tissues and odontogenesis.

Attainment of ideal root canal treatment comprises various essential factors such as proper instrumentation, biomechanical preparation, obturation, and ultimately depending upon the case, post-endodontic restoration. Main objective of the treatment is to get absolute rid of microbial entity and prevent any future predilection of re-infection. In order to achieve that, proper seal is required to cut down any chance of proliferation of bacteria and future occurrence of any pathology. Although gutta-percha has been the standard obturating material used in root canal treatment, it does not reinforce endodontically treated roots owing to its inability to achieve an impervious seal along the dentinal walls of the root canal. Gutta-percha does not from a monoblock even with the use of a resin-based sealer such as AH Plus because the sealer does not bind to gutta-percha. As a result, a monoblock is formed (consisting of Resilon core material, Resin sealer, bonding agent/primer, and dentin). Another reason of Resilon being a better obturating material could be that the removal of smear layer by ethylenediaminetetraacetic acid (EDTA) after biomechanical preparation may have allowed the root canal filling material and root canal sealers to contact the canal wall and penetrate in the dentinal tubules, which may increase the strength of roots. New silicone-based sealers like Roekoseal automix and the most recent GuttaFlow have some affirmative results regarding solubility and biocompatibility, as compared to other sealers. Methacrylate resin-based sealers and mineral trioxide aggregate (MTA)-based sealers have opened a new horizon for sealers.

An introduction to the practical application of acupuncture is presented in the light of current research. Acupuncture could supplement conventional treatment modalities. Its value in the treatment of temporomandibular dysfunction syndrome and facial pain has been well-documented. Although, it may be useful in the control of post-operative pain, its use as sole analgesia for operative care is questionable. The aim of this paper is to give a broad introduction to acupuncture to the general and dental practitioner and to emphasize the scientific background for acupuncture.

Although the advances in the diagnosis and treatment of oral cancer, it remains one of the most devastating malignancies. Early detection and prevention is a major key in combating policy of cancer. Screening offers an important opportunity for early detection. Several screening methods, visual examination, toluidine blue, fluorescence imaging, and brush biopsy, were used in oral cancer screening programs. General dental practitioner plays an important role in such programs. Therefore, this review aimed to outline the required information, knowledge, and evidence-based practice on oral cancer screening for dentists in order to incorporate this service into their daily routine.

A lot of biomedical waste (BMW) is generated in dental practices, which can be hazardous to the environment as well as to those who come in contact with the materials, if not dealt with appropriately. Most of the rules world-wide are not specific for dental BMW management and hinder easy understanding by dental practitioners. Because of lack of clear-cut guidelines either from Dental Council of India or Government of India or Indian Dental Association (IDA) on disposal of dental wastes, this article is designed to explore and review on these issues and formulate a simplified scheme. The guidelines by the Maharashtra Pollution Control Board from the directives of The Ministry of Environment and Forests, Government of India through BMW (Management and Handling) Rules, 1998, (BMW-MH-98), similar guidelines being followed elsewhere in the world, the local BMW disposal company's rules and the IDA's Clinic Standardization Program guidelines. We developed and implemented a simplified waste segregation protocol for practicing dentists and dental hospitals. A methodological dental waste segregation protocol was required considering its disposal and ill-effects on health and the environment. The simplified scheme provided a good model to be followed in developing countries like India. The scheme improved understanding among dentists because of its self-explanatory nature.

Diabetes mellitus (DM) is a complex metabolic disease, characterised by hyperglycaemia resulting from defects in insulin secretion, insulin action or both. In patients with DM, several aspects of the immune system are compromised and wound healing is impaired. Studies indicate increased prevalence, severity of periapical lesions and a decreased success rate of endodontic treatment in diabetics, suggesting that diabetes may serve as a disease modifier of periapical lesions. A reciprocal relationship exists between glycaemic control and chronic periapical lesions. Treating infections of pulp and periodontium will improve glycaemic control and help in healing of lesions similar to non-diabetics. To provide competent care to patients with DM, dental clinicians must understand the disease, its treatment, and its impact on the patients' ability to undergo and respond to endodontic treatment. This review article is a detailed assessment of the literature on DM and its implication on pulp and periapical diseases, and their treatment outcome.

Objective: To compare the effect of disinfection of dental unit waterlines (DUWLs) on bacterial load using disinfection methods and agents like 0.12% chlorhexidine gluconate (CHX), time-dependent flushing (1 min, 2 min), and using distilled water and tap water as water sources. Materials and Methods: Four dental units were taken: Unit A contained 0.12% CHX, Unit B contained distilled water, Unit C contained tap water, and Unit D included flushing for 1 and 2 min. A total of 36 water samples were collected in 2 weeks. One sample of tap water from basin was taken as study control. One sample each from Unit A, B, and C and 2 samples from Unit D (1 min and 2 min flushing) were taken as baseline samples. Samples were collected three times a week and assessed for total viable count (TVC) and types of organisms present. Results: For Unit A, no growth of microorganisms was observed. Flushing for 1 min and 2 min showed variable TVC. No significant difference was seen in TVC of units B, C, and D in comparison to the baseline samples. Conclusions: It was found that 0.12% CHX was very effective in controlling DUWL contamination. Adhering to a recommended 2 min flushing regimen can reduce the bacterial counts, but is not a reliable means of disinfection.

Objective: To determine oral health perception among officers and men of the Nigeria Prison Service, Abuja. Materials and Methods: A cross-sectional study of officers and men in Prison headquarters and Kuje command in Abuja, Nigeria, was conducted between January and May 2009 using a self-administered questionnaire. Results: A total of 407 prison officers constituting 57.0% males and 66.6% senior officers participated in this study. Only 15.7% of the respondents had good oral health knowledge. Oral health knowledge was not significantly associated with age, sex, and designation of staff (P>0.05). More than half (52.8%) of the respondents exhibited positive attitude to oral health and this was not significantly associated with age, sex, and designation of staff (P>0.05). More than half (53.3%) of the respondents cleaned their teeth with toothbrush and toothpaste in this study; however, only about one-third (32.4%) of the respondents indulge in twice-daily tooth brushing. This practice was significantly higher among younger staff (P=0.009), junior cadre staff (P=0.001), and males (P=0.931). Only 27.5% of the respondents have never visited the dentist. Oral conditions among the respondents were toothache (55.5%), gingival bleeding (61.2%), and mouth odor (47.2%). Perceived high cost of treatment and fear of dental instruments are the most commonly identified barriers to oral health utilization. Conclusion: Inadequate knowledge, negative attitude, and suboptimal practices regarding oral health were noted among the respondents. Gingival bleeding, toothache, and mouth odor were highly prevalent among the studied Prison staff. Dentist visit practice among the studied Prison staff was low with barriers as high cost of dental treatment, fear of dental instruments, no dental clinics nearby, and no time to visit the dentist.

Objective: To assess the prevalence of malocclusion and deleterious oral habits among 12 and 15-year-old school children in Shimla city, India and to find, if any correlation exists between the two. Design: Correlational study design. Setting: Twelve schools in Shimla city, India. Materials and Methods: Prevalence of malocclusion and orthodontic treatment need was assessed using the Dental Aesthetic Index (DAI) among a sample of 961, 12 and 15-year-old school children in Shimla city, who received no orthodontic treatment before or during the study. Subjects were also assessed for deleterious oral habits. Statistical Analysis: Chi-square and Mann-Whitney U tests were used. Multivariate regression analysis was used to test the correlation of habits with mean DAI score and malocclusion traits. Results: Mean DAI score was 26.81±5.25. Nearly 53% of the study sample presented with malocclusion, ranging from 'definite' to 'handicapping' based on the DAI scores. The prevalence of various deleterious oral habits was 25.9%. About 29% of children with any oral habit developed malocclusion as compared to those without any habit (P value=0.023). Tongue thrusting, mouth breathing and thumb sucking habits had a significant impact on malocclusion. Conclusion: There was high prevalence of malocclusion (52.7%). Abnormal oral habits, particularly mouth breathing and tongue thrusting had a significant impact on malocclusion, resulting in higher frequency of crowding in anterior teeth, open bite, and spacing.

Background: Self-adhesive resin cements do not require the surface treatment of teeth and are said to release fluoride, which makes them suitable candidates for bonding of orthodontic brackets. The objectives of this study was to investigate the shear bond strength (SBS) of self-adhesive resin cements on etched on non-etched surfaces in vitro and to assess their fluoride release features. Materials and Methods: Four fluoride-releasing dual-cure self-adhesive resin cements were investigated. For SBS experiment, 135 freshly extracted human maxillary premolars were used and divided into nine groups of 15 teeth. In the control group, brackets were cemented by Transbond XT (3M Unitek, USA), in four groups self-adhesive resin cements were used without acid-etching and in four groups self-adhesive cements were applied on acid-etched surfaces and the brackets were then deboned in shear with a testing machine. Adhesive remnant index (ARI) scores were also calculated. For fluoride release investigation, 6 discs were prepared for each self-adhesive cement. Transbond XT and Fuji Ortho LC (GC, Japan) served as negative and positive control groups, respectively. The fluoride release of each disc into 5 ml of de-ionized water was measured at days 1, 2, 3, 7, 14, 28, and 56 using a fluoride ion-selective electrode connected to an ion analyzer. To prevent cumulative measurements, the storage solutions were changed daily. Results: The SBS of brackets cemented with Transbond XT were significantly higher compared to self-adhesives applied on non-etched surfaces (P<0.001). However, when the self-adhesive resin cements were used with enamel etching, no significant differences was found in the SBS compared to Transbond XT, except for Breeze. The comparisons of the ARI scores indicated that bracket failure modes were significantly different between the etched and non-etched groups. All self-adhesive cements released clinically sufficient amounts of fluoride for an extended period of time. Conclusion: For the tested cements, the strongest bonds were obtained by enamel acid-etching prior to bracket bonding. All the self-adhesive resin cements had significant long-term fluoride release and could be recommended as suitable fluoride-releasing orthodontic bonding materials.

Objectives: This study aimed to estimate the prevalence of dental anxiety and examine the socio-demographic associations of dental anxiety among a representative sample of UAE college populations. Materials and Methods: Four hundred and thirteen college students of Sharjah University in the UAE completed Modified Corah's Dental Anxiety Scale (MDAS) (47% males and 53% females). The survey also included questions in a yes/no format with which respondents rated attributions for their anxiety. Results: Prevalence of dental anxiety (MDAS score of 13 or more) was 36%, with overall severity represented by a mean score of 11.52 (SD: 4.88). Students who visited their dentist more than two years ago had significantly higher MDAS scores compared with those who visited their dentist less than two years ago (t-test, P=0.02). Compared with female students, a significantly higher proportion of males indicated that their last visit to the dentist was more than two years ago (17% vs. 30%, respectively, χ² -test, P=0.002). In addition, more than half of the students (55%) perceived a need for a checkup and 54% indicated that they visited the dentist because of problems with their teeth. Conclusions: The findings of this study indicate that although dental anxiety was not associated with gender and frequency of dental visits, feeling of lack of control and pain anticipation were strong predictors of anxiety. These results highlight the important role that dental healthcare providers could play in counseling anxious patients to reduce the impact of these factors on seeking dental care.

Objectives: The aim of this study was to compare the two-body wear resistance of two different indirect composites and lithium disilicate porcelain versus human enamel antagonists. Materials and Methods: Ten specimens of each material (BelleGlass NG, Kerr Corp.; SR Adoro, Ivoclar Vivadent AG; IPS e.max, Ivoclar Vivadent AG) were fabricated. Indirect dental composites and all-ceramic restoration were compared by an in vitro tribological test against human teeth antagonist. Wear loss of antagonist was calculated using an image analyzer (Leica) Wear behavior of restorative materials was investigated with a profilometer after each individual tribological test. A scanning microscope was used to examine the crystal morphology of the samples; the crystal phases were identified by an X-ray diffractometer. Microhardness test results were analyzed using ANOVA. Kruskal Wallis multi-comparison test was used for evaluating the corrosion data. In order to understand whether there is a relationship between mean friction co-efficients, wear rate, and hardness, the statistical non-parametric relation test was used. Results: The indirect composites showed lower wear rate and friction co-efficient than all-ceramic dental materials against enamel. As for the wear loss of the enamel antagonists, the all-ceramic restorations were more harmful to human teeth than the dental composites. Conclusion: Indirect dental composite is relatively more wear-friendly than all-ceramic restoration. Furthermore, indirect composites are favorable and less offensive. Therefore, the second generation of indirect composites is promising in long-life dental restorations.

Context: Many different polymeric materials to chair-side application on pre-impregnated glass fibers (PGF) are available and different protocols are used in clinical procedure. Aims: This study evaluated protocols used for dental splinting on adhesion between PGF and resin. Settings and Design: 42 pair of nano composite resin blocks with (6 × 6 × 8) mm ³ were assigned into seven groups (n=6) and bonded according to the protocol: Gar) adhesive, resin; Ggr) glass fiber, resin; Ggar) glass fiber, adhesive, resin; Gfgar) flowable resin, glass fiber, adhesive, resin; Ggafr) glass fiber, adhesive, flowable resin, resin; Ggfar) glass fiber, flowable resin, adhesive, resin; Gfgr) flowable resin, glass fiber, resin. Materials and Methods: Micro sticks obtained from each group were submitted to the micro tensile bond strength test. Statistical Analysis: The data were statistically evaluated using ANOVA and Tukey`s test (5%). Results: The protocol had a significant effect on the bond strength results (P=0.00). Gar and Ggar resulted in the highest bond strength with no statistical difference. Conclusions: The use of adhesive agent showed to be efficient to promote initial adhesion between fiber and nano composite resin.

Purpose and Aim: The aim of this study was to evaluate the reliability of hamular notch-incisive papilla (HIP) plane as an anatomical landmark in establishing occlusal plane in edentulous subjects. Materials and Methods: Seventy subjects were selected from the South Indian population, of which 50 were dentulous and 20 were edentulous. Dental stone casts were fabricated for dentulous and edentulous subjects. Dental stone casts of the dentulous and edentulous subjects, along with occlusal rims were analyzed using the three-dimensional analyzing machines. The angles between the occlusal planes and HIP plane were determined using the reference coordinate system based on characteristic points in the dentition on the cusp tips in dentulous casts and on maxillary occlusal rim on edentulous casts. Results: The HIP plane tends to be parallel to the occlusal plane. There is no statistical difference between sexes. Conclusion: The HIP plane is parallel to the natural occlusal plane and can be used as a reference plane to re-establish the occlusal plane in edentulous patients.

Background: The aim of this study was to investigate the cytotoxicity of six different flowable composites with the methyl tetrazolium test (MTT). Materials and Methods: For MTT, six different flowable composites (Bisco Aelite, Bisco Inc., USA; Esthet X Flow, Dentsply, USA; Filtek™ Supreme XT Flowable Restorative, 3M Espe, USA; Gradia ^® Direct Flo, GC, USA; Estelite ^® Flow Quick, Tokuyama Dental Corporation, Japan; and Clearfil Majesty Flow, Kuraray Medical Inc., Japan) were prepared according to the manufacturer's instructions in standard Teflon disks (2 mm × 5 mm) and the samples were extracted in 7 ml of Basal Medium Eagle with 10% new born calf serum and 5% penicillin streptomycin gentamisin for 24 h. In the experiments: The L929 cells were plated (25.000 cells/ml) in wells of 96 well-dishes and maintained in a humidified incubator for 24 h at 37°C, 5% CO ₂ , and 95% of air. After 24 h incubation of the cells, the incubation medium was replaced by the immersed medium in which the samples were stored. Then L929 cells were incubated in contact with evaluates for 24 h. The cell mitochondrial activity was evaluated by the MTT. 12 well used for each specimen and MTT tests applied 2 times. The data were submitted to the statistically analyzed by one-way ANOVA and Tukey's honestly significant difference (HSD) tests. Results: According to the results of MTT test with L-929 fibroblasts demonstrated that all freshly prepared flowable composites did not reduce vital cell numbers (P>0.05) in comparison to control group. Conclusion: This study revealed important information for clinical applications of flowable composites in dentistry.

Background : Saliva is the first biological fluid that is exposed to tobacco and is responsible for its changes especially the salivary flow rate (SFR) and salivary pH. Aims and Objectives : The aim of this study was to analyze and compare the long- term effects of tobacco on SFR and pH between tobacco chewers, smokers, and controls. Materials and Methods : A total of 60 Subjects were divided equally into tobacco smokers (group A), chewers (group B), and controls (group C). Saliva of each subject was collected under resting condition and SFR was expressed in mL/min for 10 min. Salivary pH was determined using the specific salivary pH strips. Results : The mean (±SD) SFR for group A; 4.34 (±0.3), group B; 3.07 (±0.26) and group C; 5.65 (±0.44) mL/min when compared and a significant relation was obtained. The mean (±SD) pH for group A; 6.8 (±0.1), group B; 6.7 (±0.1) and group C; 7.04 (±0.1) when compared and a non-significant relation was obtained though, lower salivary pH were observed in group A and B. Conclusion : Present study indicates that the SFR decreases appreciably among tobacco abusers especially more among smokeless form. A lower (acidic) salivary pH was observed in tobacco users as compared with control. These alterations in SFR and pH due to long-term effect of tobacco user can render oral mucosa vulnerable to various oral and dental diseases.

Objective: Dental student training is known to be stressful and associated with physical and psychological distress, emotional exhaustion, and burnout. Aim: The aim of this study was to identify the stress provoking factors among students performing clinical tasks in a Malaysian Dental School. Materials and Methods: A modified dental environment stress questionnaire was distributed to 179 Bachelor of Dental Surgery students during the clinical years 3-5 and their responses are analyzed. Results: The most stress provoking factor was found to be "fear of failing the course or year" (72%) followed by "fear of facing parents after failure" (46%). The least stress provoking factors were related to personal issues such as personal physical health (48%) and lack of home atmosphere in living quarters (40%). Female students were found to be more stressful than the male students and financial responsibilities provoked only moderate amount of stress among many of the students. There was a significant difference in the overall stress levels perceived by students belonging to 3 ^rd , 4 ^th , and 5 ^th year of study. Conclusion: The results of this study indicate that with the advent of newer teaching modalities, a more student friendly environment can be created so that detrimental consequences of stress can be reduced.

Background: Although the prevalence of dental caries is decreasing in developed countries, it is still increasing in developing countries. No studies have reported on the oral health status of adults in Saudi Arabia; the role models and parents for the younger generation. Materials and Methods: This was a cross-sectional study carried out between January and June 2012 and included 200 randomly chosen Taibah university staff members. Each participant received a self-administered questionnaire and consent form detailing the objectives and rational of the study. Results: The response rate was 74%; mean age was 32.6 years and almost 90% had obtained higher educational qualifications. Nearly, half (48%) cleaned their teeth in the morning and evening, 77% used a tooth stick and toothbrush and almost 90% used tooth paste regularly. Under two-thirds (61%) visited the Dentist only when necessary and 13% had never visited a Dentist. The treatment received included restorations (35%), scaling and polishing (21%) and extractions (18%). Of those who did not visit the Dentist, 40% cited the high cost as the reason. The majority (78%) were aware that sugar is harmful for the teeth. Under half (46%) used tobacco and 36% had medical conditions. Those who visited the Dentist were more likely to brush twice daily (P=0.04) and of those who brushed regularly, 50% knew the number of permanent teeth present (P=0.04) and 57% were aware of the benefits of fluoride (P=0.01). Conclusion: The majority of respondents had a poor level of knowledge regarding oral hygiene. This was reflected in their poor and inconsistent brushing habits and their lack of utilization of dental services.

Oral myiasis is a relatively rare pathology in humans caused by invasion of body tissue or cavities of living animals or humans by larvae of certain dipteran flies. It is an uncommon clinical condition, being more frequent in underdeveloped countries, and in countries with tropical climate. Common pre-disposing factors are poor oral hygiene, halitosis, trauma, senility, suppurative oral lesions, and in patients with neuro-psychiatric deficits. The present article reports a case of oral myiasis involving the anterior palate in a physically and mentally disabled 24-year-old female patient.

Congenital or acquired loss of body parts is of common occurrence and replacement of such parts for restoring their lost function and esthetics is done by using various bio-compatible materials. Proper assessment of the disfigured body parts and a feasible approach to rehabilitating them has for long, been the target of clinical maxillofacial prosthodontics. The aim of this article is to present a case report of such a silicone prosthesis for a patient with a congenital unilateral auricular defect.

Increase in size of gingiva is termed as gingival enlargement or gingival overgrowth; characterized by expansion and accumulation of the connective tissue. Enlargement of gingiva can be classified according to etiology, pathogenesis, location, and distribution. Many forms of gingival Hyperplasia are of unknown etiology and termed as idiopathic gingival fibromatosis. Gingival fibromatosis is classified as two types according to its form. The localized nodular form is characterized by the presence of multiple localized enlargements in the gingiva and the other one is most common symmetric form results in uniform enlargement of the gingiva. Our aim in this case report is to present a very interesting case of patient with the unusual clinical forms of unilateral gingival fibromatosis and to discuss the histopathological and clinical features in comparison to similar enlargements.

Talon cusp is a rare form of developmental anomaly characterized by cusp like projections, usually presenting on palatal and lingual surface of the anterior teeth. Maxillary lateral incisor is most often affected followed by maxillary central incisor. This developmental anomaly is rare on the facial surfaces and very few cases have been reported. When it occurs, the effects are mainly aesthetic and functional and so early detection and treatment is essential in its management to avoid complications. An unusual case of talon cusp on the facial aspect of maxillary canine is reported. The chief complaint of the patient was impaired aesthetics. Aesthetic correction was There is only one reported case of facial talon cusp on maxillary canine till date. This case reports a very rare form of such anomaly along with management.

Adenomatoid odontogenic tumor (AOT) is a relatively uncommon distinct odontogenic neoplasm. Histogenesis of AOT is still uncertain, and whether it represents anomalous hamartomatous growth or a true benign neoplasm is debatable. We report herein an unusual case of AOT occurring in the mandible. The tumor showed an unusual and aggressive clinical course, location, and radiographical and histopathological features expressing PCNA and p53 protein, which are suggestive of its proliferative potential, aggressive tumor behavior, and invasive characteristics. Based on these evidences, we suggested it to be a benign aggressive neoplasm rather than a hamartoma, though based on the analysis of single case it is still debatable.