There are several novel anticoagulant drugs that are being increasingly used as an alternative to warfarin and acenocoumarol. Novel oral anticoagulants have emerged in recent years to overcome some of the drawbacks of classic oral anticoagulants. Rivaroxaban, dabigatran, apixaban, and edoxaban were approved by the Food and Drug Administration and European Medicines Agency. This paper examines the available evidence regarding rivaroxaban and sets out proposals for the clinical guidance of dental practitioners treating these patients in primary dental care. Literature search was conducted through May 2016 for publications in the ISI Web of Knowledge, PubMed, and Cochrane Library using the keywords, "rivaroxaban," "dabigatran," "apixaban," "edoxaban," "new oral anticoagulants," "novel oral anticoagulants," "bleeding," and "dental treatment." For patients requiring minor oral surgery procedures, interruption of rivaroxaban is not generally necessary while a higher control of bleeding and discontinuation of the drug (at least 24 h) should be requested before invasive surgical procedure, depending on renal functionality. Their increased use means that oral care clinicians should have a sound understanding of the mechanism of action, pharmacology, reversal strategies, and management of bleeding in patients taking rivaroxaban. Currently, recommendations are based on poor quality scientific data and clinical trials are required to establish best evidence-based practice guidance.

Dental identification of a deceased individual is a core task in forensic odontology. The accurate recording of clinical dental procedures has become more important over time because of the increasing trend of lawsuits worldwide. Previous reports have discussed the practical usefulness of endodontic evidence for human identification. Advances in endodontic imaging, root and root canal anatomy, and biomaterials have been consistently emerging in endodontic research and practice. This article provides an update on the interrelationship between endodontics and forensic personal identification.

Background: The organoleptic evaluation is considered the gold standard between evaluation methods of halitosis, but its main drawback is the difficulty of reproducibility. Purpose: The aim of this study was to evaluate the reproducibility of an organoleptic evaluation method using three levels of scores (0 = no odor, 1 = moderate odor, and 2 = strong odor) to increase reliability between researchers and clinicians. Methods: The evaluation was blindly conducted by two examiners previously calibrated by the Smell Identification Test and compliance in clinical trials. Statistical calculations were done with STATA ^® software version 9.0. Results: The degree of agreement between examiners was 82.5%, with estimated Kappa (κ =0.69), with substantial agreement.   Conclusion: The scale used in this study by organoleptic method was effective and reproducible but must be repeated and compared to other methods for better consistency of results.

Background: Frenal attachments are folds of mucous membrane enclosed with muscle fibers that attach the lips to the alveolar mucosa and underlying periosteum. They mostly go unnoticed by the dentist during the oral examination of the patient. Objectives: The present study was conducted to evaluate maxillary labial frenum morphology in primary, mixed, and permanent dentitions among schoolchildren in Wardha district. Materials and Methods: Thousand healthy school children between 3 and 14 years of age were included in this study. The maxillary labial frenum was examined using direct visual method and classified according to Sewerin's typology. The data obtained were analyzed statistically using Chi-square test. Results: Simple frenum (88.3%) was found to be the most common maxillary labial frenum. No sex-wise or dentition-wise differences were found in frenum morphology. Statistically significant difference was seen with persistent tectolabial labial frenum (P < 0.05). Conclusion: Simple frenum was found to be the most prevalent maxillary labial frenum morphology. Dentists should give due importance for frenum assessment during oral examination of children.

Aim and Objectives: Hyperactive gag reflex (GR) can be a big obstacle in certain dental procedures especially in making an upper arch impression. Treating those might be a challenge for both the dentist and the patient. Many patients withdraw from treatment because of their inability to cope with the procedure. One of the effective modalities in controlling this phenomenon is the use of Acupuncture. In this trial, Ear acupuncture was used aiming to control hyperactive GR during upper alginate impression. Methods: A total of ten patients aged between 20 and 60 years, with a history of GR on taking dental impressions were selected to be part of this clinical trial. All patients fulfilled the inclusion criteria had an upper dental alginate impression taken (or an attempt made at it) before acupuncture and a second upper alginate impression taken immediately after acupuncture based on traditional Chinese medicine. The gagging severity index used to assess GR before insertion of the acupuncture needle while gagging prevention index was used after the acupuncture and impression taking. Results: Seven patients scored I with the reflex obtunded and the impression taking carried out successfully, one patient scored II with the reflex partially controlled and impression taking still possible, two patients scored III with the reflex partially controlled but with frequent gagging and impression taking still possible. No adverse effects were observed, and patients were fit to leave unescorted. Conclusions: Ear acupuncture was found to be effective in controlling GR in all ten participants in different levels.

Objective: To explore undergraduate dental students' mobile technological preferences and their use in learning and patient management in dentistry. Materials and Methods: An online survey questionnaire (62 Questions in five parts) was designed to investigate the impact of mobile technology in dental education amongst the Bachelor in Dental Science and Graduate Dental Science (1 ^st -5 ^th year) students, at the School of Dentistry, Griffith University, Australia. Participation was voluntary. Results: In total, 251 dental students consented to participate in the study. The majority of participants were in the age group of 18-25 (65.3%). Mobile devices were used by 93.2% of the respondents for various activities including for educational purposes. Laptops and smartphones' ownership was almost similar; however, 75.7% favoured laptop as the primary device for resource storage, study, research, and organization of study materials. Social media were used by 52% of the 5th year respondents for studies and course-related activities. Majority of the students (78.8%) indicated that mobile devices with their software applications could positively assist in patient education and management; however, the relative lack of user-friendly quality applications meant that only 15%-25% of students used software applications for these purposes. Conclusion: The large student ownership of mobile devices and increased interest in its use to enhance learning experiences should encourage universities and software developers to funding research into mobile learning.

Objectives: Presence of Helicobacter pylori in the oral cavity may enhance the risk for gastric re-infection; hence, the present study was carried out to detect and compare the levels of H. pylori in subgingival plaque and saliva of patients with periodontal health and chronic periodontitis at baseline and 3 months following scaling and root planing (SRP). Methods: A total of 45 patients with 30 patients having chronic periodontitis (test group) and 15 periodontally healthy patients (control group) were considered. H. pylori was detected in subgingival plaque and saliva samples, collected at baseline and at 3 months using polymerase chain reaction. Clinical parameters were recorded at baseline, 1 month, 2 months, and 3 months. Results: At the baseline, in test group 60% and 40% of the samples were positive for H. pylori and in control group 26.7% and 13.3% of the samples were positive for H. pylori in subgingival plaque and saliva, respectively. At 3 months, 26.7% and 20% samples were positive for H. pylori in the test group and in control group 13.3% and 6.7% samples were positive for H. pylori in subgingival plaque and saliva, respectively, demonstrating higher levels of H. pylori in dental plaque than in saliva. There was a significant reduction in the percentage of H. pylori in subgingival plaque following SRP. Conclusion: Periodontal treatment has shown to be effective in reducing the levels of H. pylori from the oral cavity.

Objective: The objective of this study was to assess the pattern of tooth discoloration and care-seeking behavior among adolescents in a Nigerian community. Materials and Methods: A cross-sectional study using a questionnaire was carried out among 384 adolescents in Idere, Southwestern Nigeria. The questionnaire comprised questions on sociodemographic data, presence of tooth discoloration, and care-seeking behavior. Two calibrated examiners examined the labial and buccal surfaces of the teeth for the presence of tooth discoloration. Frequencies and bar charts were generated, and Chi-square test was used to test the association between categorical variables at P < 0.05. Results: The mean age of the study participants was 14.7 ± 2.3 years, comprising 222 (57.8%) and 162 (42.2%) in junior and senior secondary schools, respectively. Intraoral examination revealed 167 (43.9%) had discolored teeth while 127 (33.1%) perceived that they had discolored teeth. Extrinsic stains were the major cause of tooth discoloration in both anterior and posterior teeth (18%-84%) except in upper anterior teeth where enamel hypoplasia was the major cause (20%-30%). Among participants who perceived that they had tooth discoloration, 81.9% mentioned that they did not know that the discoloration can be treated. Older participants had more discolored teeth than their counterparts (P = 0.01). Age group, sex, and class of participants were associated with frequency of tooth brushing (P < 0.05). Participants who had anterior or intrinsic tooth discoloration sought care more often than those with posterior or extrinsic tooth discoloration (P < 0.05). Conclusions: Extrinsic staining was the major cause of tooth discoloration. Many adolescents did not know that the discoloration can be treated.

Aim: The study was undertaken to compare the filling quality of a 30 gauge cannula (NaviTip™, Ultradent Inc., South Jordan, UT, USA) used on a pressure syringe with a lentulospiral in primary molars. Materials and Methods: Thirty mandibular first and second primary molars in 28 healthy children of both sexes in the age group of 4-8 years were included in the study. All pulpectomy procedures were performed by one investigator. Before obturation, the subjects were randomly selected for the two obturation techniques. Effectiveness of the two obturation techniques was assessed by three independent evaluators using postoperative radiographs taken immediately after each obturation. Filling quality was determined by analyzing presence or absence of voids, extent of fill and apical seal. Results: The results of the obturation quality of the tested techniques were collected and statistically analyzed using chi-square test. There was a significant difference for the presence of voids between the two groups. NaviTip group showed the best results for the number of voids (mesial χ² = 3.567, P = 0.0497) (distal χ² = 5.058, P = 0.0269). The lentulospiral group showed more number of optimal fillings. When results were compared in terms of apical seal, NaviTip showed better apical seal but statistically no difference (P >.05). Conclusion: Lentulospiral produced the best results in terms of length of obturation, while NaviTip syringe was efficient enough in controlling voids and produced the best results for apical seal.

Objectives: The aim of the study was to use clinical outcomes and digital radiographs to compare the effects of two types of sealant materials on the treatment of noncavitated occlusal caries lesions regarding their progression or arrest in teenage permanent molars. Methods: The sample consisted of 28 teeth from 20 patients aged 11-15 years with random distribution to receive either a resin-based sealant (Fluroshield ^® , Dentsply, Philadelphia, PA, USA; Gres group) or a glass-ionomer sealant (RIVA Protect ^® , SDI, São Paulo, Brazil; Ggis group). Caries progression was monitored by clinical evaluation and radiographic examination. Clinical outcomes were analyzed using the Mann-Whitney and Fisher's exact test, and radiographic data were analyzed by Student's t-test for paired data (P ≤ 0.05). Results: There were no significant differences between the clinical outcomes of both groups regarding the sealant retention, thermal sensitivity, and development of new caries lesions adjacent to the sealed surface. There was an increase in the radiographic density coefficient (carious dentin density/sound dentin density) at the end of the study for the Gres group (P = 0.003), but the coefficient for the Ggis group was similar for both time points (P = 0.49). Conclusions: Radiographic features showed an increase in the mineralization of the caries lesions when the teeth were sealed with a resin-based sealant; however, both techniques may be considered an adequate clinical approach for controlling the progression of the lesions.

Background: Dental caries is one of the most common dental disorders affecting from all over the globe. Dental caries affects 60%-90% of schoolchildren in most developed countries, and in several developing countries, the prevalence rates are increasing. Objective: To know oral health knowledge and practice among 9-12-year-old schoolchildren and its relation with dental caries. Methods: This is a questionnaire-based cross-sectional studies conducted from September 20, 2015, to January 27, 2016, selecting four male and four female primary schools. Two calibrated examiners examined the students under the normal light with mirror and probe. Results: A total of 276 (92%) were included in this cross-sectional study. There were 118 (43%) were males and 158 (57%) were females with mean age of 10.61 years and having mean Decayed, Missing, and Filled Tooth/decayed, missing, and filled tooth (DMFT/dmft) 1.47/1.78 in male and 1.69/5.34 in female. Three-quarters of the sample (75%) reported to cleaning their teeth at least once per day, and >95% reported using a toothbrush and toothpaste. The mean DMFT/dmft and D/d scores of female were significantly higher (P < 0.05) than that of the males. The mean dmft and all the components decreased with age, and there was a significant association (P < 0.01) between oral health knowledge and the caries status. Children with a higher DMFT/dmft score tended to have poor oral health knowledge compared to those with low DMFT/dmft scores. Conclusion: Poor oral health knowledge contributes major role in the prevalence of dental caries in both male and female. In female higher DMFT/dmft was observed in spite of having good oral health knowledge.

A Class II malocclusion with a unilateral posterior crossbite in the late deciduous dentition is a challenging type of malocclusion to intercept. The objective is to analyze the long-term changes in a patient with a skeletal Class II division 1 malocclusion. A 5-year-old female child who was referred from a pediatric dentist came for consultation. Correction of posterior crossbite involves expansion of the maxillary arch with the aim of removal of occlusal interferences and elimination of the functional shift of the mandible. The treatment comprised three stages: (1) Expansion of the maxillary arch was performed with a modified Haas palatal expander and the clinical procedures thus resulted in improved facial symmetry and satisfactory functional occlusion in the mixed dentition (8 years 10 months). (2) Distalization of maxillary first molars was done with a Kloehn type headgear and a lip bumper was placed in the mandible to maintain the arch perimeter (12 years). (3) A 0.022 inch × 0.028 inch standard edgewise fixed appliance was used for comprehensive orthodontic treatment and the objectives were accomplished (14 years 5 months). The results showed great improvements in function and esthetics, and posttreatment stability was good after 7 years and 5 months.

Aim: Distribution of hypodontia and hyperdontia in the reported concomitant hypo-hyperdontia (CHH) patients. Materials and Methods: An extensive search of the reported literature from January 1966 to December 2015 was conducted using the "EmBase," "Google Scholar," "Medline," and "PubMed" databases. The search words used were "agenesis," "concomitant," "hypodontia," "hyperdontia," "hypo-hyperdontia" "concomitant hypo-hyperdontia" and "supernumerary teeth" in different combinations. The citation lists from the included references were subsequently examined, and a hand search was performed in an attempt to find additional data. Detailed analyses of the incidence of hyperdontia and tooth type of hypodontia were evaluated to determine the occurrence of hypodontia and hyperdontia in this condition. Descriptive statistics were carried out using a Chi-square test to determine the occurrence of hypodontia and hyperdontia in CHH, the value of P < 0.05 was considered statistically significant. Results: Overall, 103 individuals were reported on CHH in published English literature. The average age of them was 11.29 years and frequently observed in males (P < 0.05). Overall 63% of teeth were missing in all the cases that were reported on CHH, whereas 37% of supernumerary teeth were documented (P < 0.05). Most of the cases involved are an anterior region of the both arches (57%). Second premolars are the most commonly missing teeth in both maxillary and mandibular arches, and maxillary mesiodens (50%) are frequent supernumeraries in CHH patients. Conclusion: Hypodontia is more common in CHH patients than hyperdontia. Second premolars are the commonly missing teeth while maxillary mesiodens are the frequently reported in CHH patients. Posterior CHH has not been reported.