Refractory or recurrent periapical abscess often results from failed endodontic treatment due to factors such as inadequate access, poor canal cleaning, resistant endodontic microbes, faulty restorations, and procedural errors. Instrument separation during root canal treatment is a significant complication that can prevent complete cleaning of the canal beyond the broken fragment, reducing treatment success. Advances in endodontic techniques and tools have improved the ability to retrieve separated instruments, but in resource-limited settings, standard retrieval kits and ultrasonics may not be available. The reported case involves a maxillary central incisor with a file separated 2 years prior. Successful file retrieval was achieved using a combination of the braiding technique and ultrasonic scaler tip vibrations. This case report emphasizes that thorough knowledge, refined clinical skills, and experience are critical for effectively managing fractured instruments in root canals, especially when advanced equipment is not accessible.
Background: Teledentistry (TD) enables remote delivery of dental care through consultations, triage, and patient education. Although widely adopted internationally, its use in Trinidad and Tobago (T and T) has not been studied, and understanding dental professionals’ (DP) knowledge, attitudes, and practices (KAP) is essential for effective implementation. Objective: To assess DPs’ KAP of TD in T and T and explore demographic factors associated with these outcomes. Methods: A cross-sectional online survey was conducted between January and June 2025 using a validated self-administered questionnaire (Cronbach’s α =0.821). All 692 registered DPs in T and T and dental interns at the University of the West Indies, St. Augustine were invited. A total of 138 responses were received (20% response rate; margin of error ~ 7.5%). Data were analyzed using descriptive statistics and Chi-square tests (P < 0.05). Results: Respondents were mostly 25–40 years old, held a Doctor of Dental Surgery (77.8%), worked in private practice (81.9%), and had ≤10 years’ experience. While 75% reported familiarity with TD, only 40.4% had used it, mainly for emergency consultations and follow-ups via phone calls and messaging apps. High knowledge scores were observed in 48.5%, with gaps in legal (78.7%), technological (55.9%), and insurance-related (91.2%) areas. Attitudes were generally positive, with most viewing TD as beneficial. Barriers included data privacy concerns, unclear legislation, and inadequate training, while facilitators included clearer regulations, targeted education, and improved infrastructure. Conclusions: DPs in T & T have moderate knowledge and positive attitudes toward TD, but usage remains limited. Addressing regulatory, educational, and infrastructural barriers is essential to support broader adoption.
Introduction: Academic success has a great influence on a student’s self-esteem, motivation, and perseverance in higher education. The highly competitive climate, frequent examinations, and patient interaction at dental schools make dental education one of the most exhausting fields. The self-perceived confidence level is increased when students gain more experience and training. Methodology: An observational study was conducted among students pursuing dental education in Dhule district. A questionnaire consisting of 18 questions was given to dental students. Questions related to the factors affecting their academic performance and regarding regular attendance, new educational technology, social factors, facilities available and peer pressure were included. Results: 49.5% of the participants agreed that new technology will be helping them in understanding the subject. 84.7% of the participants believed that daily utilization of library and study hours affect their academic performance. Conclusion: Multiple factors affect the academic performance of the students that can be students’ attendance, well-equipped library, college facilities, extracurricular activities, etc.
Alzheimer’s disease (AD) has a substantial impact on oral health management due to progressive cognitive decline, neuromuscular incoordination, and behavioral changes. Conventional complete dentures often pose functional and compliance challenges in this vulnerable population, necessitating specific prosthetic modifications. To systematically review and synthesize the existing literature on design modifications in conventional complete dentures tailored for patients with AD. A comprehensive electronic search was conducted across PubMed, CINAHL, Cochrane Library, and Google Scholar databases. Studies discussing denture modifications specific to Alzheimer’s patients were included. An exploration of grey literature was also included through Google Scholar. Manual search in the references of the selected articles was also done for relevant articles. Risk of bias assessment was done using an eight-item questionnaire provided by Murad MH et al. The review identified limited but relevant studies. After applying the selection criteria, a total of 3 articles were selected from PubMed, and 3 from Google Scholar. Two articles from these discussed denture traceability method, three discussed denture identification method, and one discussed occlusal design modification. Alzheimer’s disease patients have special prosthodontic needs. Evidence is still lacking, despite the fact that certain denture alterations appear to have potential in enhancing function and compliance. To create standardized methods and assess their long-term effectiveness and patient outcomes, high-quality clinical research is needed.
Background: General anesthesia is the anesthetic technique of choice for laparoscopic cholecystectomy. Spinal anesthesia has become the primary choice for laparoscopic cases due to advantages such as complete relaxation of muscles, conscious state, economical, uneventful postoperative recovery, and painless early period postoperatively and reduced complications associated with general anesthesia. The present study aimed to study the effects of laparoscopic cholecystectomy under spinal anesthesia. Materials and Methods: Following approval from the institutional ethical committee, 225 patients (males = 57 and females = 168) with age ranging between 19 and 85 years were selected for the study. 0.5% bupivacaine (15–170 mg) using 25G spinal needles was used for administering a neuraxial block in L3–L4 space. After a neuraxial block, the head was kept at a low-steep position, and a 0.3 mg injection of atropine with 15 mg of injection ephedrine was given. After completing the laparoscopic procedure, patient was placed in head up and right up position. As CO2 pneumoperitoneum was achieved, 2 ml of conscious sedative agents injection midazolam 1.5 mg (1.5 ml) along with ketamine 2.5 mg (0.5 ml) and injection butorphanol 2 mg (2 ml) were administered for reducing abdominal discomfort and shoulder pain or irritation. Injection pantoprazole 40 mg and injection ondansetron 4 mg were given preoperatively for reducing risk of vomiting and aspiration. Results: The subjects comprised 52.63% of males and 60.71% of females aged <50 years, while 47.37% were males and 39.29% were females over 50 years. 8.77% of males and 52.38% of females were <160 cm in height, whereas 91.33% of males and 47.62% of females were more than 160 cm in height; 74.54% of males and 40.47% of females were <70 kg in weight, while 82.46% of males and 59.33% of females weighed over 70 kg. 26.13% of males and 47.61% of females had history of previous performed surgeries other than cholecystectomy. Surgical time taken in males were 58 min, whereas in females, it was 35 min. 17.54% of males and 34.52% of females had shoulder pain, whereas none of the patients had nausea or vomiting episodes. 26.31% of males and 22.61% of females suffered from hypotension. 3.5% of males and 1.19% of females had high spinal. Conclusion: Cholecystectomy through laparoscopy is slowly gaining popularity due to various advantages which include early mobilization, reduced morbidity, lesser postoperative pain, and fewer complications.
Irritation fibroma, also known as focal fibrous hyperplasia or traumatic fibroma, is a benign reactive hyperplastic lesion of connective tissue caused by chronic irritation. A 43-year-old female presented with recurrent gingival swelling in the mandibular right quadrant (42, 43, and 44 regions), which had enlarged over 3 years. Clinical examination revealed a firm, solitary, sessile mass without ulceration. Radiographic examination showed increased radiopacity along the marginal alveolar bone, indicative of sclerosis. The lesion was surgically excised. Histopathological examination confirmed the diagnosis of focal fibrous hyperplasia (irritation fibroma). Postoperative healing was satisfactory with no signs of recurrence after 6 weeks. The occlusion improved, and complete intercuspation was achieved following lesion removal. The recurrence was attributed to chronic irritation from occlusal trauma and food impaction due to inadequate occlusal correction after previous excisions. Effective management of irritation fibroma requires complete excision along with the elimination of underlying etiological factors, including occlusal correction.
Squamous odontogenic tumor-like proliferations (SOTLPs) are uncommon and incidental findings in odontogenic cysts. The histopathologic features overlap with central squamous odontogenic tumor and other aggressive odontogenic neoplasms, which pose a real challenge for pathologists and surgeons, as mistaking one for the other could lead to aggressive and unnecessary treatment. A 66-year-old female presented with a gradually enlarging swelling in her right upper back region. Aspiration of fluid suggested a cystic lesion. Cone-beam computed tomography suggested an aggressive odontogenic lesion with cortical perforation and maxillary sinus involvement. The lesion was enucleated and histopathologic examination was performed which revealed a benign odontogenic cyst with islands of normal-appearing squamous epithelium, which were diagnosed as an SOTLP. This case reminds us to carefully combine clinicopathologic features with radiographic findings. Accurate differentiation between incidental SOTLP and true odontogenic neoplasms is essential to prevent unnecessary aggressive treatment.
The integration of oral health into primary care remains an urgent global challenge despite longstanding recognition of health as a basic human right. Geographic isolation, limited mobility, and socioeconomic inequities perpetuate gaps in access to preventive dental services and contribute to systemic morbidity. Teledentistry, comprising synchronous video consultations and asynchronous store-and-forward imaging, has matured beyond its pandemic-era role as a stopgap and now offers a scalable framework for screening, triage, preventive counseling, and interdisciplinary co-management. This editorial contends that teledentistry is essential to contemporary primary oral health care. It reviews clinical and public health benefits, addresses implementation barriers, including infrastructure, security, reimbursement, and workforce training, and outlines a research and policy agenda to validate outcomes and incentivize adoption. Embedding teledentistry within primary care can shift oral health from episodic, access-limited care toward equitable, preventive services accessible to all.
Managing children with autism spectrum disorder (ASD) in a dental setting presents numerous challenges. Their behavior, communication abilities, sensory sensitivities, and the level of support from parents and clinicians significantly influence treatment planning. This report describes the comprehensive behavior-guided management of a child with ASD who presented with an Ellis Class II fracture of tooth 12. A stepwise, individualized approach enabled restoration of the tooth in a fully conscious state using composite resin in a modified, child-friendly manner.
Background: Role modeling is an essential part of clinical education, allowing students to develop professional values and behaviors by observing their tutors. In dentistry, clinical tutors often influence students both positively and negatively, yet little is known about these dynamics in the Caribbean context. Objective: This study explored how clinical dental students and interns at the University of the West Indies, St. Augustine, view their clinical tutors as role models, with attention to both positive and negative attributes. Methodology: A cross-sectional survey was conducted among 71 doctors of dental surgery clinical students (years 3–5) and interns. An anonymous online questionnaire collected demographic information, perceptions of role modeling, and ratings of tutor characteristics. Descriptive statistics summarized the findings. Friedman’s test with post hoc analysis compared domains, while Kruskal–Wallis and Mann–Whitney tests assessed variation by year of study and gender (significance set at 5%). Results: The response rate was 71.3%. All participants agreed that role models are important, and most (79%) reported that gender did not affect their choice. Tutors were perceived to increase career confidence (82%) and to display both positive (90%) and negative (91%) traits. Clinical competence received the highest rating (4.61 ± 0.39), followed by personal qualities (4.51 ± 0.41) and teaching acumen (4.48 ± 0.39) (P < 0.001). No significant differences were observed by year of study or gender. Conclusion: Students recognized the importance of role models in their education and identified clinical competence as the most valued attribute. While both positive and negative traits were acknowledged, the findings underscore the responsibility of clinical tutors to encourage positive behaviors and reduce negative ones to support a constructive learning environment. Clinical Relevance: Understanding how students perceive clinical tutors as role models can inform faculty development initiatives within Caribbean dental schools. Supporting positive role modeling and addressing negative behaviors may strengthen dental education and prepare students for professional practice.
Cleft lip and palate (CLCP) is one of the common congenital anomalies (birth defects) in humans. It is multifactorial in etiology. Infants or children with CLCP usually suffer from a range of problems, such as inadequate nutrition, severe speech, hearing, and social developmental disorders. Furthermore, CLCP children usually face esthetic problems, maxillary hypoplasia, malocclusion conditions, and poor oral hygiene, which consequently affect their quality of life. Hence, timely treatment of these abnormalities through appropriate surgical procedures, and their special care usually play a significant role in reducing some of these associated problems/disabilities of CLCP-affected pediatric patients. In recent years, rapid evolution in digital technological innovations and advancements in various aspects of management or care of CLCP patients is evident from pertinent literature. Similarly, applications of immersive extended reality technologies, including virtual reality (VR) and augmented reality (AR), have been reported by several recent studies in the context of different aspects of cleft lip and cleft palate care. Oral health professionals and researchers always need to remain updated about such emerging digital technologies in managing the CLCP patients effectively. Therefore, the goal of this article was to extensively explore and review the current literature and subsequently, to discuss and highlight it in a narrative way. An exhaustive search strategy for multiple databases was executed using relevant keywords and their combinations to explore and identify pertinent published records. The important findings related to extended reality technologies (VR, AR, and MR) in CLCP management have been discussed in this narrative review article.
The most widespread chronic disease affecting children in the world today is oral disease. Problems, such as dental caries, periodontal disease, and other oral diseases, are major contributors to poor nutrition and growth in children. These also affect their later life in terms of education, health status, and happiness. Schools represent a strategic gateway to promoting preventive oral health practices because children are exposed to them in the formative years, when their oral habits remain unchanged throughout their lives. Integrate oral hygiene education into school curricula to enhance knowledge and behaviors and reduce the burden of preventable dental diseases. It is common for school-based oral health programs to implement health education, supervised toothbrushing, dietary counseling, dental checks, and referral programs. Studies have shown that these interventions markedly improve oral hygiene and reduce dental morbidity among school-aged students. Teachers, providers of health services, and policy makers have important roles in the sustainability of these programs. In a world where dental care is often on a deficit basis, school oral health practices emerge as a cost-effective public health strategy. This editorial section outlines the need for oral hygiene education, describes key elements of effective programs, and proposes that these programs have the potential to strengthen preventive oral health at the core practice level in primary care settings.
Medication-related osteonecrosis of the jaw (MRONJ) is an increasingly recognized complication often associated with long-term use of antiresorptive and antiangiogenic medications such as bisphosphonates and denosumab. The condition presents ongoing challenges in identifying and managing affected patients and may significantly affect oral function and quality of life. With the rising number of individuals receiving these therapies, updated and practical guidance for oral healthcare providers has become essential. A comprehensive review of the literature was conducted through PubMed, SCOPUS, and Google Scholar. Relevant journal articles, clinical recommendations, and case reports were selected using terms including MRONJ, bisphosphonates, denosumab, osteonecrosis, and oral health, and were critically examined to summarize current understanding of MRONJ, including its biological mechanisms, diagnosis, treatment options, and emerging approaches. Evidence suggests that MRONJ is influenced by multiple interconnected biological and clinical factors, such as impaired bone turnover, reduced blood supply, immune alterations, and local trauma. Clinical evaluation and imaging, guided by staging systems such as the American Association of Oral and Maxillofacial Surgeons criteria, play key roles in assessment. Management may involve conservative approaches, surgical treatment, and prosthetic rehabilitation, often requiring collaboration across specialties. The COVID-19 pandemic has added further complexity due to delayed dental care and increased steroid use, potentially heightening MRONJ risk. Overall, MRONJ remains a significant concern in modern dental and medical practice. Early recognition, coordinated care, and the integration of developing technologies such as regenerative therapies and AI-assisted diagnostics are essential for improving patient outcomes and supporting comprehensive management.
Background: Chewing betel quid is common masticatory habit among Southeast Asian and Pacific region population despite its harmful health consequences. The most deliberate individual level harmful effect is oral cancer. There are ample studies on the prevalence of this habit. Nevertheless, variations of this habit the different patterns, underlying determinants and the factors that affect cessation of this habit are not studied widely. Aims/Objectives: To study on social determinants and factors related to cessation of betel quid chewing. Methods: In-depth interview-based qualitative study on purposive sample would contribute to some extent to minimize the evidence gap. In-depth interviews were conducted among apparently healthy 20–45-year-olds individuals living in Kalutara district Sri Lanka. Results: This reveals that chewing habit pattern develop mainly on living and social environment. Poor knowledge on this habit is identified reason why people engage in these behaviors. Most of the betel quid chewers who want quit need support to quit these behaviors. Conclusion: Health education and persuasive communication program would benefit on betel quid chewers who are willing to quit the betel quid chewing habit/behaviors.
Background: The early identification and noninvasive treatment of developing lesions with new remineralizing agents is becoming the paradigm for caries control. This study compares the remineralization potential of commercially available agents (toothpaste and mouthwash) on white spot lesions (WSLs) in primary teeth that are artificially created. Materials and Methods: In this in vitro randomized trial, eighty extracted or exfoliated primary teeth were randomly divided into eight groups: Group A–Cheerio toothpaste (Sodium monofluorophosphate [MFP]), Group B–Amflor toothpaste (Amine fluoride), Group C–Toothmin toothpaste (Calcium sucrose phosphate), Group D –Dent91 toothpaste (NanoHydroxyapatite), Group E–Aloe HA toothpaste (Aloe Vera), Group F–Dabur Meswak herbal toothpaste (Meswak), Group G –Kidodent Mouthwash (Sodium fluoride), and Group H–Hiora Mouthwash (Meswak). WSLs were artificially induced, and samples were treated with the respective agents. DIAGNOdent readings were measured before demineralization, after remineralization, and at baseline. Results: All groups showed significant improvement within groups in DIAGNOdent values after remineralization (P < 0.001). However, intergroup comparisons indicated that the calcium sucrose phosphate group, followed by the sodium MFP group, demonstrated a more significant remineralization potential than the other groups. Conclusion: Although all tested agents demonstrated effective remineralization potential, with comparable differences among them, calcium sucrose phosphate, closely followed by sodium monoflurophosphate, exhibited greater remineralizing potential, indicating its suitability for noninvasive management of early carious lesions in primary teeth.
Evidence-based practice (EBP) integrates the best research evidence, clinical expertise, and patient values to guide decision-making. In pediatric dentistry, it is essential because of the high burden of early childhood caries, malocclusion, trauma, and the needs of children with systemic conditions. India, with its large child population and marked rural–urban disparities, faces major barriers to EBP adoption, including limited resources, uneven workforce distribution, gaps in education, and cultural challenges. At the same time, systemic reforms and technological advances create new opportunities. Initiatives such as Ayushman Bharat, the National Oral Health Programme, and digital health missions provide a foundation for embedding oral health into mainstream healthcare. Emerging tools such as tele-dentistry, digital decision support, and minimally invasive dentistry further enhance access and quality of care. This paper discusses the relevance of EBP in Indian pediatric dentistry, outlining key challenges and potential solutions such as curriculum integration, clinical pathways, school-based preventive programs, antibiotic stewardship, and practice-based research networks. A 5-year strategic roadmap is proposed, focusing on national guidelines, equitable access to essential materials, digital integration, and outcome monitoring.
Context: Pharmacovigilance (PV) and adverse drug reaction (ADR) reporting are essential components of patient safety and rational drug use. Dentists routinely prescribe medications such as antibiotics and analgesics, making their participation in ADR reporting vital. Despite this, ADRs remain underreported, largely due to gaps in knowledge, attitude, and practice among healthcare professionals. Evaluating the KAP toward PV and ADR reporting among practicing dentists is necessary to identify deficiencies and promote effective pharmacovigilance. This study assesses the KAP of practicing dentists in Maharashtra toward PV and ADR reporting. Aims: The aim of this study was to evaluate the knowledge, attitude, and practice (KAP) toward pharmacovigilance (PV) and adverse drug reactions (ADRs) reporting among practicing dentists in Maharashtra. Settings and Design: This questionnaire-based cross-sectional study was conducted with total 264 practicing dentists in Maharashtra, after receiving the proper Institutional Review Board approval. Subjects and Methods: A prevalidated questionnaire Google Forms comprised three divisions, first division (Q: 1–6) analyzed knowledge domain, second division (Q: 7–9) analyzed attitude, whereas third division (Q: 11–14) analyzed practice domain were distributed to all participants. Statistical Analysis Used: Data were analyzed using descriptive statistics. Results: The mean age of study participants was 20.35 ± 0.67 involves 69.3% were female participants and 30.7% male. Out of 101 participants, 59.7% had adequate knowledge about PV and 95.8% had better attitude and 65.62% had better practice toward ADR reporting. Conclusions: The above results indicate that the KAP toward PV and ADR reporting among practicing dentists were satisfactory. Thus, the improvement seen shows a positive attitude toward pharmacovigilance and gives confidence that future healthcare professionals can effectively reduce the underreporting of adverse drug reactions.
The pediatric population has malocclusions with a higher prevalence worldwide. Malocclusion in the mixed-dentition phase has a negative impact on the oral health-related quality of life of pediatric patients and their families. Discrepancy in the transverse dimensions of the maxillary arch may present a range of malocclusion conditions, including cross-bite, functional shift, crowding, impaction, and ectopic eruption of permanent teeth, etc. Usually, orthodontic intervention involves the maxillary expansion to correct the abovementioned malocclusion conditions. In growing children with mixed dentition, various orthodontic intervention modalities using removable or fixed appliances for addressing the maxillary/palatal constriction condition. However, literature highlights various drawbacks or limitations of these traditional appliances. In recent years, the use of clear aligners in pediatric patients in early orthodontic intervention for correcting various malocclusions, including dental crowding, anterior or posterior cross-bite, etc., has been described in the literature. Moreover, clear aligners have been highlighted recently in literature about its use for the purpose of maxillary expansion in the mixed-dentition stage of children. However, to date, there is no comprehensive review article in the existing literature describing the different clinical aspects and factors of the use of clear aligners for maxillary expansion in the mixed-dentition phase of growing patients. Hence, the intention of this review article was to extensively explore the relevant literature in online different databases and to summarize or highlight the clinically important findings and aspects reported by the pertinent published studies.
The cancer of the mouth and back of throat is referred to as oral cancer or mouth neoplasms. Oral cancer is the biggest public health issue found globally. Due to India’s diverse population and its association with smokeless form of tobacco addiction which is irrespective of culture, ethnicity, or geography due to which oral cancer is one of the most common health outcomes found. Premalignant lesions and oral cancer have the common causes related to numerous exposures. Smokeless form of tobacco use, alcohol use, and even spicy food consumption are all significantly seen in the Indian population. There is enough information in the literature to conclude that there are number of factors which influence the risk of oral cancer. It was found that scoping review was the best way to address this broad research question. The scoping review was undertaken in accordance with Arksey O’Malley’s five steps, and Levac and colleagues,’ and the Joanna Briggs Institute’s (JBIs) suggestions for improvement were also included (JBI method). This scoping review comprised publications that were found through a systematic search of articles from multiple sources, including PubMed and Google Scholar, hand searching of important journals, and investigation of the many databases linked to risk factors of oral cancer. The results of the scoping revealed the various risk factors related with oral cancer in the Indian population. After reviewing the articles, many factors such as smokeless and smoke form and even lifestyle were found to be related with the disease.
Background: There have been conflicting reports on the benefits of fixed orthodontic treatment on crowded dentition in the outcome of periodontal status. This study aims to compare and evaluate the salivary microbial levels and periodontal status in patients with crowded dentition undergoing fixed orthodontic therapy. Materials and Methods: The study included 10 patients scheduled for fixed orthodontic therapy; all were bonded with metallic orthodontic brackets, bands, and auxiliaries and were also given similar oral hygiene maintenance instructions. Periodontal status was assessed by plaque index, gingival index, and probing pocket depth, and salivary samples were analyzed for total bacterial count and Streptococcus mutans count, before placement of the appliance and 6 months after initial leveling and alignment phase of fixed appliance therapy. Results: The mean total salivary microbial and S. mutans levels decreased from 330.31 × 105 colony-forming units (CFU)/mL and 35.90 × 105 CFU/mL to 168.60 × 105 CFU/mL and 11.10 × 105 CFU/mL, respectively, which was statistically significant (P < 0.05). There was a slight increase in probing pocket depth and plaque index, but no change in gingival index, which was statistically insignificant (P > 0.05). Conclusions: The initial leveling and alignment of the crowded dentition decreased the salivary microbial levels and S. mutans levels. The gingival index remained the same, with a mild increase in plaque index and probing pocket depth after initial orthodontic alignment.
