Tobacco is a plant product derived from a variety of plants belonging to the genus Nicotiana. The alkaloid nicotine present in the plant leafs is a stimulant and has an addictive effect. The tobacco plants have been historically grown and used for recreational purposes by the American local population. The dried tobacco leaves are consumed as chewing tobacco, snuff, and smoked in a variety of dispensations. Tobacco use (TU) has an adverse effect on various body systems and is a determinant for different diseases ranging from cancers to atherosclerosis. TU is a modifiable environmental risk factor for various diseases. Hence, with public health education and behavior modification, its burden can be reduced in a given society. Thus, the understanding of the incidence and prevalence of its use is necessary. This review attempts to sum up the significance and determinants of TU.

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Background: The prevalence of third molar pathology and problems associated with surgical extraction of impacted third molars has been extensively discussed in the literature; however, few have discussed the pathologies that can be associated with impacted third molar tooth. Aim: The aim of the current study, therefore, is to evaluate the types of associated pathologies with impacted third molars in Sub-Saharan Africans. Materials and Methods: This is a prospective study that was conducted in the Department of Oral and Maxillofacial Surgery, Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Osun State, Nigeria, between January and March 2012. Consented patients between ages 18 and 35 years were recruited into the study. Data were analyzed using IBM SPSS Statistics for Windows Version 20 (IBM Corp., Armonk, NY, USA). Statistical significance was set at P < 0.05. Results: A total of 135 mandibular third molar extractions was carried out during the study period from 72 (53.3%) females and 63 (46.7%) males (F:M = 1.1:1). Mesioangular impaction was the most frequent spatial relation of the impacted mandibular third molar to the lower second molar tooth (70 [51.9%]), followed by distoangular impaction (29 [21.5%]). Mesioangular impaction was mostly associated with pathology (70 [51.9%]), with a statistical significant difference of P = 0.000. Pathological pocket and caries on both impacted lower third molar and lower second molar tooth accounted for the highest number of associated pathologies (37 [27.4%]). Conclusion: Caries and pathological pockets were the most common associated pathology with impacted third molar.

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A total of 305 stools samples during the period of October 2011 to June 2012 were collected from patients attending Brack General Hospital and Medical Technology, Department of Brack, Al-Shati, Libya. All stool samples were examined by direct smear preparation in normal saline, iodine, and eosin stains and 4 concentration methods (formalin-ether, normal saline sedimentation, zinc sulfate, and Sheather's sugar flotation). Of the 305 samples, 18.03% stools were found positive for protozoan parasites in direct smear microscopy. Normal saline sedimentation and zinc sulfate flotation detected 27.21% and 23.6% positive samples, respectively. However, formalin-ether was found to be the most sensitive method. Sheather's sugar flotation failed to detect Entamoeba histolytica/dispar, Entamoeba coli, and Blastocystis hominis. B. hominis was the most common parasite among the patients. Concentration techniques showed significantly higher (P < 0.05) detection rates of parasites compared with direct smear microscopy.

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Purpose: The purpose of the present study was to assess current status of knowledge and attitude regarding preventive options in oral care among dentists in Davangere city, Karnataka, India. Materials and Methods: A cross-sectional questionnaire-based survey was adopted to carry out the study among 97 practising dentists in the city. Data on preventive options in oral care was collected by means of 26 self-administered knowledge-, attitude-, and practice-based questions. Microsoft excel and Statistical Package of Social Sciences (SPSS) software were used for statistical analysis of the data collected. Statistical evaluation was done by Chi-square test. Results: Among 97 respondents, 91 (93.80%) were aware of preventive dentistry and 88 (90.7%) were aware that initial lesions can be remineralized. Forty-eight (49.5%) of the respondents were aware that Casein Phosphopeptide and 93 (95.90%) were aware that tooth mousse can be used as remineralizing agent. A total of 53.95% respondents correctly answered the knowledge-based questions. Statistically significant differences were found (P < 0.05) between variables like professional reading and responses. There were no associations found between gender, age, practice location, years of experience, practice type, and participation in continuing dental education programs. Conclusions: The result of this study demonstrated the need to increase the emphasis on preventive dentistry education. It alarms the need to carry out a continuing dental education programs for practising dentists in order to update dentists' knowledge and attitude regarding preventive dental care .

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Introduction: Salivary gland secretion is mainly under autonomic nervous control, but various hormones may also modulate the salivary composition. Psychological stress exerts its effect on salivary composition, increasing the value of saliva as a dynamic biological fluid determining the overall psychological health of an individual and also in maintaining adequate oral health. Aim and Objective: To determine the salivary flow rate, pH, and viscosity among working men and women. Materials and Methods: The present study consisted of 50 patients, of them 25 were working men and 25 working women. The levels of stress among them were assessed by job stress scale (Shukla and Srivastava, Cogent Business and Management, 2016). Results: The mean flow rate of saliva in working men and women was 0.36 ml/min and 0.25 ml/min and flow rate in men and women with stress was 0.2 ml/min and 0.15 ml/min, respectively. pH in working men and women was 7.1 and 6.7, respectively. pH in men and women with stress was 6.5 and 6.4, respectively. The viscosity of saliva in working men and women was 1.05 cP and 1.29 cP, respectively, whereas the viscosity of saliva in men and women with stress was 1.3 cP and 1.5 cP, respectively. Flow rate in working men and women with stress was found to be significant. Conclusion: To conclude, the stress job exerts its influence on salivary gland function, creating an impact on the quantity and quality of saliva in maintaining the oral health.

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The susceptibility to various diseases is studied with association to genetic polymorphisms. Among these polymorphisms, single-nucleotide polymorphisms (SNPs) are very common throughout the genome. The recent advances in genetic assay techniques and increase in SNP databases are paving a way for investigation of susceptibility genes for periodontitis. This article attempts to review the role of SNP and its implications in periodontal disease and management.

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A total of 56 anterior blepharitis cases including 22 cases of ulcerative blepharitis and 34 cases of seborrheic blepharitis were studied. The predominant age group of anterior blepharitis cases was above 40 years. With males affected more than females. In the order of decreasing frequency, the isolated bacteria from anterior blepharitis in order of decreasing frequency were Staphylococcus aureus 14 (25%), Staphylococcus epidermidis 14 (25%), similar Klebsiella species 10 (18%), viridans Streptococci five (9%), Pseudomonas aeruginosa five (9%), Proteus species four (7%), Enterobacter aerugenes three (5%), and Escherichia coli one (2%). The common isolates observed in both samples were S. aureus, S. epidermidis, and Proteus species. The Gram-positive cocci S. aureus were resistant to four antibiotics and viridans Streptococci were resistant to three antibiotics, whereas the Gram-negative bacteria were resistant to two antibiotics. Improper selection of antibiotics, inadequate dosing, and poor compliance to therapy may play an important role in increasing resistance. Identification of anterior blepharitis pathogens and performing antibiotic susceptibility test are important factors in reducing the resistance to therapy.

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Background: Hepatitis B virus (HBV) is a major worldwide cause of acute and chronic liver infection. Dentists, dental students, and their paramedical staff are at a heightened risk of exposure to HBV. Aim: The aim of this study was to assess the knowledge and attitude of the graduating dentist from Faculty of Dentistry, Sebha University (Libya), toward hepatitis B infection. Subjects and Methods: Ninety-nine participants completed the self-administered, structured, pilot-tested close-ended 37-item questionnaire. Results: It was found that the graduating dental students from different study years have similar knowledge and attitude, except for the responses to questions on curriculum, contracting hepatitis B virus (HBV) from patient, vaccination schedule, perception, and treatment modality for HBV-infected patient, where statistically significant difference was noted. Conclusion: The results indicate that there is need to spread greater awareness about risk and seriousness of the HBV infection among the graduating dentists. We recommend that the dental policymaker considers modifying the dental curriculum to include a detailed session of training in areas of universal infection control procedures, handling high-risk patients, combating fear while treating patients, and teaching them to avoid discriminatory behavior beginning in the 3rd year itself.

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Dental caries is a dynamic process which results in demineralization of inorganic constituents and destruction of organic structure of the tooth. The basic mechanism of inorganic demineralization has been studied and documented well enough. However, the exact mechanisms and enzymes responsible for the organic matrix breakdown remain unknown. Matrix metalloproteinases (MMPs), a family of endopeptidases which are responsible for degrading all extracellular matrix components, which are expressed in normal dentin-pulp complex. MMP's are believed to act as double-edged sword since it causes progression of caries process and also helps in repair and defense mechanism initiated by caries in dentin-pulp complex. Several MMPs are also found in normal dentin-pulp complex cells and tissues, and they are considered to be involved in many physiological processes during the formation and maintenance of the dentin-pulp complex. This article gives a brief review of MMPs and its role in oral health.

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The aim of this study is to suggest a technique to improve the retention of the prosthesis in grossly resorbed ridge and minimize the trauma of thin, atrophic knife edge ridge with severe undercuts. Significant numbers of patients seek treatment for edentulism throughout the world. In the current scenario, implant retained/supported prostheses have been considered a standard of care for rehabilitation of completely edentulous patients, but still this treatment modality is out of reach of many patients due to economic factor. In such patients, conventional removable complete dentures are considered for functional rehabilitation. However, in some of the patients with grossly resorbed ridges and knife edge ridges or ridges with severe undercuts, these prostheses have compromised retention and also continuously causes trauma to knife edge ridges and mucosa covering the undercuts during insertion and removal of the prosthesis thereby reducing the compliance of the patient. By incorporating, a layer of resilient permanent silicone soft liner on the tissue surface of a new or old denture is a novel way to reduce the trauma of thin and severe undercut ridges and also improve the retention of the prosthesis. This study described the successful functional rehabilitation of three completely edentulous patients with grossly resorbed, thin knife edge, and severe undercut mandibular ridges with permanent silicone soft liner. Permanent silicone soft liner act as a shock absorber, helps in equal dissipation of occlusal stresses, maintains an intimate contact with the underlying tissues and compressed during function thereby increasing retention and minimizing trauma by preventing a direct contact of hard denture base with compromised tissues.

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Background: Periodontitis is a persistent bacterial infection characterized by the progressive destruction of the tooth-supporting structures and can lead to tooth loss. By triggering inflammatory reactions, periodontitis can detrimentally affect systemic health. Periodontitis is a prevalent disease in developed countries like the USA, whereas none is known about its prevalence or the motivations to ask for periodontal treatment in Libya. Aim of the Study: The aim of this study is to understand and analyze the motivation factors to seek periodontal care in the Libyan community; we recorded the chief complaints (CCs) of Libyan patients seeking periodontal treatment in a dental clinic. To the best of our knowledge, this is the first attempt to gather data regarding periodontal disease and the associated CCs in the Libyan community. Materials and Methods: A total of 121 (20–80 years) Libyan patients with periodontitis who sought periodontal care in a private polyclinic were examined. Their CCs were recorded and grouped into true periodontal CC, emergency, esthetic, or referral based. Results: Most of the patients had moderate-to-severe chronic periodontitis. The examiner recorded 170 CCs. They were divided into 14 different CC groups. The most popular CC (32%) was “I was told that I have gum disease,” which is not a true periodontal CC. The second (31%) was “my gum bleeds when I brush my teeth,” which represents a true periodontal CC. Pain constituted only 3% of the patients' complaints. Other true periodontal CCs reported in descending order were: teeth mobility, recession, gum enlargement, bad odor, tooth sensitivity, and gum discoloration. All together constituted 20%. The rest presented for checkup and “cleaning” (9%) or were referred before commencing orthodontic treatment (4%) or implant placement (1%). Conclusion: The major motivation factor to seek periodontal care was found to be the information given to the patient that they had periodontal problems. This emphasizes the crucial role of health-care providers in determining patients with periodontal diseases and raises the awareness level of this silent disease among the Libyan population.

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Background: Many studies have demonstrated the beneficial effect of tea on dental caries. Aim: The aim of the present study was to compare and evaluate the effect of green tea and black tea infusions on salivary pH in caries free and with caries individuals. Settings and Design: Randomized double-blinded concurrent parallel study. Materials and Methods: Forty healthy subjects, aged 18-20 years participated in the study. Commercially available green tea (Tetley Pure Green Tea) and black tea (Tetley Black Tea) were used in the study. The pH of saliva and of the tested tea products was determined with a digital pH meter. pH of whole saliva was measured at baseline and immediately after the intake of product (0), 5, and 10 min later. Data analysis was carried out by Student's t-test and repeated measure ANOVA. Results: In vitro pH determination of infusion showed pH value of green tea (6.27 ± 0.02) was higher compared to black tea (6.13 ± 0.03). Both green and black tea infusion intake led to a statistically significant rise in salivary pH, both in caries-free and with caries groups, which remained above the base salivary pH over the whole period of measurements. Conclusion: The present study demonstrated that after intake of both green and black tea there was an increase in salivary pH both in caries-free and with caries groups. The pH rise was more in green tea intake compared to black tea.

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Introduction: The use of English as a medium of instruction in the medical and dental schools in Sebha University, Libya has been officially acknowledged for more than 10 years ago; however, given the fact that Libyan students begin their English language learning at a relatively late age, some of them might face difficulties in their academic studies. Furthermore, the question of whether or not Libyan students prefer to be taught in English only has not been answered yet. Objectives: This study aims to find out whether Libyan medical and dental students prefer the use of English as a medium of instruction during their study at Sebha University or not. Methods: A total of 254 Libyan medical and dental students were surveyed. The participants were administered a questionnaire comprised of 18 multiple-choice questions. At the end of the questionnaire the students were asked to write a short paragraph about themselves. The responses of the participants were analyzed and compared using Chi square test. We assume that teaching core subjects in English only might be challenging to students since they lack proficiency in English as a result of learning English at a late age. Results: The results of this study show that the majority of the students surveyed prefer that core subjects be taught in both Arabic and English as this can facilitate the understanding of the material and enables them to improve their English language skills at the same time. Hence, the results of the study support our assumption. Conclusion: The present study provides an insight into the way Libyan medical and dental students view the use of English language as medium of instruction. According to students' views, the use of both students' native and target languages in teaching core subjects can be beneficial in terms of materials comprehension and language skills improvement.

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The concurrent development of better techniques has resulted in greater understanding of the apical anatomy, greater treatment success, and a more favorable patient response. These developments marked the beginning of the endodontic microsurgery era that began in the 1990s. There is a substantial difference in surgery outcome between those using the microscope and those do not. Use of advanced technology like a microscope, specially designed instruments, improved root end filling materials help to achieve faster wound healing with lesser postoperative complication.

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The purpose of this article is to review and understand currently used elastomeric impression materials in the fabrication of complete dentures. The article focuses on polyether (PE), polysulphide, vinylpolysiloxanes (VPS) (addition silicones) and condensation silicone (CS) by comparing their clinical implications and properties. The choice amongst different elastomeric impression materials depend on the combination of their characteristics, clinician's comprehension of the notions and principles in impression making.

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There is a lack of knowledge regarding genetic diseases and its prevention among general population an important premise is that a better understanding of the genetic etiology of the diseases can facilitate early detection in high risk subjects. It also helps in designing more effective intervention strategies. Exciting new technology based on the foundation of genetic research has the potential to further enhance the quality of life. Progress in the field will require training of a new generation of the scientists with requisite skills, as well as greater collaboration and interdisciplinary work. The traditional epidemiologic approach has proved useful for generating hypotheses and unraveling disease etiologies. But now it is possible to go beyond these methods and look inside the "black box" of the disease process which would be able to change the definition of the risk factors or clarify their location in the casual model.

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Dentigerous cyst or follicular cyst is an odontogenic cyst with the crown of an impacted, embedded, unerupted, or developing tooth. It is the second most common odontogenic cyst associated with an impacted, embedded, unerupted, or developing tooth. A case of large dentigerous cyst associated with an impacted canine in the mandible. This case is of interest due to its extensiveness and the presence of an impacted canine in the mandible. The purpose of this report was to describe the successful outcome of conservative surgical management of a large dentigerous cyst associated with an impacted mandibular canine. Treatment modalities range from enucleation to marsupalization which is influenced by the age of the patient, severity of impaction, size of the cyst, and root formation of associated tooth/teeth.

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Mini implant has been the major tool in anchorage management in present era. Accurate positioning of mini implant is critical due to the anatomical limitation and biomechanical utility of the implant. Currently several grids and guides are in use for the same purpose. The objective of the present article is to describe the fabrication of a simple grid for accurate positioning of orthodontic implants with minimal armaterium.

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Background: Dental caries can be traced to be as old as civilization with its evidence seen even in skeletal remnants of prehistoric humans. Dental caries is the most prevalent dental affliction of childhood. Materials and Methods: A stratified cluster sampling technique was employed in the selection of 39 schools in the geographical region. A total of 5688 students was screened. Of the total students screened, 1623 students were 5-year-old, 1936 were 12-year-old and 2129 were 15-year-old students. Pearson Chi-square test and Fishers exact test were the statistical tests employed in the survey. The level of significance was set to be P < 0.05. Results: The present study revealed that the majority (73.9%) of the 12 years students had healthy gingiva. It was revealed that among girls, 21.8% had calculus, and 2.5% had bleeding gums. Among boys, 24.3% had calculus, and 3.1% had bleeding gums. The prevalence of dental caries was the highest among 5 years students who belonged to the lower socioeconomic status (41.5%). The difference was found to be statistically significant (P = 0.004). The mean decayed, missing, and filled teeth was found to be the highest in students of 5 years age group when compared to their counterparts (P = 0.041). Conclusion: The study reveals that dental caries still remains as a major oral health problem among school children of all age group. Gingival problems also formed one of the major oral health problems of 12 and 15-year-old school children.

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Introduction: Laser is an acronym for "light amplification by stimulated emission of radiation." They are being developed for a variety of uses in periodontal therapy. The diode laser in dentistry is used for treatment of diseased periodontal soft tissue, allowing significant bacterial reduction, and removal of the inflammatory products while creating excellent hemostasis. A flexible fiber optic delivery system allows the clinician easy and safe access around the periodontal pocket. The wavelengths are transmitted through water and are very poorly absorbed in apatite crystals, making them an excellent choice to use in a periodontally involved sulcus that has inflamed tissue and pigmented bacteria. This study was undertaken to evaluate the effectiveness of diode laser as an adjunct to scaling and root planing (SRP) in the nonsurgical treatment of chronic periodontitis. Aim: To evaluate the effectiveness of diode laser on plaque index (PI), gingival index (GI) probing pocket depth (PPD) and clinical attachment level (CAL) in chronic periodontitis patients and to compare the outcome with SRP alone. To evaluate the efficacy of diode laser on plaque microorganisms namely Aggregatibacter actinomycetemcomitans and Prevotella intermedia. Materials and Methods: A total number of 20 generalized chronic periodontitis patients were selected for the study. A randomized split-mouth design was followed to assign quadrants in each to one of the two treatment groups: SRP alone (Group I control group) and diode laser as an adjunct to SRP (Group II test group). The assessment of clinical parameters was carried out at baseline, day 30, 90, and 180. The microbiological analysis was done prior to the start of the treatment at baseline, day 15, 30, 90, and 180, respectively. Results: At baseline mean colony count was equal in both groups, however, at all the subsequent time intervals, mean colony count was lower in Group II as compared to Group I. All the groups showed statistically significant reduction in relation to PI, GI, PPD, CAL, and microbial count. Discussion: In this study, an attempt was made to evaluate the adjunctive role of diode lasers on gingival inflammation, pocket probing depth, the level of clinical attachment, and microbial count in relation to SRP using a case-control design. Recently, the use of laser has emerged as an adjunctive procedure in enhancing the clinical outcome of the periodontal treatment. It is one of the most promising new technical modalities for nonsurgical periodontal treatment and has an advantage of reaching sites that cannot be approached by conventional mechanical instrumentation. Conclusion: In the present study, an attempt was made to evalute the adjunctive role of diode lasers on plaque index, gingival index, pocket probing depth, level of clinical attachment and microbial count in relation to scaling and root planning using a case-control design. On the basis of these findings, adjunctive treatment with diode laser at a higher but clinically safe frequency (940nm) at repeated intervals showed a better efficacy in ensuring a better periodontal health as compared to SRP alone.

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Background: Electronic apex locators can be a useful adjunct with a high level of accuracy for determining the real root canal length in clinical practice. Aim: The objective of this ex vivo study was to evaluate the accuracy of electronic apex locator for real working length determination in comparison with a manual method. Materials and Methods: Forty single-rooted teeth were used in this study. After coronal access, manual measurement of the real working length of each root canal was performed by placing a size 10 K-file, using as reference the exceeding of the file in the apical foramen. The file was retracted by 1 mm, and its extension was measured to determine the real working length. The electronic measurement of the working length was performed in the same teeth using the Joypex 5 electronic apex locator. Results: Data were submitted to statistical analysis (Wilcoxon-Mann-Whitney test, P > 0.05) and no significant difference was found between the electronic and manual methods (P > 0.05). Conclusions: It may be concluded that the electronic apex locator is a reliable and accurate method for determining the working length of root canals, optimizing the odontometric procedure in clinical practice.

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Introduction: Though the possibility of contracting infection from human immuno-deficiency virus (HIV) infected patient is very slim, dental professionals show high reluctance to treat such patients. Their attitude and behavior is a reflection of their understanding about the disease. Aim: The aim of the survey was to evaluate the knowledge and attitude of dental students toward HIV/acquired immuno-deficiency syndrome (AIDS), oral indicators, ethical aspects of its treatment, and their inclination to treat HIV/AIDS patients. This is the first attempt of such evaluation among Libyan students to the best of our knowledge. Materials and Methods: The study was conducted as a cross-sectional survey using a questionnaire among 101 dental students comprising 3 ^rd year, the final year and BDS interns in Faculty of Dentistry, Sebha University, Sebha, Libya. The results were analyzed for statistical significance using SPSS version 17.0 (SPSS Inc., Chicago, IL, USA). Results and Discussion: The response rate to the questionnaire was 100%. Statistical significant correlations were observed in attitudes toward the curriculum, modes of transmission, treatment of HIV-infected patient, information of HIV status to patients, rights to reject treatment of infected patients, stress on treating and resuscitation of such patients. Conclusion: Our study reflects the knowledge status and positive attitude of Libyan students toward management of HIV. Sincere efforts should be made to improve the modes of educating the students about the HIV infection and its dental implications.

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Background: Ameloblastomas, the second-most common odontogenic tumors, are locally aggressive benign lesions that derive from cellular components of the enamel organ. Objective: The objective of the study is to assess the possible influence of cell proliferation markers Ki-67 and proliferating cell nuclear antigen (PCNA) on the biological behavior of ameloblastomas. Materials and Methods: A PubMed database search through February 2018, using the following medical subject headings (MeSH) terms were performed: “ameloblastoma” and (“Ki 67 antigen” or “proliferating cell nuclear antigen”). Selection Criteria: Studies with findings on cell proliferation markers in ameloblastoma. There were no restrictions regarding language or date of publication. Data Analysis: The data were analyzed using statistical software RevMan 5.3 (The Cochrane Collaboration, Oxford, UK). For continuous outcomes, the estimates of effects of an intervention were expressed as mean differences using the inverse variance method together with 95% confidence intervals. Results: Fourteen studies on cell proliferation markers in ameloblastoma were included in this meta-analysis. A greater significant Ki-67 expression in recurrent ameloblastomas (P < 0.01), in follicular type of solid/multicystic ameloblastomas (P < 0.05) and maxilla located ameloblastomas (P < 0.05) was found. In contrast, no significant influence of Ki-67 expression was observed in the following parameters: clinical type of ameloblastoma, histological type of unicystic ameloblastoma, age, gender, or size of the lesion. Finally, PCNA expression had no significant influence in any case. Conclusions: Ki-67 but not PCNA antigens seem to have an influence on the biological behavior of ameloblastomas.

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