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Locating all the root canals, cleaning and shaping them and then sealing them completely with a root canal filling material is very important for the root canal therapy to be successful. Missed canals lead to failure of the root canal treatment rendering the patient in pain. A dentist should be well-versed with the variations in the root canal system. The given case report presents a case of lower first molar with six canals, 4 distal and 2 mesial. All the canals were located using the champagne bubble test and the bleeding points were identified and the area was scouted to locate the canals. The clinician should evaluate all the cases clinically as well as radiographically for the presence of anomalies. Usually, the clinicians try to locate only the predominant canals and do not scout the chamber for any abnormal variations. This failure to locate a canal will lead to remnants of pulp in the tooth which is the major reason for re-infection and failure of the treatment. Also, in some cases it can be a reason for persistent pain for the patient. So, it’s important to locate all the canals and clean them for a successful root canal treatment.

Background: Days of high asthma admissions (HAADs) or readmissions (HARDs) create substantial acute burdens on hospital systems. An important component of asthma care is understanding potential causes of these admission spikes with potential of mitigation of risk. Crucial to this research is accurately distinguishing these events from background seasonal changes and time trends. To date, classification methods have been based on ad hoc and un-tested definitions which may hamper understanding of causes due to HAADs and HARDs misclassification. The aim of this article is to introduce an easily applied robust statistical approach, demonstrated to have high classification accuracy in other settings. It is referred to as the Seasonal Hybrid Extreme Studentized Deviate (S-H-ESD) method.Methods: We demonstrate S-H-ESD on a time series between 1996 to 2009 of all daily paediatric asthma hospital admissions from the Victorian Admitted Episodes Data set (VAED).Results: The S-H-ESD method clearly identified HAADs and HARDs without applying ad-hoc classification definitions, while appropriately accounting for seasonality and time trend. Furthermore, this was able to be done with statistical testing to provide evidence in support of their identification. Conclusion: The S-H-ESD is useful and statistically appropriate for the accurate classification of HAADs and HARDS. This method removes the need for ad-hoc approaches and presents as a means of systemizing the accurate classification and detection of high asthma admission days. This will strengthen synthesis and efficacy of research in order to understand causes of high asthma hospital admission and readmission.

Pediatric asthma hospital readmission is a burden on the individual and costly for Australian hospitals. Grass pollen's role, a known trigger for asthma admissions, is unexamined in readmissions. We examined the association between grass pollen and pediatric asthma readmission.The Victorian Admitted Episodes Dataset was used to identify all primary admissions with a principal diagnosis of asthma in children aged 2-18 years between 1997 and 2009. Readmissions were defined as subsequent admissions within 28 days of index admission discharge. Generalized additive models were used to assess associations between readmission, grass pollen season, and daily grass pollen counts, lagged and cumulative. Models were further stratified by sex and age group.Mean daily readmission was higher during grass pollen season than other times of the year, incidence rate ratio (IRR) 1.44 (95% CI, 1.03, 2.02) and for children aged 2-5 years, IRR 1.99 (1.26, 3.14). Same day grass pollen was nonlinearly associated with daily readmission for the 13-18 age group between 110 and 256 grains/mGrass pollen exposure was associated with higher readmission rates for pediatric asthma. Treatment plans prior to discharge could be implemented to reduce the likelihood of readmission by younger children during the pollen season.

Periods when asthma admissions peaks have serious implications for asthma sufferers and hospitals. We assessed the association between aeroallergen exposure and childhood asthma peak periods during two grass pollen seasons using the Melbourne Air Pollen Children and Adolescent Health (MAPCAH) study conducted in Melbourne, Australia. Two peak periods were identified. Effect modifications by atopy and sex were considered. All pollen 2 days prior was associated with increased odds of these peak periods. Same day fungal spores, but not pollen, were important. Grass at lag 2 was associated with increased odds 1.03 (95%CI 1.01, 1.05) as was the same day Alternaria 1.02 (1.00, 1.04) per spore/m3 for boys. In addition to pollen, fungal spores particularly Alternaria may result in days of high exacerbations during pollen seasons. Further guidance is needed to better prepare families/carers with information about the increased risk of asthma attacks in children prior to pollen seasons.

Background Paediatric asthma-related readmissions significantly challenge public health systems. As evidence suggests readmissions are possibly associated with ambient grass pollen levels, we sought to determine the relationship between grass pollen exposure and the risk of readmission for asthma among children in Victoria, Australia. Methods The Victorian Admitted Episodes Dataset 1st July 1997–30th June 2009 was used to identify primary admissions with a principal diagnosis of asthma for children aged 2-18 years. Total sample size was 48,068 admissions. Readmissions were defined as a subsequent admission within 28 days of index discharge. Multiple semi-parametric Poisson Generalized Additive Models were used to assess associations between the grass pollen season and daily grass pollen counts (lagged and cumulative) with repeat admissions, while controlling for meteorological factors and air pollutants. Results Readmissions totalled to 2,152 (4.47% of all admissions). Mean daily readmissions were 1.44 times higher during the grass pollen season (95%CI 1.03-2.02). Pollen season was associated with readmission only for the youngest age group (2-5), incident rate ratio 1.99 (95%CI 1.26-3.14). Daily readmission was non-linearly associated with same day pollen counts only for the 13-18-year age group. Lag 2 pollen counts were non-linearly associated with all daily readmissions for boys in gender-stratified and younger age groups (2-5, 6-12) in age-stratified analysis. Conclusions Grass pollen exposure was associated with higher readmission rates for paediatric asthma. Key messages Younger children and boys with severe or poorly controlled asthma need to be assessed for preventive therapies before the grass pollen season to reduce the repeat admissions.

The burden of adolescent cigarette smoking is substantial. We assess mothers' and fathers' attitudes and behaviours on adolescent smoking using a cross-sectional study of n = 707 adolescents. Associations between parental attitudes and behaviours in adolescent smoking were assessed using logistic regression separately for boys and girls. Occasional alcohol use by both parents increased odds of smoking once a day (OR = 2.44, 95% CI 1.26, 4.71, OR = 1.51, 95% CI 0.97, 2.35, respectively). Fathers smoking increased odds for girls (OR = 1.59, 95% CI 1.01, 2.52). A democratic mother decreased odds for boys (OR = 0.32, 95% CI 0.10, 0.93) whereas a protective, demanding mother increased the odds for girls (OR = 8.65, 95% CI 1.38, 54.22). Public health smoking prevention programs could support changing parental behaviours and attitudes in early years to address this burden in countries with authoritarian parenting styles. WOS:000638522200001 2-s2.0-85103492921 PubMed: 33918478

Supplemental material, sj-pdf-1-aar-10.1177_21526567211010728 for Community Response to the Impact of Thunderstorm Asthma Using Smart Technology by Ala AlQuran MPH Mehak Batra MDS Susanto Harry Nugroho PhD Anne E. Holland PhD Janet M. Davies PhD in Allergy & Rhinology

BackgroundThe most severe thunderstorm asthma (TA) event occurred in Melbourne on the 21st November 2016 and during this period, daily pollen information was available and accessible on smart devices via an App. An integrated survey within the App allows users to self-report symptoms.ObjectiveTo explore patterns of symptom survey results during the period when the TA event occurred.MethodsSymptom data from the Melbourne Pollen Count and Forecast App related to asthma history, hay fever symptoms, and medication use was explored. A one-week control period before and after the event was considered. Chi-square tests and logistic regression were used to assess associations between sex, age, symptoms, and medication use.ResultsOf the 28,655 responses, during the 2016 pollen season, younger (18 to 40 years) males, with no hay fever and no asthma were the most single and regular responders. During the TA event for new users, sex was only significantly associated with hay fever ( p = 0.008) of which 60.2% of females’ responses reported having hay fever, while 43% of males’ responses did not. Those with mild symptoms peaked during the TA event.ConclusionsMany individuals completed the survey on the app for the first time during the TA event indicating the potential of digital technologies to be used as indicators of health risk among populations at risk of TA events.

Oral health is a burden among all populations and is linked with major chronic diseases such as cardiovascular diseases. Migrants, in particular South Asians, have poor oral health which requires further understanding to better inform oral health interventions by targeting specific aspects of this heterogenous South Asian population. This review is undertaken to systematically synthesize the evidence of oral health understandings, knowledge, attitudes, beliefs, practices, and behaviors of South Asian migrants residing in high-income countries. A comprehensive systematic search of seven electronic databases and hand-searching for peer-reviewed studies was conducted. All study designs were included, and quality assessment conducted. Of the 1614 records identified, 17 were included for synthesis and 12 were quantitative in design. These studies were primarily conducted in the UK, USA, Canada, and Europe. South Asian migrants had inadequate oral health knowledge, attitudes, and practices—influenced by culture, social norms, and religiosity. In the absence of symptoms, preventive oral hygiene practices were limited. Barriers to access varied with country of origin; from lack of trust in dentists and treatment cost in studies with India as the country of origin, to religiosity, among poorer nations such as Bangladesh. Fewer studies focused on recent arrivals from Bhutan or the Maldives. Culturally and socially appropriate strategies must be developed to target oral health issues and a “one-size” fits all approach will be ineffective in addressing the needs of South Asian migrants.

© 2017 Indian Journal of Cancer. INTRODUCTION: This is a retrospective study with data collected from breast cancer cases from five major Apollo Hospitals across India, as part of a biobanking process. One aspect of our study focused specifically on data from triple-negative breast cancer (TNBC) cases. The aim of this study was to analyze epidemiology, treatment options, and survival of the patients with TNBC. Our goal was to draw conclusions on the preponderance of the disease and also to understand the outcomes using the existing therapy options. MATERIALS AND METHODS: Data were collected after due ethical clearances and were coded with regard to patient identifiers to protect patient privacy. Data were not only from the various departments of the respective hospitals and the treating physicians but also from the follow-up made by hospital staff and social workers. RESULTS: About 20% of all cases of breast cancer comprised TNBC. Although the disease is generally thought to be an early onset disease, there was no major difference in the median age of diagnosis of TNBC compared to other breast cancer cases. More than 85% of the TNBC cases were of early stage disease with

Background: Outdoor air pollution and childhood asthma are increasing problems in South Asian countries. However, little is known about the associations between levels of air pollution and severe childhood asthma requiring hospital treatment in these regions. Methods: We undertook a systematic review to assess the evidence between outdoor air pollution exposure and childhood and adolescent asthma hospitalization in South Asia. MEDLINE, Web of Science, Google Scholar, CINAHL, Embase, Scopus, ProQuest Central databases were searched for peer-reviewed papers, and examination of reference lists was conducted for additional studies. We identified all the literature published in English up to January 2021 for the study population comprised of children aged less than 19 years. The search strategy was designed to identify all the studies and screen them as per the inclusion criteria. The method of qualitative synthesis using the standard tool determined the comprehensiveness of the assessment of bias. Results: Of the original 367 studies screened three studies were ultimately included from India, Pakistan and Sri Lanka and a narrative synthesis was conducted. Although studies reported adverse effects of outdoor pollution on asthma hospitalizations, limitations in exposure assessments, varying definitions of asthma hospitalizations and limited data analysis were identified. Conclusions: There is currently limited evidence that can provide meaningful risk estimates of the impact of outdoor air pollution on asthma hospitalizations during childhood and adolescence. Studies with comparable outcome definitions, appropriate exposure assessments and study designs are needed to inform future public and environmental health policy. PROSPERO registration: CRD42020156714 (28/04/2020)

Aim: To investigate the practice-, patient- and dentist related barriers to the provision of preventive dental care as perceived by dentists of Udaipur city, Rajasthan, India. Settings and Design:- A cross sectional descriptive survey was conducted among 120 dentists of Udaipur city, Rajasthan. Material and Methods: Mean Content Validity Ratio (CVR) was calculated as 0.87 based on the opinions expressed by a panel of total six academicians. Cronbach's coefficient was found to be 0.88, which showed a high internal reliability of the questionnaire. The questionnaire consisted of demographic questions and 12 specific research questions. Statistical analysis used:- Student's t-test and ANOVA test were applied for the statistical evaluation of means. Level of significance was set at 0.05. Results: The barriers correlated strongly with each other (0.60 to 0.85). A significant gender difference was observed in mean sums of scores of practice and patient related barriers. Practice, dentist and patient related barriers for very much hindrance were reported by 8 to 13%, 5 to19% and 0 to 29% of the dentists respectively. A significant difference was observed among mean of sum scores of practice and patient related barriers with age and experience. Qualification was significantly related to practice related barriers. Conclusions: Perception of dentists showed that patient related barriers were found to be the foremost to the provision of preventive care. Also, dentist's attitude towards health promotion and disease prevention needs a radical transformation.

Active cigarette smoking is the major cause of lung cancer and an important established cause of cardiovascular disease mortality. Risks have been shown to increase with even light or intermittent active smoking. Objectives To assess the prevalence of smoking, age of initiation and the knowledge and attitude towards smoking among dental college students of Rajasthan, India. Methods A cross-sectional study was conducted among 1,383 undergraduate and postgraduate dental college students of Rajasthan using self-administered closed-ended questionnaires consisting of 14 questions divided into four sections. A chi-square test was used to determine the association between dependent and independent variables. Results Of all the participants, 777 (56.2%) were male and 606 (43.8%) were female. Among these 258 (33.2%) males and 51 (8.4%) females had tried or experimented smoking. Majority of males (24.7%) initiated this habit at a very young age, before 16 years. About 79.5% males and 72.3% females felt that it was difficult to quit smoking. According to 88.1% females and 48.7% males, people feel less comfortable at public places or social gatherings. Conclusion The study has shown that the smoking prevalence among dental college students is high and has managed to contribute additional information regarding their attitude towards smoking. Comprehensive tobacco education and smoking cessation programmes should be aggressively promoted in dental settings.

Background: Salt workers are exposed to the adversities of environmental conditions such as direct sunlight, salt dust and contact with brine, which have an impact on the health of workers. Since oral health is an integral part of the general health, we planned to determine its effect on the oral cavity. Objectives: To assess the oral health status and the treatment needs among the workers of Sambhar Salts Limited at Sambhar Lake, Jaipur, India. Material and Methods: A cross sectional, descriptive survey was conducted among 979 subjects (509 males; 470 females) who were aged between 19–68 years, who were the workers of Sambhar Salts Limited, Sambhar Lake, Jaipur, India. An interview on the demographic profile followed a clinical examination for recording the oral health status, based on the World Health Organization guidelines. The Chi–square test, t–test, One way Analysis of Variance and a Stepwise multiple linear regression analysis were used for the statistical analysis. Results: Females had a significantly greater prevalence of dental fluorosis (71.7%) and periodontal disease (96.4%) as compared to males (p= 0.001). The mean number of healthy sextants (0.71 ± 0.09) and the mean DMFT (5.19 ± 4.11) were also significantly higher in females as compared to those in males (p=0.001). One surface filling (78.2%), followed by pulp care and restoration (76.1%) were the most prevalent treatment needs. The gender and oral hygiene practices for dental caries and periodontal disease were respectively identified as the best predictors. Conclusion: Considerable percentages of salt workers have demonstrated a higher prevalence of oral diseases. Higher unmet treatment needs suggest a poor accessibility and availability of oral health care, in addition to a low utilization of preventive or therapeutic oral health services.

Context: Periodontal disease is one of the most prevalent dental diseases which affects the adult population of the world, varying only in degree from mild to severe. Its prevalence, which was reported in various studies which were conducted in different parts of the globe, signifies its need for a control. Aims: To assess the periodontal status among the Kota stone workers in Jhalawar and to provide a baseline data for the planning and evaluation of the oral health care promotion programmes. Settings and Design: A cross-sectional descriptive survey was conducted among the Kota stone workers who were working in the Kota stone factories which were located in the Ricco Industrial Area in Jhalawar. Method and Materials: The study population comprised 420 subjects who were in the age group of 21 to 60 years. The data were collected by means of a close ended, self administered questionnaire and clinical examination with the use of the CPI index. Statistical analyses which were used: Chi-square, Student’s t-test, One way Analysis of Variance (ANOVA), and Multiple Logistic Regression. Results: The socio-demographic characteristics, except the gender, were found to be significantly associated with the periodontal status in the study population (P≤0.05). Multivariate analysis showed high CPI scores which were associated with males (OR=1.313), the 21-40 year age group (OR=0.548), education upto 10th class (OR=4.776), oral hygiene practices other than toothbrush with toothpaste (OR=0.774) and smoking (OR=3.994). Conclusion: The observations of this study indicate the need for a reorientation of the dental care services, with further emphasis on the preventive care in such a population.

© 2015 Ministry of Health, Saudi Arabia. Objective of the present study was to investigate relationship between oral health-related quality of life using Oral Impacts on Daily Performances (OIDP) scale and specific clinical dental measures. A cross sectional descriptive survey was conducted among 800 students. Oral health status and impacts were assessed using WHO guidelines and OIDP index respectively. Chi square test and multiple logistic regressions were employed for statistical analysis. Participants with caries were significantly (. p≤. 0.05) more likely to have an impact on cleaning (OR. =. 2.487) and sleeping and relaxing (OR. =. 8.996). Similarly participants with oral mucosal conditions were more likely to have an impact on eating (OR. =. 3.97), cleaning (OR. =. 2.966) and physical activities (OR. =. 11.190). Dental Aesthetic Index (DAI) impacted on cleaning (OR. =. 2.134), emotional stability (OR. =. 3.957) and social contact (OR. =. 3.21). OIDP Index showed acceptable psychometric properties in the context of an oral health survey. Subjects presented a strong and consistent relationship between dental status and perceived impacts.

To examine the effect of chocobar ice cream containing bifidobacteria on salivary mutans streptococci and lactobacilli.A double-blind, randomised controlled trial was conducted with 30 subjects (18 to 22 years of age) divided into 2 groups, test (chocobar ice cream with probiotics) and control (chocobar ice cream without probiotics). The subjects were instructed to eat the allotted chocobar ice cream once daily for 18 days. Saliva samples collected at intervals were cultured on Mitis Salivarius agar and Rogosa agar and examined for salivary mutans streptococci and lactobacilli, respectively. The Mann-Whitney U-test, Friedman and Wilcoxon signed-rank tests were used for statistical analysis.Postingestion in the test group, a statistically significant reduction (p0.05) of salivary mutans streptococci was recorded, but a non-significant trend was seen for lactobacilli. Significant differences were was also observed between follow-ups.Short-term daily ingestion of ice cream containing probiotic bifidobacteria may reduce salivary levels of mutans streptococci in young adults.

To assess and compare the antimicrobial potential and determine the minimum inhibitory concentration (MIC) of Jasminum grandiflorum and Hibiscus rosa-sinensis extracts as potential anti-pathogenic agents in dental caries.Aqueous and ethanol (cold and hot) extracts prepared from leaves of Jasminum grandiflorum and Hibiscus rosa-sinensis were screened for in vitro antimicrobial activity against Streptococcus mutans and Lactobacillus acidophilus using the agar well diffusion method. The lowest concentration of every extract considered as the minimum inhibitory concentration (MIC) was determined for both test organisms. Statistical analysis was performed with one-way analysis of variance (ANOVA).At lower concentrations, hot ethanol Jasminum grandiflorum (10 μg/ml) and Hibiscus rosa-sinensis (25 μg/ml) extracts were found to have statistically significant (P≤0.05) antimicrobial activity against S. mutans and L. acidophilus with MIC values of 6.25 μg/ml and 25 μg/ml, respectively. A proportional increase in their antimicrobial activity (zone of inhibition) was observed.Both extracts were found to be antimicrobially active and contain compounds with therapeutic potential. Nevertheless, clinical trials on the effect of these plants are essential before advocating large-scale therapy.

To assess the level and determine the relationship between knowledge, attitudes and practices related to oral health promoting factors among secondary caregivers attending day-care centres. A cross-sectional descriptive survey. A survey was conducted among 110 caregivers in Udaipur. Data were collected through self-administered questionnaire addressing aspects of knowledge, attitudes and practises of oral health promoting factors in children. Caregivers age, education and duration of employment were significantly associated with knowledge, attitude and practise scores (p ≤ 0.05). Primary job option and number of children under care were significantly associated with practise scores. A positive relationship was found between the average knowledge, attitude and practise scores of respondents, but this was not statistically significant (p ≥ 0.05). General Linear Model (GLM) with Bonferroni post hoc was used for statistical analysis. Good understanding of caregiver knowledge and attitude is essential for oral health promotion efforts to be effective.

Objectives: The purpose of the study was to evaluate saliva and tongue coating pH and also to assess the degree of tongue coating in healthy subjects before and after chewing herbal leaves (tulsi, mint, and curry leaf). Materials and Methods: A double-blind, randomized, concurrent, parallel-group study was conducted among 60 volunteer subjects, who were randomly assigned into three groups of 20 each (tulsi, mint, and curry leaf) and were asked to chew five to six fresh leaves of the respective plants twice daily for 7 days. Salivary and tongue coating pH were measured by a digital pH meter and color pH indicators. Data were analyzed statistically using repeated measure analysis of variance and Student's t-test. Results: Mean salivary pH values showed an increase immediately and 30 min after chewing the herbal leaves. A significant difference (P < 0.01) was observed between mint and curry leaf groups immediately after chewing and between tulsi and curry leaf groups (P < 0.05) 30 min after chewing the leaves. Tongue coating pH showed an increase toward alkalinity in all the groups. The assessment of tongue coating showed an increase in scores among tulsi and curry leaf groups, but this difference was not statistically significant. Conclusion: Chewing traditional medicinal plant leaves can be considered as safe, effective, and economical alternate options for maintaining good oral health.