The American National Standards Institute (ANSI) approves that the process under which the general and clinical standards that define the requirements for the safe use of different kinds of lasers and the safe use of lasers specific to healthcare facilities was conducted in a fair and open manner following due process safeguards.

COVID-19 had a catastrophic effect on the world resulting in numerous deaths worldwide. It possessed a risk of spread, hence there was a need in modification of dental treatment of children. AAPD and WHO suggested modifications in treatment protocols/techniques like Hall’s technique, rubber dam, Tell-show-do, silver diamine fluoride and “limiting the use of syringes” which were adapted by dentists. A survey using Google forms was composed referring to various scientific journals and articles to assess the changes adopted by the pediatric dentists post pandemic. This survey was circulated amongst 400 pediatric dentists. In this survey, the techniques and methods adopted by the dentists during the covid pandemic period and their continuation in their clinical practice post covid were evaluated.

Keywords: children; modified pediatric treatment protocol; post covid

After exodontia, some biological tissue repair phenomena occur. Invagination of the gingival epithelial tissue and subsequent resorption of the alveolar bone walls is expected. Clinically, bone resorption can compromise the future installation of osseointegrated implants, hindering the rehabilitation of edentulous areas. Guided Tissue Regeneration and Guided Bone Regeneration techniques can be used to prevent post-exodontia bone resorption. These techniques should also be associated with more cautious and preservative exodontias to safeguard regenerative results. The polypropylene membrane has been used after exodontia with the main aim of maintaining and immobilising the blood clot inside the alveolus and, due to the possibility of exposure to the oral environment, without suffering contamination or adsorption of dental biofilm and subsequent infection. The purpose of this article is to present the case of the use of a polypropylene membrane after the exodontia of a molar, in order to preserve and maintain bone tissue for the future installation of an osseointegrated implant and the respective implantoprosthetic rehabilitation. The case has been followed up for 10 years.

Keywords: Tissue Regeneration; Bone Regeneration; Bioengineering; Oral Surgery; Implantology; Rehabilitation

When patients are admitted to Intensive Care Units, they become more prone to the risk of opportunistic infections. These infections can be both systemic and stomatological. As a result, the length of hospitalisation increases, as do the costs, and the need for pharmacological therapy increases, which can lead to an increase in the morbidity and mortality rate. From a preventive perspective, the presence of a dental surgeon in hospital, particularly in intensive care, plays an important role in the prevention and treatment of stomatological alterations, sometimes temporary or permanent. The purpose of this article is to discuss preventive aspects and the importance of infection control through the presence of a dental surgeon in Intensive Care.

Keywords: Dentistry; Hospital; Intensive Care Unit; Oral Health; Oral Hygiene

     Intraductal carcinoma of salivary gland is an exceptionally discerned neoplasm exhibiting distinct histological variants with unique molecular characteristics and specific reactions upon immunohistochemistry. Commonly, parotid gland is incriminated. Characteristically, tumefaction is composed of intra-cystic or intra-ductal proliferation of neoplastic epithelial cells.

     Tumefaction is additionally designated as low grade cribriform cystadenocarcinoma, low grade intraductal carcinoma, low grade salivary duct carcinoma or salivary duct carcinoma in situ.

     Intraductal carcinoma of salivary gland simulates ductal carcinoma in situ of mammary gland and represents with distinctive architectural configurations as cribriform, micro-papillary, solid, comedo or clinging subtype.

     Intraductal carcinoma of salivary gland manifests variants as the frequently encountered intercalated duct-like variant, apocrine variant and a mixed or hybrid variant. An oncocytic variant may be described which appears indicative of intercalated duct-like subcategory of intraductal carcinoma.

Light is a form of electromagnetic energy that occurs as a particle, and progresses in waves, at a sustained velocity. The basic unit of this radiant energy is called a photon; the wave of photons travels at the speed of light and it can be defined by two basic properties- amplitude and wavelength. Amplitude is defined as the vertical height of the wave oscillation from the zero axis to its peak and it corresponds with the amount of energy in the wave. The latter that is wavelength is the horizontal distance between any two corresponding points on the wave [1].

A laser is a device that transforms the light of various frequencies into a chromatic radiation in the visible, infrared, and ultraviolet regions, with all the waves in the phase being capable of mobilizing immense heat and power when they are focused at a close range. Amplification is a part of a process that occurs inside the laser. Stimulated emission is the process which takes place within the active medium due to the pumping mechanism, and it was postulated by Albert Einstein in 1916 [2].

A number of lasers are used in dentistry named based on their active media such as carbon dioxide (CO₂) laser, neodymium yttrium-aluminum- garnet laser (Nd:YAG), Erbium laser and Diode laser [3]. Each of these lasers represents some features which make them applicable for specific dental goals. They can be applied for many dental branches like diagnosis, prevention, restorative procedures and endodontics [4]. The high intensity lasers treatment are intended for ablation, vaporization cutting and coagulating of the tissue because they work with increasing temperature, while the low intensity lasers are used in the processes of tissue repair, inflammation and in cases in which analgesia is required and are often referred to as photo biomodulation [5].

The light energy produced by a laser can have four different interactions with a target tissue: reflection, transmission, scattering, and absorption[6]. When a laser is absorbed, it elevates the temperature and produces photochemical effects depending on the water content of the tissues. When a temperature of 100°C is reached, vaporization of the water within the tissue occurs, a process called ablation. At temperatures below 100°C, but above approximately 60°C, proteins begin to denature, without vaporization of the underlying tissue [7].

Introduction: Older adults are the population group that consumes most medications and the most susceptible to adverse reactions from psychotropic drugs.

Objective: To assess the effectiveness of a system of educational actions aimed to the frequent use of psychotropic drugs in older adults

Methodological design: A community intervention study was carried out aimed at older adults who belong to the Family Medical Office # 22.25 in "Mariana Grajales" community, in Cifuentes municipality within the years 2019 and 2020. Theoretical methods were used: historical-logical, analysis-synthesis, inductive-deductive and systemic-structural; Empirical: documentary analysis and to assess the proposal, the criteria of specialists. In addition, mathematical-statistical methods were used.

Results: The diagnosis made demonstrated the need for changes in the use of psychotropic drugs and information in the older adults studied, for which structured educational actions were designed in five themes: psychotropic drugs, risk factors and complications of psychoactive drug use, adverse reactions of psychotropic drugs, diet and healthy lifestyles and treatment of comorbidities. The proposal was valued by specialists as updated, contributing, transcendental and viable.

Conclusions: The educational actions were effective in reducing the use of psychotropic drugs in the investigated older adults, achieving an acquisition of knowledge in relation to this topic once implemented.

Bimaxillary protrusion is a commonly seen deformity in Asian populations. This condition is characterized by protusive and proclined upper and lower incisors and incompetence of lips, gummy smile, mentalis muscle strain and anterior open bite [1]. This condition poses a serious threat to the aesthetic concern of the patient which is interwined with psychological trauma and social inter-relation disturbances. A Successful treatment depends on the thorough evaluation of the condition, understanding the need and the concern of the patient and providing an appropriate treatment plan. This case report describes correcting a bimaxillary protrusion by treating the upper anteriors with Root Canal Treatment, placing a post and core with change in the angle of inclination and restoring them with a crown & bridge prosthesis.

Dental implants play a very important role in dentistry. A very careful diagnosis and treatment planning must be followed to grant a successful outcome. It must be taken into consideration the challenges of oral cavity and its anatomical structures and in the maxilla, the maxillary sinus is the most important in this situation.

Anxiety and apprehension of the dental pain tends to avoid the dental treatment. As per the particular requirements of the patient, an ambit of local anesthetics drugs is customized to control the dental pain. Hence, gaining a perception of the aspect of local anesthetics and the knowledge to deliver anesthetic injection techniques correctly is an essential prospect of the Oral Surgery curriculum[1]. Every faculty should go through learning module schedule of the subject topics which is given for the SCORE Learning management system [LMS] module [2].

     Digital orthodontics has been there around a decade, but the recent advancements in technology and the inherent desire of orthodontist to go paperless has dramatically turned the tables in favour of digitalizing the practice. Beginning from the initial patient communication, to record keeping, photographs, radiographs, treatment planning and outcomes, everything under the practice of orthodontics can be digitalized. The heart of any good orthodontic treatment lies in its diagnosis and treatment planning. Incorporation of three-dimensional digital technology for radiographic imaging, 3D reconstruction of face, fabrication of study models, construction of 3D stereolithographic models, prediction of treatment outcome, virtual surgical planning and artificial intelligence has lead to correct diagnosis and better clinical outcomes. All this begins with the collection of digital data and this trend will continue to dominate the practice of orthodontics in coming future.

     From the onset of the viral outbreak in Wuhan City (China) in December 2019 and, declared as a pandemic in March 2020 by the World Health Organization (WHO), COVID-19 brought many losses and misfortunes [1-3].

     Several diseases and conditions associated with and resulting from coronavirus infection were constantly observed. Various signs and symptoms such as headache, impaired consciousness, confusion, dizziness, sore throat, congestion, coryza, nausea or vomiting, diarrhoea were and still are quite frequent [1-3].

     Stomatological and otorhinolaryngological alterations have been also described, particularly those related to smell (hyposmia and anosmia) and taste (hypogeusia and ageusia) [1-3]. Salty taste has been reported in 19 patients contaminated by coronavirus, independently of diet and consumption of salty foods, as well as the use of toothpaste or mouth rinses or habits such as smoking [2].

     For years we have been viewers of the extensive burden of Dental Caries in our populations. From global to local, this disease is considered a public health problem that significantly impacts the quality of life of societies, communities, families, and individuals. This health problem affects children worldwide and represents a significant challenge for health systems. Moreover, the most critical risk is socially disadvantaged communities with extensive health inequities and poor social determinants.

     Damaging consequences by severe dental caries go beyond the local physical impact on the tooth surface. It is well known that chronic pain, infections, and tooth extraction are inevitable consequences of disease progression. However, the opening scope of the problem should expand our diagnostics and assessment to understand the other areas that are also being highly affected.

Today the world is rapidly progressing towards digitalization. Humans have re-formed intelligence for better human decision making and to relieve themselves of the stupendous workload. Artificial intelligence can act as a supplementary tool to improve life. Every sphere of the world has adopted the artificial intelligence with great enthusiasm. Artificial intelligence has changed the horizons of medical and dental field too. It has enormous fields of application which have made dentistry to reach another level. However, this advancement in technology is still at budding stage. There is a need for the dentists to be mindful about its implications for a worthwhile clinical practice in near future. This article is an attempt to highlight the role of artificial intelligence in dentistry.

Keywords: Artificial Intelligence; Dentistry; Applications

Warthin’s tumour is a benign salivary gland neoplasm commonly incriminating parotid gland. Tumefaction enunciates cystic configurations coated with a dual epithelial cell layer with subjacent dense, lymphoid stroma. Additionally designated as papillary cystadenoma lymphomatosum papilliferum or adenolymphoma, Warthin’s tumour is frequently expounded and follows pleomorphic adenoma in frequency. Generally, Warthin’s tumour occurs due to incorporation of lymphoid tissue within the parotid gland. Alternatively, inflammatory infiltrate may induce cystic and oncocytic modifications within pertinent salivary gland. Neoplasm may be concordant with tubercular infection induced by Brucella mellitensi [1, 2]. Warthin’s tumour is a non clonal, diploid neoplasm. However, neoplasms concurrent with muco-epidermoid carcinoma appear associated with chromosomal translocation t(11;19) and fusion transcript of CRTC1/MAML2 genes. Besides, deoxy-ribonuclease (DNA) of human herpesvirus 8 (HHV8) may accompany Warthin’s tumour [1, 2].

The impact of oral health on the health of all people in the world and the improvement of living standards in recent years has led to increased attention to the factors affecting oral health. One of the important factors in oral health is early monitoring of dental and gingival microcirculation to be used in the diagnosis of many oral diseases in the early stages. Due to the location of the teeth in the oral cavity covered by the gums, direct monitoring of dental and gingival health is a complex task that requires specialized tools to enable routine clinical use in dentistry in a simple, painless, cost-effective and non-invasive. Pulp vitality normally represents the vascular supply of tooth innervated by sensory fibers. Most of pulp sensitivity tests such cold, thermal and electric tests are dependent on the stimulation of nerve fibers with false positive and false negative response in traumatized and necrotic teeth or patients under the influence of drugs or alcohol can lead to unnecessary endodontic procedures. Current therapeutic decisions in dentistry are made using clinical examination, pulp sensitivity tests, and radiography which are practical but not enough to provide a valuable diagnosis information of vascular supply in dental pulp, especially in procedure like root canal. The important of finding a tool to assist in the pulp diagnosis leading to an appropriate treatment planning, this paper is providing a comprehensive review of current pulp testing methods by pulse oximetry and laser Doppler flowmetry.

Ceramic veneers are well known as a conservative treatment option for anterior teeth presenting wear, discolorations or shape anomalies.
The high esthetic outcome offered by the ceramic laminate veneers are the most important reasons of their indications. In recent years, an increased number of ceramic materials have become available for veneer’s fabrication, with the outcomes of each material supported by literature of varying degrees of scientific rigor.
The reproduction of a final color that matches the patient’s teeth shade is one of the biggest challenges met with ceramic veneers, since the color of the ceramic restorations depends on several factors such as the basic color of the used ceramic, the thickness, teeth’s color and the cement color. The feldspathic ceramics offer the highest esthetic value compared to all the other systems.
Feldspathic porcelain veneers have a remarkable 10-year survival rate of up to 95 percent after being bonded to enamel.
However, a major concern with the feldspathic ceramics was their low mechanical resistance.
Nowadays, the feldspathic blocks for CAD CAM systems allows matching the optical outcome of the original feldspathic veneers and the strength offered by the CAD CAM ceramic restorations.
In this case report article, we will show a step-by-step procedure of CAD/CAM feldspathic veneers fabrication for an esthetic rehabilitation of dento dental disharmony.

Smile rehabilitation of dental microdontia is a real therapeutic dare. Alterations in size have esthetic, functional, and psycho-social repercussions for patients.
Often associated with diastema and other dental anomalies, patients usually visit seeking an esthetic smile rehabilitation.
Multiple options are now available when it comes to treating encountered problems related to smile refinement. Orthodontic, periodontic, restorative, and prosthodontic, or a combination of all these procedures may be indicated to fulfill the patient’s esthetic and functional demands.
This article presents a combination of an orthodontic and prosthodontic procedure as well as the conditioning of the gingival tissue to treat anterior diastema associated with the presence of peg laterals.

Lichen planus is a mucocutaneous lesion, relatively frequent in oral cavity. Clinically, lichen planus can present in typical or atypical forms. The typical forms are generally milder and asymptomatic, whereas the atypical ones cause painful symptoms, which in turn make dental procedures and oral hygiene more difficult, favouring the development of periodontal diseases. The purpose of this article is to present a case of lichen planus that affected the buccal keratinized gingiva bilaterally on mandibular premolars and molars, simultaneously with periodontal disease. Periodontal treatment was performed, by sessions of scaling and root planing and oral hygiene instruction. Remission of the gingival lesions was observed, as well as control of the periodontal disease. The patient has been followed up for 11 years.

Non small cell carcinoma lung is a pulmonary epithelial carcinoma disparate from small cell carcinoma lung. Majority (85%) of pulmonary malignancies are comprised of non small cell carcinomas.
Non small cell carcinoma is comprised of adenocarcinoma, squamous cell carcinoma or large cell carcinoma. Infrequently, subtypes such as pleomorphic carcinoma, carcinoid tumour, salivary gland carcinoma, unclassified carcinoma or uncommon, histological variants as mixed cell subtype may emerge [1, 2].

The state of being free of mouth and facial pain, oral infections and sores, and other oral diseases that disturbs the rhythm of presenting and socializing in this world.
Despite of economic and social burdens due to neglection of oral care many countries are unaware of the need of making society aware of the importance of oral health.
Oral health is a silent treatment of overall health.

Juvenile Nasopharyngeal Angiofibroma (JNA) is a rare, benign, locally invasive, vascular neoplasm that accounts for less than 0.5% of all head and neck tumors. Other terms used for this tumor are nasopharyngeal angiofibroma, bleeding fibroma of adolescence, fibroangioma. In this paper, a rare case of Juvenile Nasopharyngeal Angiofibroma in a 19 years old male patient has been discussed along with mini review of pathogenesis and histological features and treatment modalities.

Major oral discomfort related to periodontal diseases, pain, halitosis, gingivitis, hypersensitivity, cervical caries, and gingival recession; altogether is the part consequences of food impingement/impaction. Dentistry should deal with rebuilding the proper anatomy of teeth in case of direct or indirect restoration which can ultimately resolve the problem along with proper periodontal treatment.

Non-communicable diseases (NCDs) are a group of conditions that affect modern lifestyle, and are the result of a combination of genetic, physiological, environmental and behavioural factors. They includes four major NCDs namely: cancer, diabetes, cardiovascular diseases and chronic respiratory diseases. NCDs are one of the major challenges for health and sustainable human development; characterized by a long disease phase, and then became the leading cause of death in our society. Each year, it can cause 41 million people deaths, which is about 71% of all global deaths. In addition, NCDs kill >15 million 30-69 year-old people and low- and middle-income countries are mostly affected for premature deaths which account for 85% [1].

Disaster, outbreaks, and health emergencies extend various ethical obstacles related to maintaining quality and standard of care and practices. Often there are no prophylactic regimens available or effective during an emergency such as the Covid-19 pandemic. Since outbreaks of H1N1, Zika, and Ebola, exploring new modalities and treatment plan is a key aspect, and it needs a multidisciplinary ethical review team that accelerates the research review process and hasten to accomplish the project. Globally, every country has its guidelines for research review. But investigating facts during public health emergencies e.g., Covid-19, there is a significant necessity for a fasttrack review system. Focusing more on peer review practices for research on Covid-19 might suggest the upcoming time of peer review system in reviewing research. In an early pandemic situation, an unprecedented surge in the publication in a scholarly journal is a backbreaking task. The documented manuscript entails authenticating its relevance and appropriateness by proceeding through the review process. Enabling a fasttrack review system could be effective in reducing average submission and review time and preventing unnecessary delays in publications. Various questions come to mind- Is it long-lasting? Are we prepared for a fasttrack review of all research? Are we have any guidelines for research review in public health emergencies that provide a uniform and standard review system across the world? Now Fasttrack review implementing mainly for emergencies research projects. It is burdensome to review all research proposals on an emergency basis. fast tracking all types of research affect the quality of reviewing as well as the overburden to review teams as manpower has limited.

Charlie Chaplin had once said “always keep in your mind that you will always find your life a worthwhile one, just if you keep a beautiful smile on your face every time.” The power that a simple smile holds cannot be emphasised upon enough and rendering someone the ability to smile again with confidence is something that makes the field of prosthodontics so inspiring. We have come a long way from carving dentures out of ivory and using cattle teeth to simulating teeth within the jaw as seen in implant osseointegration. A study conducted by CDC over 2011 to 2016, revealed that one out of six adults aged 65 and older had lost all their teeth and around one-fourth of the adults aged 65 and older have 8 or less teeth making edentulism a significant setback and these numbers are expected to grow in the next two decades. Edentulism, besides being a functional and esthetic problem, has a psychological component as well. A recent encounter that was personally enriching was with a patient who had lost her last few remaining teeth due to severe periodontitis. She expressed the apprehension to smile caused due to her tooth loss.

Introduction: Snoring endangers the health and can lead to the emergence or worsening of existing diseases, such as high blood pressure and heart attack. There are numerous surgical and non-surgical treatment options for snoring and snoring apnea syndrome (SAS). All surgical and conservative treatments do not address the cause of snoring, only the symptom. Gaumfit® is the first device that treats 90% of the causes of snoring.
Aim: To verify that primary snoring improves when the oral musculature is trained by the Gaumfit® exercise device. Method: In a retropspective analysis on 100 test persons (83 males and 17 females) the effectiveness of the innovative concept of Gaumfit® exercise device was analyzed. The subjects wore Gaumfit® for 3x10 minutes a day(!) and were interviewed after four weeks.
Results: Snoring was reduced in 94 out of 100 subjects. This represents a success rate of 94%. This finding is highly significant (p=0.008). It felt more rested in the morning 79% of Gaumfit® users. 94 subjects used Gaumfit® during the four weeks and rated the innovated therapy method with the predicate “good” (school grade 1.95).  
Conclusion: The oral muscle training device Gaumfit® significantly strengthens the palatal and tongue muscles and is therefore suitable to alleviate primary snoring.

Digital dentistry has grown in popularity over the last two decades, with applications in crowns, bridges, inlays, onlays, and prosthetic rehabilitation of facial defects. The first 3D printer machine was in late 1980, during this time increased of using of 3D printer in medical field. Stereolithography (SLA) is a 3D printing technique that uses a computer to control the movement of a laser beam. CAD/CAM milling can be used for dry or wet milling restoration with high aesthetic value. CAD/CAM milling makes communication with labs easier and faster than traditional methods.

     A 54 years old patient, partially edentulous, non-smoker and female was treated with a new innovative and minimal invasive technique(IPD-DET Technique). The patient had a severe bilateral atrophic posterior maxilla. Since now, in cases like that we use extensive surgical protocols like sinus lift elevation with high cost, discomfort for the patients and unstable results. IPG-DET technique introduces the sinus membrane intentional perforation as an alternative. By using this method with an autologous biomaterial(CGF-CD34+Matrix) we can have a safe and stable alternative solution in such difficult cases. In our case we can see the new bone formation after only a few months of the surgical placement of the implants. IPG-DET is simple, safe less painfull and cost-efective procedure.

Keywords: Maxillary Sinus; Bone Augmentation; IPG-DET Technique; Flapless Surgery; Dental Implants; Sinus Membrane Intentional Perforation; Concentrated Growth Factors; CD34- Positive Stem Cells

So you wake up in the morning with a sore tooth? This might be accompanied by a general feeling of discomfort. You probably have tooth sensitivity, which is when your teeth are sensitive to hot or cold foods and liquids. The causes of tooth sensitivity are diverse, so it’s important to know how to treat it and when to see your dentist. That being said, here’s what you need to know about tooth sensitivity.

In this world of growing competition and Google generation patients are aware about quality of dental services that should be provided to them. Hence, patient’s expectations have increased. 

Earlier, forces like corporate growth, medical tourism and insurance were only limited to Hospital industry, with the growing awareness of Dental health quality of Dental clinics is also taken under consideration by the patients.

The restoration of an endodontically treated central incisor is a major challenge to the clinician in his daily practice. In fact achieving a natural mimicry of the single maxillary central incisor restoration with the adjacent dentition is a real challenge. An anterior dental restoration must be able to restore proper function, aesthetics and confort for the patient. A large variety for aesthetic treatments in the anterior dentition from the less invasive to the most invasive, ; such as tooth bleaching, direct composite restorations, ceramic veneers or full coverage crowns.
The choice of the suitable treatment option depends on characteristics and severity of dental defects or tooth decay. Crowning an anterior too this indicated when there is extensive coronal destruction and we can’t do a direct restoration. In a recent systematic review, endodontically treated teeth restored with crowns had higher long-term survival after 10 years (81 ± 15%) compared to teeth without crowns (63 ± 15%) [14] This review also showed that the survival rate of crown-free root
fillings was satisfactory in the first three years (84% ± 9%), but decreased significantly after that [18]. Many materials can be used for crowns: metal, ceramics or zirconia.
Nowadays, the ceramic systems made it to restore the symmetry, color, shape and incisal translucency. This clinical report describes the treatment of a discolored and endodontically treated central incisors and to show the different guidelines to guarantee a natural mimicry using a zircon abased ceramic restoration.

The SARS-CoV-2 pandemic began at Wuhan in December 2019, and the World Health Organization designated it a public health emergency in 2020 [1-3]. Oral health care services were ignored by the public health organizations in developing nations and it is not an easy task to tackle the inequalities among the communities [4-5]. The purpose of this article is to raise awareness and explore the possible impact of the COVID-19 pandemic on oral health disparities. 

A 3 Dimensional printing, also referred to as additive manufacturing is a process of making 3-D objects with the help of 3-D printers which forms the entire 3-D object by adding multiple layers to create the precise design [1, 2]. In cross section, each layer is represented as thin horizontal section of the object [3]. It is also known as rapid prototyping [4, 5]. Recently, 3-D printing is gaining popularity among various dental fields and is mainly focused in the field of oral surgery, prosthodontics, orthodontics and with less applications in periodontics and endodontics [6]. The first 3-D object was printed using Stereolithography (SLA) by Charles Hull in 1983 [7].

Sulfonamides, oxicam NSAIDs, allopurinol, aromatic anticonvulsants and anti-HIV drugs like nevirapine are all known to cause Stevens Johnson Syndrome. The severity of condition is determined by the amount of bodily surface area it affect and is called Stevens Johnson Syndrome(SJS)/Toxic Epidermal NecrolysisTEN or TEN in the appropriate case. SJS is treated by discontinuation of the causative medication, systemic steroids and supportive care. SJS as a result of azithromycin is a very uncommon event thus, we report on one such case which was successfully managed at our hospital.

Ectopic eruption is known as changing way of eruption the tooth does not follow normal course. Although ectopic eruption of tooth is not a common phenomenon, cases have been reported in the maxillary sinus, mandibular condyle, nasal cavity, chin. Owning to ectopic teeth’s scarcity, cases should be discussed. Odontogenic tumors and odontogenic cysts can result from ectopic tooth. Thus, ectopic teeth should be evaluated regularly as there is no symptoms. If the patient has orofacial pain, maxillary sinusitis and radiating pain, the patient should be examined regarding ectopic tooth.

In the history of medicine there have been many outbursts of morbid infectious diseases and it is challenging to every health care professional to reduce and prevent its burden. The field of Dentistry is always a source of high-risk infectious material generation owing to its professional nature. Most of the morbid infections are viral in origin and quite often transmit via droplet or aerosols. In this context, the field of Periodontology is not an exception. The recent pandemic spread of novel corona virus infectious disease (COVID-19) is alarming the community and has gained focus in terms of prevention at each echelon in the chain of transmission of infection. It becomes a mandatory duty as responsible clinicians in combating against the spread of such an infection.

Caries is considered as a biofilm-mediated, diet modulated, multifactorial, non-communicable, dynamic disease which results in a net mineral loss of dental hard tissues. It is influenced by biological, behavioral, psychosocial, and environmental factors [1]. This process is evident throughout life, both in primary as well as permanent teeth, causing damage to the clinical as well as exposed anatomical part of the tooth. Caries involving primary dentition is termed as early childhood caries, which involves the presence of one or more decayed (cavitated lesions or noncavitated), missing (due to caries), or filled tooth surfaces in a child under 6 years of age [2]. Dental caries usually results from microbiota especially S.mutans and S. sobrinus as initiating and lactobacillus as progressing species which cause metabolization of the sugars to produce acid, lowering the intra-oral pH, leading in a shift of balance towards loss of minerals of involved tooth structure [3]. Other factors include improper dietary and feeding practices, developmental enamel defects (enamel hypoplasia), systemic diseases (juvenile diabetes mellitus) and medications (containing sugar), socioeconomic and ethnic factors. These situations which prolong the event of demineralization eventually leads to breakdown hence, cavitation.

Direct foundation restorations have been fairly successful in reducing invasiveness to a fairly significant extent. It is generally indicated in cases where a substantial amount of tissue exists at the periphery of the prepared tooth. By employing this technique, a prefabricated post is cemented inside the root canal, and the core is built directly on the prepared tooth.

Cutaneous fistulas of dental origin are rare and often remain unrecognized by practitioners and confused with dermatological lesions, they lead the patient to consult various specialists; and undergoing inadequate drug or surgical treatment, leaving permanent scars. So how can we circumvent all these ambiguities in order to ensure better care? The purpose of this work is to clarify certain Gray areas through a clinical case. Chronic endodontic complications are the most frequent causes of cutaneous fistulas of the face and neck. Diagnosis is often delayed because of the weak symptomatology. A meticulous clinical and radiological examination is revealing of the causal tooth and confirms the diagnosis. The etiological treatment allows in the majority of cases alone the disappearance of the cutaneous fistula, but sometimes for old fistulas with significant adhesions and scar tissue an intervention cosmetic surgery is required.

Odontoma is odontogenic tumor defined by the WHO as tumors of epithelium and odontogenic ectomesenchyme with or without formation of mineralized dental tissues [1]. The Broca invented odontoma in 1866 [2]. As he put it “tumors formed by the overgrowth of dental tissues transitory or complete [2]. The majority ofodontomas are asymptomatic in nature and are discovered on radiographs. They are often linked to an unerupted or impacted teeth or show evidence of infection, where they appear with signs and symptoms [3]. Odontomas usually have modest growth rate and rarely grow larger than a tooth. Expansion of cortical bone is noticed when their size is large [4].

A palliative care (PC) consultation in a skilled nursing facility’s (SNF) admission procedure confers multiple benefits, including clarification of patients’ care preferences. However, many SNFs do not offer PC consultations, and rates of advance directive (AD) and power of attorney (POA) completion are low. In a quality improvement intervention to increase AD–POA completion rates, SNF patients were offered, upon admission, a PC consultation and an opportunity to complete ADs–POAs. AD–POA completion rates during the 12-week intervention period were compared with completion rates during a 12-week period absent PC consultation. Lewin’s change theory was used to develop policy–practice guidelines. During intervention, AD–POA completion rates (100%) substantially exceeded the target, 60% (control, 0%). By intervention end, all intervention participants’ (n = 57) medical records contained ADs–POAs; by control period end, only 49% of control participants’ (n = 61) medical records contained ADs–POAs. Project outcomes supported the premise of the PICOT question, “In patients admitted to a SNF during a 12-week period, how will a PC consultation affect the AD–POA completion rate (i.e., how will the intervention group’s rate compare with the rate seen in standard practice)?” Following these outcomes, the SNF’s policy now mandates that all incoming patients be offered a PC consultation. The intervention’s outcome suggests that including, during patient admission, a PC consultation and opportunity to complete documents can improve AD–POA completion rates and is likely to generate for a SNF and its patients the benefits that these documents can confer.
Keywords: Advance directives; Skilled nursing facility; Palliative care

Dental caries has long beam recognized as an infectious disease which occurs due to interplay of four factors namely host, cariogenic microbial flora, a diet rich in refined carbohydrate to sustain that flora and therefore the time for the flora to act on substrate. For almost 100 years, G.V. Black’s classification of caries by site has guided the dental profession for restorative management. Therefore, the new understanding of early diagnosis of dental caries and remineralization process changed G.V. Black’s definition “Extension for Prevention” to “Minimally Invasive”. MID is defined as a conservative philosophy based on sound scientific principles. It is concerned with the first occurrence early detection and repair, rather that replacement of defective restoration and minimum invasive treatment.

Our study was presented to increase the awareness of deep neck infection caused by wisdom tooth. Deep neck infections are not rare and occur as a result of the several etiologies (tonsillitis, pharyngitis, foreign body ingestion, odontojenic infections). Patient was transferred for oral and maxillofacial department for the evaluation of causative left mesiangular impacted wisdom tooth. Surgical removal of wisdom tooth was performed and surgical region was closed primarily under the antibiotic covarage. Patient was followed strictly after the removal of wisdom tooth. After two weeks following wisdom tooth extraction, neck swelling was resoluted and patient returned to daily life. Odontogenic infections are the most common causes of deep neck infections in adults. Not only early diagnosis but also antimicrobial and surgical therapy need to treat deep neck infections of odontogenic origin. Early recognition of inflamation’s focus is key for management of patient.
Keywords: Abscess; Wisdom tooth; Neck

Periodontal disease is an inflammatory condition which affects and damages the tissues that supports and surround the tooth, it is seen among 15 to 20 % of population around the globe [1]. Periodontal disease can also be considered as epidemic based on its prevalence. To add upon, severity of this oral condition haven’t been spoken for years [2].

Avulsion of permanent teeth represents the most dramatic accident among active young patients. That’s why this traumatism should be managed immediately and correctly to restore damaged structures and function, which can affect daily patient’s life. Treatment of tooth expulsion is often complicated and challenging. Prognosis can be poor as it is in relation with the damage severity of both tooth and supporting tissues. Other factors can affect the prognosis such as status of traumatised tooth, root maturation, extra-oral time and storage conditions prior to the replantation and duration of splinting. 

The fracture of an endodontic instrument in the root canals can create a stressful situation that the clinician can face in his daily practice. These fractures often occur due to incorrect use of instruments. Operators can utilize incorrect movements during cleaning and shaping or use deformed instruments pushing them beyond their ability to absorb the workload. If failure has occured the non-surgical retreatment is indicated at first.

Endodontic periodontal lesions are still controversial as far as diagnosis and classification are concerned. And from this follows another problem in the treatment plan which was based for a long time on the chronology of the lesion. Nevertheless, the prognosis of this type of lesions is very variable and sometimes unpredictable. 

Saliva as a diagnostic tool provides a simple, inexpensive and noninvasive tool for disease detection and screening. Saliva collection is more practical, comfortable and is highly desirable body fluid for biomarker detection in clinical applications. The role of saliva as a successful adjunct to the diagnostic parameters in various diseases and pathologies have been well documented. The article reviews the significance of various salivary markers in the diagnosis and clinical application.

Dental esthetics, also known as cosmetic dentistry, is concerned with improving the appearance of smile and has become a popular topic among all disciplines in dentistry. Any kind of esthetic problem in childhood and adolescence can have a significant effect on psychosocial development and interaction with peers [1]. So, creating a perfect smile is one of the important objectives of the field. Esthetics in Dentistry is a philosophy concerned especially with the appearance of a dental restoration, as achieved through its color or form.