Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : April | Volume : 16 | Issue : 4 | Page : ZC23 - ZC27 Full Version

A Cross-sectional Survey on Dentist’s Knowledge and Perception towards the Application of Arnica Montana in Dental Practice


Published: April 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/52518.16225
Hani Mawardi, Lena Elbadawi

1. Associate Professor, Department of Oral Diagnostic Sciences, King Abdulaziz University, Faculty of Dentistry, Jeddah, Western Saudi Arabia. 2. Assistant Professor, Department of Periodontics, King Abdulaziz University, Faculty of Dentistry, Jeddah, Saudi Arabia.

Correspondence Address :
Dr. Hani Mawardi,
2792, Abdullah, Ibn Musidah, Jeddah, Western, Saudi Arabia.
E-mail: hmawardi@kau.edu.sa

Abstract

Introduction: Postsurgical oedema (PSE) is a common complication encountered in the dental field following different surgical procedures including wisdom teeth extraction and other periodontal and implant surgeries. Arnica Montana (AM) is a homeopathic agent which may represent as a safe, effective and an alternative agent for Non Steroidal Anti-Inflammatory (NSAID) medications to prevent or decrease the risk of PSE.

Aim: To evaluate the knowledge of practicing dentists and their experiences using AM supplements in their daily practice for management of PSE.

Materials and Methods: This was an observational, cross-sectional self reported electronic based study to survey practicing dentists on the application of AM in daily dental practice conducted from January to September 2021. The electronic survey included 13 questions on: 1) dentist’s demographics and educational backgrounds; 2) knowledge related to AM supplement; and 3) previous experience, if any, with AM use for management of PSE. The survey was distributed to potential subjects and descriptive statistics was used to summarise the data, and presented as percentages and frequencies using Microsoft Excel for mac (Version 16.40).

Results: A total of 84 subjects participated in the survey, out of which 23 (27.3%) were familiar with AM use in dentistry. Overall, 15 participants (65.2%) indicated preventions or reduction of PSE risk and pain and seven participants reported prevention and reduction of postsurgical discolouration and bleeding (30.4%) as potential indications for AM use. In total, eight participants (34.7%) have prescribed AM to patients before, mainly for external and internal sinus grafting (4/8; 50% for both) and surgical extraction of impacted teeth (2/8; 25%). Out of all, five participants (5/8; 62.5%) reported significant benefit with using AM following a surgical procedure and four participants (50%) reported numbness of the lips, altered taste sensation and increased bleeding as associated toxicities.

Conclusion: From the present study the uses and user based experienced of the material AM in the field of dentistry can be well understood and analysed. This was the first survey to discuss the knowledge and application of AM among dentists from various specialties.

Keywords

Dentistry, Homeopathy, Postsurgical Oedema

A common complication encountered in the field of dentistry is PSE, following different surgical procedures such as wisdom teeth extraction and other periodontal and implant surgeries (1). The degree and severity of PSE are influenced by several factors such as the complexity of the surgical procedure, patient’s medical condition, age and gender, in addition to practitioner’s clinical experience (1). Traditionally, the use of anti-inflammatory medications such as ibuprofen and corticosteroids to manage PSE has been a common and an effective practice in the medical field (2),(3),(4),(5). However, potential organ toxicities should always be considered. As a result, other pharmacological options should be considered including AM (6).

Homeopathic remedy for management of pain, swelling and other inflammatory conditions has been a common practice for centuries (7). The AM is a homeopathic supplement which may represent a safe, effective and an alternative agent for NSAID (8). It is an extract from different plant species belonging to the Aesteraceae family including AM, Arnica Chamissonis and Arnica Fulgens and can be found in Central Europe and the Siberian mountains (9). Cumulative, emerging evidence suggests that the common practice of prescribing NSAIDs to manage Postsurgical Sequala (PSS) of oedema, pain and echymosis can be replaced with AM with less anticipated toxicities (7). As of today, the exact mechanism of AM has not been elucidated; however, it is believed to inhibit histamine release from mast cells, promote secretion of serotonin from platelets and thromboxane B2 formation (10). Available literature has demonstrated superior outcome of AM when compared to placebo in the management of PSS (11),(12),(13). Overall, AM is considered safe for human consumption as reports demonstrated Asteracea containing cures were often times utilised as part of german essential care, and their uses were not related to toxic responses (6),(8),(14),(15). Potential side-effects are mild and include itching, stomach pain and diarrhoea (16).

As of today, no literature is available on the dentist’s perception and knowledge toward AM supplements and its application in among dentists from various specialties. The aim of this study was to survey practicing dentists for their experience with using AM supplements in their daily practice.

Material and Methods

This was an observational, cross-sectional self-reported electronic-based study to survey the knowledge and perception of a convenient sample of practicing dentists (general practitioners and specialists in private and governmental sectors) on the application of AM in daily dental practice. The study was conducted from January to September 2021. A Human Research Ethical approval No. 045-05-20 was obtained through King Abdulaziz Univeristy, Faculty of Dentistry, Jeddah, Saudi Arabia.

Inclusion criteria: All practising dentists (general practitionors and specialists in private and governmental sectors) willing to participate in the study were included.

Exclusion criteria: Exclusion criteria retired dentists; non English speaking subjects; and subjects who were not willing to participate or complete the study were excluded.

Study Procedure

The electronic survey was administered in English language and created in Qualtrics® (Drive Provo, UT, USA) (17). It included a total of 13, close-ended questions divided over three sections on 1) dentist’s demographics and educational backgrounds; 2) knowledge related to AM supplement; and 3) previous clinical experience, if any, with AM in managing dental patients. It was estimated for the survey to take three to seven minutes to answer all questions. Prior to survey distribution, validation of included questions was completed by field experts and pilot tested through enrollment of 10 dentists and collection of comments and suggestions with Cronbach’s alpha value of 0.8. Minor modifications of four questions in terms of language and style were completed based on provided feedback.

Consent was obtained from all subjects prior to participation in the study. The survey link was distributed to potential subjects through several portals including national dental societies, social media portals (i.e., Twitter®, Instagram®, WhatsApp®, Facebook®) incorporating paid advertisement as well as personal communications. Follow-up message was sent after two and four weeks respectively, after the initial distribution to encourage subject participations.

Statistical Analysis

Collected raw data were saved securely in a password protected and encrypted server. Descriptive statistics was used to summarise the data, and presented as percentages and frequencies using Microsoft excel for mac (Version 16.40).

Results

A total of 84 subjects participated in the survey and responded to all questions. There were 44 males and 40 females, most of the study participants had master’s degree (33/84; 39.2%) or PhD/Doctorate degree (24/84; 28.5%). Most dentists were oral medicine specialists (25/84; 29.7%), followed by general dentists (20/84; 23/8%) and oral surgeons (8/84; 9.5%). Demographics details of study participants are listed in (Table/Fig 1).

Knowledge and experience with AM: Out of all participants, 23 (27.3%) were familiar with AM use in the dental field (Table/Fig 2). In this subgroup, there were 16 males with age 25 years or above and most participants were holders of PhD/Doctorate degree (12/23; 52%), followed by Master’s degree (10/23; 43.4%) and had a work experience ranging from 0 to >25 years. There were nine periodontists (39.1%), six oral medicine specialists (26%), four oral surgeons (17.3%), two prosthodontists (8.6%) and a single participant from each, endodontics and dental public health (4.3%).

All 23 participants were asked several questions related to AM application in the dental field (Table/Fig 3). When asked about AM proposed benefits, 15 participants (65.2%) indicated preventions or reduction of PSE and pain and seven participants reported prevention and reduction of postsurgical discoloration and bleeding (30.4%). In terms of indications for AM use in the dental field, 19 participants (82.6%) reported surgical extraction of impacted teeth, followed by bone and soft tissue grafting procedures (10/23; 43.4% for both).

Overall, eight participants (34.7%) had prescribed AM to patients before, mainly for external and internal sinus grafting (4/8; 50% for both) and surgical extraction of impacted teeth (2/8; 25%). Out of all, five participants (5/8; 62.5%) reported significant benefit with using AM following a surgical procedure. However, two participants (2/8; 25%) reported minimal benefit and one participant (1/8; 12.5%) reported no benefit at all. In terms of side-effects, four participants (50%) reported lip parathesia, altered taste sensation, increased bleeding, trismus and hypersalivation and all were minor and self limiting.

Discussion

The homeopathic agent AM is also known as leopard’s bane and mountain tobacco, marketed and used for centuries for prevention of postprocedural ecchymosis and oedema as well as pain (commonly known as PSS) which may occur following skin, laser or cosmetic procedures (18). Its flowers contain glycosides, tepinoids, amines, coumarins, and volatile oils and are available in different formulations including tablets (generally recognised as safe-Generally Recognised as Safe (GRAS) by Food and Drug Administration (FDA), and topical gel or spray which were recently approved by the German Commission E (19). As of today, the exact mechanism of AM has not been elucidated; however, it is believed to inhibit histamine release from mast cells, promote secretion of serotonin from platelets and thromboxane B2 formation (10). Due to its historic application in the medical/dental field, this survey aimed at understanding the knowledge of practicing dentists on the indication and potential use of AM in the daily dental practise (6),(7),(20),(21).

Most of the study participants were holders of master’s degree in dental sciences or above (67.8%; 57/84). However, only 23 participants were familiar with AM application in the dental field. This could be attributed to the lack of sufficient research on its potential benefits. A previous cross sectional survey conducted among 250 practicing dentists in Germany reported AM among the most common homeopathic remdies prescribed (64%) mainly for PSS (22). Another survey was conducted in West Bengal, India reported that among a total of 949 dental patients AM constituted 17.8% of all prescriptions (23). Even with majority of participants were periodontists, oral medicine specialists and oral surgeons in this study, only 15 participants (65.2%) were familiar with AM benefit in preventions or reduction of PSE and pain. Considering the nature of surgical procedures performed regularly under these particular specialties, better knowledge and familiarity with AM use is expected among those specialists. This can be attributed in part to AM availability, cost, fear over side-effects and lack of standardised protcol for dental application (24),(25).

Searching the current medical literature, several Randomised Clinical Trials (RCTs) evaluating oral AM as a prophylaxis agent for prevention of PSS have showed mixed outcomes in which few were related to the dental field (7),(16),(26),(27),(28). This may explain the fact that only seven participants (30.4%) in this study were familiar with AM potential to prevent and reduce PSS, including PSE. The heterogenicity of avilable AM data could be linked to differences in type of surgical procedures techniques conducted and proceudre duration (24),(25),(29). The non standardised formulation of AM, dilution and manufacturing are other factors to consider when assessing available efficacy studies (24),(25),(29).

As of today, the application of AM in the dental field continues to be sparse and limited (28),(30). This could be attributed to several factors, most importantly the lack of evidence based indications and protocols for incorporating AM in the dental practice. A recent pilot study reported a role for AM in reducing oedema, pain and bruising following surgical extraction of impacted mandibular 3rd molars (28). Even with a smaller sample study size (total of 30 extractions in which 22 were completed using AM), the study was able to demonstrate the first evidence supporting AM positive effect following dental surgeries. A recent review study reported on potential benefit from herbal extracts containing ethanolic extracts, including AM, in preventing and managing periodontal tissues inflammation due to their anti-microbial and anti-inflammatory effects (30). No other studies on AM dental application exist in the literature.

In the current study, 19 participants (82.6%) reported surgical extraction of impacted teeth, followed by bone and soft tissue grafting procedures (10/23; 43.4% for both) as potential indications of AM for dental patients. Considering the common application of AM in procedures with high risk for oedema and haemorrhage, the reported responses fall within this spectrum (28),(31). A total of five participants (5/8; 62.5%) reported major benefit with using AM and two participants (2/8; 25%) reported minor benefit; however, it is hard to generalise these findings due to small sample size. Lack or limited patient’s knowledge and awareness of AM availability as an agent to reduce their PSS experience as well as the poorly characterised safety profile of oral AM could be other factors contributing to dentist’s hesitation to offer this product to patients prior to dental surgical procedures. Literature reported toxicities include stomach irritation, dry mouth, headache, sore tongue, lethargy and drowsiness which were mild and well tolerated (32). In addition, topical AM was associated with pruritus, petechiae and dry skin (32). Compared to the present study’s data, four participants (50%) reported parathesia of the lips, altered taste sensation, increased bleeding, trismus and hypersalivation as side-effect associated with AM use which was all mild and self limiting. Further, well-designed studies will help to confirm these findings and if other potential toxicities with AM use should be considered by health care professionals.

Limitation(s)

This study had several limitations. First, the low number of participating dentists and diversity in their dental specialties; Second, the study subjects were citizens of seven countries in total and it would be more helpful to understand the perception toward AM use in other countries. Third, sampling bias may have not allowed for more precise representation of the dental community practice and use of AM.

Conclusion

This was the first survey to discuss the knowledge and application of AM among dentists from various specialties. Based on the current data, 27.3% of practicing dentists included in the survey were familiar with AM application in the dental field. In addition, 34.7% of the dentists who regularly prescribed AM for their patients reported promising outcome with minimal toxicities. Even with the study limitations, it shed the light on AM potential application in dentistry. Future randomised clinical trials are warranted to better understand the role of AM in the daily dental practice.

Author contributions: HM designed, conducted the study, analysed the data and preprepared the manuscript. LE preprepared the manuscript.

References

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Ham H, Uy CE, DeWitt D. Facial swelling and rash following tooth extraction. J Gen Intern Med. 2016;31(3):358. Epub 2015/06/25. Doi: 10.1007/s11606-015-3443-y. PubMed PMID: 26105680; PubMed Central PMCID: PMCPMC4762810. [crossref] [PubMed]
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Kupeli I, Gulnahar Y. Impact of pre-emptive intravenous ibuprofen on perioperative analgesia in patients undergoing third molar extraction: A randomised controlled study. Turk J Anaesthesiol Reanim. 2019;47(6):480-84. Epub 2019/12/13. Doi: 10.5152/TJAR.2019.09623. PubMed PMID: 31828245; PubMed Central PMCID: PMCPMC6886821. [crossref] [PubMed]
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DOI and Others

DOI: 10.7860/JCDR/2022/52518.16225

Date of Submission: Sep 21, 2021
Date of Peer Review: Dec 08, 2021
Date of Acceptance: Jan 12, 2022
Date of Publishing: Apr 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Sep 22, 2021
• Manual Googling: Jan 10, 2022
• iThenticate Software: Jan 27, 2022 (3%)

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