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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
Case Series
Full Version
Silver Diamine Fluoride as Indirect Pulp Capping Agent in Primary Molars: A Case Series
Correspondence Address :
Dhanraj Kalaivanan,
Old Mahabalipuram Road, Rajiv Gandhi Salai, Chennai-600119, Tamil Nadu, India.
E-mail: drdhanraj.dental@sathyabama.ac.in
According to the current recommendations of the American Academy of Paediatric Dentistry (AAPD), Indirect Pulp Capping or Indirect Pulp Treatment (IPT) is defined as a procedure that preserves the deepest cavities adjacent to the pulp to prevent pulp exposure. Preserving and protecting the vital pulp through remineralisation of hypomineralised carious dentin poses a significant challenge in restorative dentistry. Traditionally, managing deep caries often led to pulp exposure and subsequent root canal treatment. Selective or stepwise caries removal is based on the concept of halting the progression of carious destruction, allowing for biological repair of the pulp-dentin complex by promoting the formation of tertiary dentin between temporary and definitive restorations. Silver Diamine Fluoride (SDF) has gained popularity due to its unique combination of silver and fluoride, which provides antimicrobial and remineralising properties. In this case series of three cases, three-year-old preschool boy, five year old girl and five year old girl, in whom, deep carious lesions in primary molars were treated using selective caries removal techniques with SDF as an IPT agent, resulting in successful minimally invasive restorative procedures. This case series underscores the importance of employing selective caries removal techniques and the potential use of SDF as an IPT agent in such scenarios to preserve tooth vitality in a less invasive therapeutic approach suitable for the paediatric population.
Deep caries, Dental, Indirect pulp therapy, Vital pulp therapy
Minimally Invasive Paediatric Dentistry (MIPD) has become the new standard in the post-pandemic decade because it reduces aerosol spray during dental treatments while still offering child-friendly and high-quality restorative dentistry. Despite the availability of contemporary restorative materials, traditional surgical excision of deep carious lesions contributes to the risk of pulp exposure or loss (1). According to new caries management guidelines, there is a significant need to enhance the adoption of minimally invasive methods as a conventional choice rather than a compromise alternative for addressing deep carious primary teeth (2). SDF had previously been used in dentistry as a desensitising agent and to prevent tooth cavities. Its well-known qualities might be applied in vital pulp treatment for primary and young permanent molars (3). IPT, is a treatment used to protect the vitality of the pulp in deep carious lesions (4). Selective or stepwise caries removal is based on the concept of interfering with the progression of carious destruction, which allows for biological healing of the pulp-dentine complex through the development of tertiary dentin in deep caries lesions (5). A few clinical trials have recently advocated for the effective use of SDF as IPT in primary as well as permanent molars (6),(7),(8). This case series encompasses three clinical scenarios in paediatric patients where deep carious lesions were minimally and successfully intervened with selective caries removal techniques and SDF as an IPT agent.
Case 1
A three-year-old preschool boy presented to our department with occasional sensitivity during food consumption as the chief complaint. Upon anamnesis with the parents, there was no history of continuous pain or swelling. Additionally, there were no relevant medical issues, and it was his first dental visit. The behavior of the child was rated as positive based on Frankl’s behavioral rating scale (9). A deep carious lesion involving enamel and dentin was observed in tooth 84, classified as ICDAS code-6 according to the International Caries Detection and Assessment System (ICDAS) (10). Provisionally, it was diagnosed as reversible pulpitis in tooth 84 along with deep pits and fissures in tooth 85 (Table/Fig 1)a. Radiographic examination revealed no pulp involvement, with the lesion affecting only the enamel and dentin (Table/Fig 1)b, confirming the final diagnosis of reversible pulpitis. Therefore, IPT was performed on tooth 84 to preserve the vitality of the pulp.
Treatment
The parents were informed about the procedure, and informed consent was obtained. The authors decided to perform the therapeutic intervention with the child on the parent’s lap to foster a positive dental attitude for future appointments. Under the TEDIE technique (11) and a flexible behavioral approach in the mother’s lap, local anaesthesia was administered, and isolation with a rubber dam was achieved using the split dam technique and 13A winged retainers (Coltene®, USA) and liquid dam (Peroxidam®). After isolation, selective caries removal was conducted using a chemomechanical caries removal agent (Carie-Care®) and a sharp spoon excavator (Osung®). Soft carious dentin was selectively removed, while hard residual dentin was left behind according to guidelines (2). Following the manufacturer’s instructions, SDF (Kids-e-Dent, India) was applied over the remaining hard dentin using an applicator microbrush and restored with resin-modified glass ionomer (Fuji II, GC, Asia) (Table/Fig 1)c. The patient remained asymptomatic both clinically and radiographically during the 17-month follow-up (Table/Fig 1)d-f. The clinical image of the boy undergoing treatment is shown in (Table/Fig 2).
Case 2
A five-year-old girl presented at our outpatient clinic with occasional sensitivity in the lower right back tooth region as the main complaint. Upon clinical examination, enamel and dentin involvement corresponding to ICDAS code 6 was observed, and a provisional diagnosis of reversible pulpitis was made (Table/Fig 3)a (10). Radiographic evaluation confirmed the absence of pulpal involvement, consistent with the clinical findings, and the final diagnosis of reversible pulpitis was established (Table/Fig 3)b. Therefore, IPT with SDF and restoration using resin-modified glass ionomer (Fuji II, GC, Asia) was planned for teeth 84 and 85.
Treatment
After obtaining informed consent from the parents, isolation of the teeth was achieved using a rubber dam and the split dam technique. Selective carious removal was performed using a chemo-mechanical caries removal agent (Carie Care®) and a sterile sharp spoon excavator (Osung®), with the remaining hard dentinal lesion left behind (Table/Fig 3)c,d. Subsequently, SDF was applied to teeth 84 and 85 using an applicator brush, followed by the placement of glass ionomer restorations in teeth 84 and 85 (Table/Fig 3)e-g. The patient remained asymptomatic during the six-month follow-up, with clinically and radiographically intact restorations (Table/Fig 4)a,b.
Case 3
A five-year-old girl presented at our specialty clinic, complaining of short and intermittent episodes of pain and discomfort in the lower left back tooth region during the previous week. On Frankel’s behavioral scale, she received a positive rating (9). Clinical and radiographic evaluations revealed enamel and dentin involvement corresponding to ICDAS code 6, provisionally diagnosed as a deep carious lesion with proximal surface involvement. Radiographic examination confirmed the final diagnosis of reversible pulpitis (Table/Fig 5)a,b (10). Selective carious removal and IPT were planned to be performed in the affected tooth (number 75), followed by SDF application as an IPT agent.
Treatment
After obtaining informed consent from the parents, local anaesthesia was administered, and the teeth were isolated using the split dam technique (Table/Fig 5)c. Selective caries removal was performed using a chemo-mechanical caries removal agent and an Osung® spoon excavator, leaving behind the hard dentin (Table/Fig 5)d. This was followed by the application of SDF using a microbrush. Since the affected tooth did not have sound cavosurface margins on the mesial wall, it was restored with a stainless steel crown (Kids Crowns®, South Korea) to provide a better peripheral seal, minimising microleakage of oral fluids (Table/Fig 5)e,f (2). The patient was followed-up for a period of nine months, with no clinical or radiographic signs or symptoms (Table/Fig 6).
The World Health Organisation (WHO) identified SDF as one of the most effective, safe, and cost-effective medications for meeting critical health system requirements for adults and children in 2021 (12). SDF is a colorless alkaline solution with a pH of 9 to 10. Although the makers have not revealed specific chemical information, their SDF products mostly contain silver, fluoride, and ammonia (13),(14). Studies have shown that SDF reduces biofilm development, promotes remineralisation, prevents collagen degradation, and blocks dentinal tubules (13),(15),(16). These attractive qualities make SDF a good treatment option for tooth cavities and dentin hypersensitivity (3).
Recent research has demonstrated that SDF inhibits Matrix Metalloproteinases (MMPs) involved in collagen breakdown in carious lesions (13). The interaction of SDF with the dentin-pulp complex, which alters the physicochemical characteristics leading to tertiary dentin formation, is the mechanism of action for caries arrest and desensitisation (13). This justifies the use of SDF as an IPT agent. Long-term studies have shown that IPT has a higher success rate than Direct Pulp Cap (DPC) and pulpotomy, according to the AAPD guidelines 2022 (4),(17).
Baraka MMAL et al., assessed the clinical and radiographic production of tertiary dentin in young permanent teeth with Cone Beam Computed Tomography (CBCT) images after SDF treatment in deep carious lesions and found no difference between SDF and RMGIC as IPT agents (6). Shafi N et al., determined that SDF had a 96 percent clinical and radiographic success rate as an IPT agent in primary molars when compared to calcium hydroxide and suggested that SDF could be used as a viable therapeutic agent for IPT in primary molars (7). Patel MC et al., used a similar approach to examine the clinical and radiographic effectiveness of SDF as IPT and documented a predicted clinical success rate. Based on optimal case selection, they concluded that the removal of all infected dentin in deep carious lesions is not required for successful caries treatment, and Silver Modified Atraumatic Restorative Treatment (SMART) can be recommended as a potential biologic approach to manage asymptomatic deep dentinal lesions, which was followed in our protocol (8).
According to American Academy of Paediatric Dentistry (AAPD) recommendations, the choice of restorative material is also important in the effectiveness of IPT (4). Therefore, the authors selected RMGIC as a restorative material in two instances, and a stainless steel crown in the final case of our series to establish a proper peripheral seal and reduce microleakage of oral fluids (1).
The efficacy of IPT in our case series may be attributed to the “zombie effect” of SDF, which occurs when dead silver-containing bacterial cells come into contact with active bacterial cells (18). According to a systematic review, the moderate irritation of the pulp caused by SDF may also stimulate the pulp defense systems to develop reactionary or tertiary dentin, contributing to the success of IPT in our case series (19).
However, this case series has a few limitations in terms of follow-up and the type of restorative material used. The authors had successful follow-up for more than twelve months in one of the cases, and the authors believe that appropriate case selection based on ICDAS classification and the use of selective caries removal procedures in deep caries lesions may have resulted in minimally invasive and long-lasting restorations.
Although many biomaterials are available in the market for IPT, SDF could be a viable and economically conducive alternative for developing countries in minimally invasive paediatric dentistry. This case series underscores the need for practitioners to follow such guidelines, resulting in minimally invasive treatments that preserve tooth vitality in primary and young permanent teeth, thereby avoiding the risk of pulp therapy. Additionally, this case series supports SDF as a therapeutic IPT agent in deep caries lesions, emphasising the importance of proper case selection based on ICDAS classification, the use of selective caries removal procedures, and adequate isolation in such lesions.
DOI: 10.7860/JCDR/2023/64386.18359
Date of Submission: Jun 03, 2023
Date of Peer Review: Jul 10, 2023
Date of Acceptance: Jul 31, 2023
Date of Publishing: Aug 01, 2023
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jun 06, 2023
• Manual Googling: Jul 08, 2023
• iThenticate Software: Jul 22, 2023 (8%)
ETYMOLOGY: Author Origin
EMENDATIONS: 6
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