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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
Original article / research
Full Version
Effect of Chlorhexidine Mouthwash, Povidone-iodine Gargles and Herbal Mouth Sanitiser on Colour Stability and Surface Roughness of Conventional Nanohybrid Composite- An In-vitro Study
Correspondence Address :
Nimisha Chinmay Shah,
Professor and Head, Department of Conservative Dentistry and Endodontics,
K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, India.
E-mail: nshah7873@gmail.com
Introduction: Chlorhexidine is commonly used to treat dental diseases as a broad-spectrum topical antibacterial medication. Povidone-iodine is a water soluble blend of molecular iodine and the solubiliser polyvinyl pyrrolidone. Amsarveda (pharmaceutical company) developed a natural mouth sanitiser with liposomal curcumin.
Aim: Comparative evaluation of the effect of chlorhexidine mouthwash, povidone-iodine gargle and herbal mouth sanitiser on colour stability and surface roughness of conventional nanohybrid composite.
Materials and Methods: This in-vitro study was conducted in the Department of Conservative Dentistry and Endodontics at KM Shah Dental College and Hospital, Vadodara, Gujarat, India, from November 2020 to June 2021. Total 60 extracted human permanent maxillary premolar teeth were selected. Class V restorations were performed on the extracted teeth with nanohybrid composite resin. The samples were divided into three groups by computer randomisation. The three test solution groups (n=20 each) ie., group A- chlorhexidine 0.2% mouthwash, group B has povidone-iodine (2%), group C- herbal mouth sanitiser. The colour change and surface roughness of all the samples were measured before and 15 days after immersion into the test solutions. The data was collected and statistically analysed using one-way Analysis of Variance (ANOVA) and Tukey’s post-hoc test.
Results: The ΔE values for all three groups show a statistically significant difference (p-value <0.001). The mean baseline and after 15 days values for surface roughness in groups A and B showed a statistically significant difference (p-value <0.001). Whereas, no statistically significant difference in group C (p-value=0.654).
Conclusion: Based on the results of the present study, it can be stated that the povidone-iodine gargle showed more surface roughness and colour change of conventional nanohybrid composite followed by chlorhexidine mouthwash and herbal mouth sanitiser.
Discolouration, Mouthrinse, Profilometer, Resin composite, Spectrophotometer
The most common choice of materials for anterior and posterior restorations is composite. Resin composite should resist colour change and polish maintains its aesthetic property over a long period of time (1). Composite discolouration is an undesired effect, even though it is unavoidable in the oral environment. It can be due to various colouring agents present in food. These can change the colour of composite resins through absorption and/or adsorption when consumed for long period of time (2),(3). While deciding on a restorative material, surface roughness and colour stability of aesthetic dental materials are often disregarded over other physical and mechanical properties (1).
Mouthrinses are routinely used formulations for cleansing the mouth, primarily before dental surgical procedures, due to their ability to lower the microorganisms in the oral cavity (4),(5),(6). Although there is no scientific proof that mouthwashes help prevent Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) transmission, the American Dental Association (ADA) and the Centers for Disease Control and Prevention (CDC) have suggested using preprocedural mouthwashes before oral therapies (7). However, regular usage of mouthrinses may be harmful to oral and dental tissues (8),(9).
Chlorhexidine is commonly used to treat dental diseases as a broad-spectrum topical antibacterial medication. It is known to discolour oral tissues and restorations, especially when combined with dietary variables. Povidone-iodine is a water-soluble blend of molecular iodine and the solubiliser polyvinyl pyrrolidone. It is used for one to two minutes of mouth rinsing like chlorhexidine before dental treatment (10). Similar to mouthwashes, recently mouth sanitiser have been introduced. Amsarveda (pharmaceutical company) developed a natural mouth sanitiser with liposomal curcumin. As per the claims of the manufacturer, it can be swirled in the mouth for a minute and could be used every 2-4 hours. It is stated that any pathogene is entrapped and deactivated by it. This mouth sanitiser contains aloevera extract, berberis aristata extract, green tea extract, liposomal curcumin, ocimum sanctum extract, andrographis paniculate extract and Glycyrhhiza glabra extract.
Aloevera extract prevents the formation of microorganisms that can cause infections in humans, soothes wounds, and lowers dental plaque. Berberis aristata extract, green tea extract, liposomal curcumin, and ocimum sanctum extract are anti-inflammatory, antioxidant-rich, and antiviral in nature (11).
However, considering the rise in the usage of mouthwashes, the researches comparing composite discolouration due to mouthwashes are minimal (12),(13). Previous in-vitro studies have researched about the discolouration of composites due to various beverages and foodstuffs (2),(13),(14). But not much has been explored with the discolouration of composites due to regular use of mouthrinses, especially povidone-iodine gargle and herbal mouth sanitiser which can be recommended during Coronavirus Disease- 2019 (COVID-19) times. Thus, the aim is to evaluate and compare the effect of chlorhexidine mouthwash, povidone-iodine gargle and herbal mouth sanitiser on colour stability and surface roughness of conventional nanohybrid composite before and after 15 days time interval. The null hypothesis was that there will be no difference between effect of chlorhexidine mouthwash, povidone-iodine gargle, and herbal mouth sanitiser on colour stability and surface roughness of conventional nanohybrid composite.
This in-vitro study was conducted in the Department of Conservative Dentistry and Endodontics at KM Shah Dental College and Hospital, Vadodara, Gujarat, India, from November 2020 to June 2021. The approval was obtained from the Institutional Ethics Committee (SVIEC/ON/Dent/SRP/20118).
Inclusion and Exclusion criteria: Intact mature premolar teeth extracted for orthodontic purpose were included in the study. The teeth with caries, attrition, any hypoplastic defect, cracks, and previous restorations were excluded from the study.
Sample size calculation: A minimum 42 samples (14 per group) should be taken for present study to achieve 95% confidence interval and 80% power. Using the formula,
N=2×(Z×SD/d2)
where, Z=3.24, SD=0.12, d=0.15.
Thus, the final sample size was 60 extracted human permanent maxillary premolar teeth.
Procedure
The extracted teeth were disinfected in 0.5% chloramine-T trihydrate solution for one week and were cleaned off calculus and periodontal tissue using an ultrasonic scaler. All teeth were stored in normal saline at 4o until further processing. All the teeth were treated by the principal investigator. For all extracted teeth, the operator prepared Class V cavities with 3 mm (mesiodistal), 2 mm (occluso-gingival), and 1.5 mm depth at the occlusal margin and 1 mm depth at the cervical margin on the buccal surface. For restoration of cavities, selective enamel etching was done with 37% phosphoric acid (Prime Dental) and rinsed with distilled water for one minute. Then, universal bonding agent (Tokuyama Palfique bond) was applied to the enamel and dentinal walls of the cavity and light-cured for 20 seconds. This was followed by the incremental layering of nanohybrid resin composite (Palfique LX5, Tokuyama, Japan) and then light-cured for 20 seconds. The curing light used during this study was of GC D Light Duo (Tokyo, Japan) (Dual Wavelength) (400-480 nm). The light intensity of the unit was regularly checked using the curing light intensity meter. The final cure of composite was completed through the application of glycerine which improves surface resistance and allows for better finishing and polishing procedures (15). After the completion of the composite placement, the standard finishing and polishing regime was carried out by the Shofu Super Snap Rainbow Kit.
The extracted teeth were stored in artificial saliva for 24 hours after the finishing and polishing regimen. The colour change and surface roughness of all the samples were measured after composite restoration and before immersion into the test solution. A spectrophotometer (Vita Easyshade Advance 5.0 digital shade guide) was used for evaluating colour stability. The surface roughness of the material was tested using a SJ-210 profilometer (Mitutoyo, Japan). The samples were then divided into three groups by computer randomisation on www.randomizer.org.
• Group A (n=20)- Chlorhexidine 0.2% mouthwash (Dr. Reddy’s Clohex ADS liquid)
• Group B (n=20)- Povidone-iodine Germicide gargle 2% (Betadine)
• Group C (n=20)- Herbal mouth sanitiser (Amsarveda Mouth sanitiser)
The samples were stored in a 3 mL test tube in artificial saliva (wet mouth). The samples of group A were immersed in the test solutions for one to two minutes twice a day for 15 days. The samples of group B were immersed in the test solution according to the manufacturer’s instructions. The samples of group C were immersed in the test solution for one minute three to four times a day for 15 days. The solutions have different advised usage time and frequencies; hence the samples were immersed in these for different duration and frequency. Thermocycling of the samples of all groups was done two times in a day for 15 days, at 5°C±2°C to 55°C±2°C with 30 seconds dwell time, and five second transfer time. After 15 days the samples were stored in artificial saliva and evaluated for surface roughness and colour change. The colour stability and surface roughness evaluators and statistician were blinded.
Statistical Analysis
All the data was collected and statistically analysed using one-way Analysis of Variance (ANOVA) and Tukey’s post-hoc test using Statistical Package for the Social Sciences (SPSS) software version 21.0. (IBM, Chicago, IL, USA).
Evaluation of colour stability: The ΔE values for all three groups show a statistically significant difference (p<0.001) (Table/Fig 1) which suggests a colour change in all three groups. The highest ?E value was seen with group B (povidone-iodine) and the least in group C (herbal mouth sanitiser). On intergroup comparison, it was found that the ?E values for group A vs group B and group B vs group C, showed a statistical significance (p-value <0.001) and, no statistically significant difference was found between group A vs group C (Table/Fig 2).
Evaluation of surface roughness: The mean baseline and after 15 days’ values for surface roughness in group A and group B showed a statistically significant difference (p-value <0.001) and no statistically significant difference in group C (p-value=0.654) (Table/Fig 3). On intergroup comparison, it was found that the mean difference values for group A vs group C, and group B vs group C showed statistical significance, thus, chlorhexidine mouthwash and povidone-iodine gargle used in COVID-19 era can cause surface roughness of composite restorations and herbal mouth sanitiser can be used as a mouthrinse. Also, there was no statistically significant difference between group A and group B which suggests that chlorhexidine and povidone-iodine both cause significant surface roughness (Table/Fig 4). Povidone-iodine gargle showed more surface roughness and colour change amongst the three groups followed by chlorhexidine mouthwash and herbal mouth sanitiser.
In clinical setting, tooth coloured restorative materials have been widely employed to satisfy patients’ aesthetic needs (16). Restoration of teeth with recently developed nanocomposites is the most significant input of nanotechnology to the dental fraternity. Colour stability is one of the qualities of composite resins that must stand the test of time (17). Aesthetics is given a high priority in modern dentistry. The oxidation of tertiary amine results in surface staining in nanohybrid composites. This produces a yellowish discolouration. The colour stability of a composite restoration is related to its surface roughness. Surface roughness can contribute to higher plaque retention and stain absorption than a smoother surface (18).
The aetiology of composite discolouration is complex, with proprietary mouthrinse being one of the contributing factors (19). The hardness, wear, and colour stability of composites may be affected by low pH of the mouthrinse. Furthermore, alcoholic components are not the sole element causing softening of resin and alcohol-free mouthrinses can impair colour stability composites; a study has revealed that color stability can be reduced by both alcohol-containing and alcohol-free mouthrinses (20). The mouthrinses emulsifiers and organic acids may cause surface deterioration of resin composite materials (21).
In the current study, the povidone-iodine group showed the highest surface roughness and colour change. The composition of the povidone-iodine germicidal gargle, as per manufacturer consisted of povidone-iodine 2% w/v, absolute alcohol content 8.38% v/v, and mint flavour aqueous base. Essential oil’s (including eucalyptol, thymol, menthol, and methyl salicylate) as an active ingredient in some mouthrinses. Therefore, essential oil’s active ingredient in addition to high alcohol content and low pH of the mouthrinse containing alcohol and essential oil’s may have played a role in the increased colour change and surface roughness of the nanohybrid resin composites used in this study (22). A study by Bayraktar Y et al., evaluated the effect of SARS-CoV-2 effective mouthwashes on the staining, translucency, and surface properties of a nanofill resin composite. The chlorhexidine group displayed the lowest ΔE3 value, povidone iodine and cetylpyridinium hydrochloride group were found statistically similar to the chlorhexidine group (23).
Chlorhexidine mouthwash consists of chlorhexidine gluconate 0.2%, sodium fluoride 0.5% and zinc chloride 0.09%. It has been hypothesised that tannin-containing dietary components have a significant chromatogenic potential, especially when combined with chlorhexidine. Denatured proteins and iron from food include thiol groups, which give sulphur and eventually create iron sulphide, which causes the stain (24). A study has revealed that chlorhexidine-containing mouthrinse having 0.2% of chlorhexidine gluconate could cause perceptible colour change in composites (25).
The COVID-19 outbreak and pandemic are creating significant worry in all countries’ healthcare systems. According to Moosavi MS et al., using mouthwash before dental operations reduces the risk of viral transmission to the dental team via aerosol and saliva (26). Amsarveda (pharmaceutical company) developed a mouth sanitiser with natural extracts (11). No studies have yet evaluated the discolouration potential of this mouth sanitiser. This group showed the least colour change and surface roughness on composite. The less discolouration could be because of the non alcoholic contents of the mouth sanitiser.
CHX has a high ionic concentration, which may cause the release of soluble components from the resin composites, increasing surface roughness. Similarly, Abo EN and Yousef M have also reported increased surface roughness of resin composites exposed to mouthrinses containing CHX (27).
In this study, a Digital spectrophotometer- Vita Easyshade 5 was used for measuring colour stability. ΔE is appropriate for small colour changes evaluation and repeatable, sensitive, objective method (28). The oral environment determines the performance of a material. For example, mouthwashes in contact with restorations influence physical properties due to their compositions (19),(29). Some studies focussed on effects of different exposure protocols of mouthrinses on surface characteristics of a few aesthetic restorative materials (12),(30). The results of a study by Miranda Dde A et al., showed that those mouthwashes containing alcohol or hydrogen peroxide present an increased chance of change in the superficial roughness and hardness of the tested composites. The Knoop microhardness and surface roughness of the tested composites depends on the time period of immersion (31).
A statistical significant difference between the colour stability and surface roughness of the three groups was obtained. Thus, the null hypothesis of this study was rejected.
Limitation(s)
The limitation of the study is that as it is an in-vitro study, it is not possible to mimic oral conditions completely including the effect of food and beverages. Thus, it is difficult to extrapolate the result of this study to in-vivo conditions.
This in-vitro study demonstrated the povidone iodine gargle showed more surface roughness and colour change of conventional nanohybrid composite amongst the three groups followed by chlorhexidine mouthwash and herbal mouth sanitiser. Within the limitations of the study, it can be stated that the herbal mouth sanitiser group performed better than the povidone iodine and chlorhexidine group and can be considered for future in-vivo evaluation and use.
Declaration: This manuscript is purely for research purpose and no
brand is being promoted here.
DOI: 10.7860/JCDR/2022/52969.16369
Date of Submission: Oct 23, 2021
Date of Peer Review: Dec 29, 2021
Date of Acceptance: Feb 15, 2022
Date of Publishing: May 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? No
• For any images presented appropriate consent has been obtained from the subjects. No
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