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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
Efficacy of a Commercially Available Herbal Formulation for the Disinfection of Elastomeric Heavy Body Impression Materials
Correspondence Address :
Dr. Vamsi Lavu,
Professor, Department of Periodontology, Sri Ramachandra Institute of Higher
Education and Research, Porur, Chennai-600116, Tamil Nadu, India.
E-mail: vamsilavu@sriramachandra.edu.in
Introduction: Cross infection refers to the transfer of harmful microorganisms from one person to another. Dental impressions are considered semi-critical as it directly comes in contact with patient’s saliva and oral mucosa. Improper handling of these dental impressions can potentially have the risk of transmitting infections especially to the dentist. The role of herbal preparation in disinfecting the dental impressions is sparse in the literature.
Aim: To evaluate and compare the disinfection ability of a commercially available herbal formulation (HiOra®) with chlorhexidine digluconate solution (0.2%) and 1% sodium hypochlorite on dental impressions made using condensation silicone.
Materials and Methods: A cross-sectional study was conducted in Outpatient Department of Periodontology and Implantology at Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India, between June 2019 and November 2019. A total of 60 maxillary and mandibular dental impressions using condensation silicone material were obtained from 30 systemically healthy volunteers. The impressions were divided into three groups and were subjected to three antimicrobial agents for 10 minutes: 1% Sodium Hypochlorite (group 1); 0.2% chlorhexidine digluconate (group 2); HiOra® (group 3), respectively. Following this, microbial culturing was performed to detect the presence of Streptococcal and Staphylococcus species in samples obtained both prior and after impression disinfection. One-way Analysis of Variance (ANOVA) was performed to assess the significance of the difference in microbial reduction between the groups.
Results: Antimicrobial efficacy was similar against both Streptococcus spp., and Staphylococcus spp., for the three disinfectants tested. No statistically significant difference in the microbial colony count reduction between the three disinfectants tested was observed (Streptococcus spp, p-value=0.064, Staphylococcus spp., p-value=0.337).
Conclusion: The herbal mouthwash was found to have an equivalent efficacy as chlorhexidine, sodium hypochlorite for disinfection of impressions made from condensation silicone.
Chlorhexidine digluconate, Dental impressions, Herbal mouthwash, Microbial reduction, Sodium hypochlorite
Disinfection is the destruction of pathogenic microorganisms or their toxins by direct exposure to chemical or physical agents. The various disinfectants are broadly classified into physical and chemical agents (1). The ideal requisites for the disinfectant are: they should not be toxic even if absorbed into circulation, should have a broad spectrum of activity, speedy action, and should be stable (1).
Disinfection is an integral part of the dental practice, and one of the commonly overlooked areas of disinfection is dental impressions. Dental impressions are made with a wide variety of materials such as alginate, addition and condensation silicone materials, and polyethers (2). The risk of spread of infection through impression has been highlighted in a study by Egusa H et al., (3). The authors assessed alginate impression from 56 patients and concluded that patient derived dental impressions and casts were contaminated with pathogens like Streptococci spp., Staphylococci spp, Methicillin-Resistant Staphylococcus Aureus (MRSA), Candida spp., P.aeroginosa, which is responsible for cross infections. Hence, there is an absolute need for the disinfection of the dental impressions (4).
Several methods of disinfection of dental impressions have been used. These include the use of chemicals of specific concentrations such as hydrogen peroxide, sodium hypochlorite, aldehyde based agents, alcohols of high concentrations (>70% and above), chlorhexidine gluconate (5). Physical methods such as the use of ultraviolet light and microwave have also been attempted for impression disinfection with varying degrees of success (5). Though extremely efficient, these disinfectants can pose a risk to the dentist’s health and the environment (6). Hence, an alternative disinfectant should be used which is both effective and is not hazardous to the dentist and the environment.
HiOra® is an antimicrobial, antiseptic herbal mouthwash manufactured by the Himalaya drug company. Its main composition consists of Meswak (Salvadora Persica), Betel (Nagavalli) leaf, Belleric Myrobalan (Bibhitaki) (7). It is commonly used for plaque control, to prevent halitosis, and combats common oral bacteria and fungi (8). The above-mentioned herbal formulation has not been tested as a disinfectant for impression materials to date, and it may thus provide a viable eco-friendly alternative to disinfection of impression materials.
The aim of the present study was to evaluate and compare the disinfection ability of a commercially available herbal formulation (HiOra®) with chlorhexidine digluconate solution (0.2%) and 1% sodium hypochlorite (NaOCl) on dental impressions made using condensation silicone.
A cross-sectional study was conducted in Outpatient Department of Periodontology and Implantology at Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India, between June 2019 and November 2019. Informed consent was obtained prior to enrolment in the study. The Ethics Committee approval was obtained prior to the start of the study (CSP/17/JUN/59/198). The study was conducted in line with the ethical principles established by the Helsiniki Declaration (2013).
Sample size calculation: Sample size calculation was done based on the observations of Contreras GF et al., 2016 (9). Assuming power (?) of 80% and alpha value of 5% and a sample size of 18 per group was needed for establishing the .difference between the groups. A total of 20 samples were selected for each of the group.
Inclusion and Exclusion criteria: Systemically healthy individuals (both males and females) in the age range of 20-35 years, who were non smokers were included in the study. Individuals with extensive prosthodontic or orthodontic appliances, individuals with existing periodontal disease and patients taking long term medication were excluded from the study.
Study Procedure
A total of 60 impressions were taken from both maxillary and mandibular arches of the 30 patients (one each from maxilla and mandible of each individual). The study consisted of immersing the impressions made of condensation silicone into three different disinfection agents as given below:
• Group 1: Immersion of 20 condensation silicone impression in 60 mL of 1% sodium hypochlorite (NaOCl) for 10 minutes.
• Group 2: Immersion of 20 condensation silicone impression in 60 mL of 0.2% chlorhexidine digluconate solution for 10 minutes.
• Group 3: Immersion of 20 condensation silicone impression in 60 mL of the Herbal formulation (HiOra®) for 10 minutes.
The methodology involved the following clinical and laboratory protocols (Table/Fig 1).
Step 1: The subject’s mouth was dried using suction, and a baseline sample was obtained using a sterile swab from six regions in either the maxilla or the mandible (anterior labial region, anterior lingual region, left posterior buccal, left posterior palatal/lingual region, right posterior buccal region, right posterior palatal/lingual region) (Table/Fig 2)a-f.
Step 2: Maxillary and Mandibular Impressions were obtained from the patient using Condensation silicone putty (Zhemarck Zetaplus) (Table/Fig 3)a. Number of impressions obtained were 60.
Step 3: Twenty impressions each were immersed in 60 mL of 1% sodium hypochlorite, 0.2% chlorhexidine gluconate, and herbal formulation for 10 minutes each (10).
Step 4: Postimmersion swab was taken from the dental impression made from condensation silicone after the completion of the immersion period (Table/Fig 3)b.
Step 5: The collected swabs were transported to the Microbiology laboratory for further processing without any delay. In case of any delay, the swabs were stored in ice packs for a maximum of not more than one hour. In the laboratory, the swabs were inoculated by streaking on Trypticase Soy Agar plates (Table/Fig 3)c.
Step 6: The plates were incubated overnight at 37°C.
Step 7: After overnight incubation, the plates were observed for any growth. If growth was present, the morphology and the colony count (Semi-quantitative) were recorded (Table/Fig 3)d-f. Staphlococcus aureus appeared as white opaque colonies whereas Streptococcus appeared as tiny transluscnt colonies.
The Staphylococcus spp. or Streptococcus spp. group was identified by subjecting the colony growth to a gram stain. The Staphylococcus spp. appeared purple and was arranged in groups and clusters, whereas the Streptococcus species were arranged in pairs and chains (11). Further confirmation was done by doing a catalase test which was positive for Staphylococcus spp. and negative for Streptococcus spp. (Table/Fig 4)a-c (11).
Statistical Analysis
The statistical analysis for the categorical data obtained on comparing the antimicrobial efficacy of the chlorhexidine and HiOra® were done using one-way Analysis of Variance (ANOVA). All the statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 11.0 (SPSS for Windows, Version 11.0. Chicago, IL). A p-value <0.05 was considered statistically significant.
The mean age of the study population was 30±2.8 years. There were 18 females and 12 males included in the study. The demographic data is summarised in (Table/Fig 5). The growth of the Staphylococcus and Streptococcus species in culture plates streaked using the swabs collected at baseline (from patient mouth) showed considerable variation and this data is summarised in (Table/Fig 6)a.
The antimicrobial efficacy of 1% sodium hypochlorite against Streptococcus spp. was 99.99% and against Staphylococcus spp. was 99.83%. The antimicrobial efficacy of 0.2% chlorhexidine digluconate solution against Streptococcus spp. was 100.00% and against Staphylococcus spp was 99.93%. The antimicrobial efficacy of HiOra® against Streptococcus spp. was 99.97% and against Staphylococcus spp. was 99.98% (Table/Fig 6)b.
One-way ANOVA was done to determine the significance of the difference in the antimicrobial efficacy between the groups for the two bacteria evaluated. No significant difference in the efficacy could be determined between the antimicrobial agents (groups 1,2,3) tested for Streptococcus spp. (p-value=0.064) and Staphylococcus spp. (p-value=0.337) (Table/Fig 7).
Disinfection and dentistry complement each other, and disinfection has been around since the inception of dentistry. Disinfection is practiced by various methods in dentistry (e.g., autoclaving of dental/surgical instruments, incineration of used cotton) (12).
Disinfection of dental impressions can be done by two different techniques: immersion and spray techniques. The immersion method is considered the gold standard amongst the two as the immersion method allows uniform distribution of the disinfectant over the surface of the impression material (2). A condensation silicone impression material was chosen due to its hydrophobic nature which allows for immersion into the disinfectant without significant dimensional change or alteration of surface properties (13).
Concerns on time needed for a complete disinfection, alteration of the properties of the impression materials following immersion have been well studied in the literature (12). Silva SMLM da and Salvador MCG reported on the influence of the dimensional stability of the condensation silicone impression material following immersion for 10-20 minutes in 1% sodium hypochlorite and 2% glutaraldehyde (14). The authors reported no significant differences in the dimensional stability following this method. Shetty S et al., reported on wettability changes of polyether impression material after immersing in four different chemical disinfectant solutions (2% glutaraldehyde, 5% NaOCl, 0.05% iodophor, 5.25% phenol) for two time periods of 10 minutes and 30 minutes, respectively (15). The authors concluded 0.05% iodophor was an effective disinfectant without affecting wettability of the polyether impression material (15). A 10 minute immersion time was also found to be effective for disinfection of the impressions made (15).
A more recent study by Azevedo MJ et al., evaluated the efficacy of 3% hydrogen peroxide, MD 250 (Durr Dental), 1% sodium hypochlorite and 5.25% sodium hypochlorite in impression disinfection by immersion technique for 10 minutes duration (16). In addition, the dimensional stability of addition silicone impression materials was also evaluated. The authors reported no alteration in the dimensions of the impression made and a 99.9% reduction of the microbial load as assessed by the colony forming unit count.
The herbal formulation HiOra® is an antimicrobial, antiseptic herbal mouthwash manufactured by the Himalaya drug company (7). The present study evaluated the efficacy of a commercially available herbal formulation, chlorhexidine gluconate 0.2% and sodium hypochlorite 1% for impression disinfection by the immersion method (10 minutes duration). Antimicrobial efficacy was evaluated against two common oral species Staphylococcus aureus and Streptococcus viridans. Trypticase Soy agar was used to selectively grow the two species from the sample collected intraorally using the sterile swab. The herbal formulation was found to be equally efficacious as the chlorhexidine and 1% sodium hypochlorite in reducing the microbial load (>99%) as assessed by CFU count after plating in agar plates. The present study is possibly the first to evaluate the usefulness of this herbal formulation HiOra® as a disinfectant of impression materials.
Literature on the dimensional changes of the impression after immersion in the disinfectants has reported varied outcomes. Studies by several authors reported no significant changes in the dimensional stability of the impressions made with elastomeric impression materials (14),(15),(16). However, a scanning electron microscopic evaluation of the surface changes in impressions made using four different elastomeric impression material which were disinfected with 0.525% NaOCl, 0.3% benzalkonium chloride and ozone revealed a wrinkling of the surface for short disinfection times of 2-5 minutes irrespective of the disinfectant and technique and significant surface degradation with exposure of the silicone crystals following long exposure periods of 30 minutes (17). In contrast, Mc Cabe JF and Storer R reported silicone based impressions has the least dimensional change when immersed in 2% alkaline glutaraldehyde, 4% formalin, and 1% sodium hypochlorite for 16 hours (18).
A recent systematic review by AlZain S, evaluated the studies published on the different disinfectants used and their influence on properties of the impression made with different impression materials (5). The authors selected data from 70 studies for evaluation and concluded there were variations in the outcomes reported (especially in dimensional stability, surface changes, wettability), which was attributable to the variations in the immersion times used, the difference in the methods of evaluation of the outcomes, the difference in the concentrations of the disinfectants used and also differences in the materials used to make the impressions. The authors further suggested that manufacturers of the dental impression materials propose specific disinfectants to be used with particular protocols which help maintain the material properties along with achieving an adequate disinfection.
Limitation(s)
One of the limitations of the present study was that, this study evaluated only the disinfection efficacy of the herbal formulation and not its influence on dimensional stability of the impressions made. In addition, pre-disinfection swab had been obtained from the patient’s mouth and the post disinfection swab has been obtained from the impression material.
In conclusion, the herbal formulation was found to have an equivalent efficacy as 0.2% chlorhexidine gluconate and sodium hypochlorite 1%, for disinfection of impressions made from condensation silicone. Further studies are needed to assess any dimensional changes of the impression following disinfection with this herbal formulation.
DOI: 10.7860/JCDR/2022/52919.16383
Date of Submission: Oct 18, 2021
Date of Peer Review: Nov 29, 2021
Date of Acceptance: Feb 21, 2022
Date of Publishing: May 01, 2022
AUTHOR DECLARATION:
• Financial or Other Competing Interests: Summer Research Fellowship, Sri Ramachandra Institute of
Higher Education and Research (10,000/which will be given for research support).
• 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
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