Padjadjaran Journal of Dentistry (PJD) is an open-access journal published by the Faculty of Dentistry at Universitas Padjadjaran,issued thrice annually in March, July, and November, with p-ISSN 1979-0201 and e-ISSN 2549-6212. Padjadjaran Journal of Dentistry is also affiliated with Indonesian Dental Association. Padjadjaran Journal of Dentistry is a scientific publication. It publishes original research manuscripts, systematic reviews, and case reports in the fields of Dental Assisting, Dental Hygiene, Periodontics, and Dentistry (Miscellaneous). However, articles focusing on indigenous health research and the use of natural resources in dentistry are also welcome. It provides a medium for sustained discussion of relevant issues that fall within the focus and scopes of the journal. Articles published in PJD undergo a double-blind peer-review process. All submissions must be written in English, must be original, unpublished, and not under simultaneous consideration elsewhere. The PJD Editorial Board screens submissions for plagiarism using plagiarism detection software. Manuscripts with a plagiarism level exceeding 20% are automatically rejected. The final decision regarding the acceptance of a scientific article rests with the Editorial Board, based on the recommendations of peer reviewers.Prior to submission, all authors must follow the journal template and complete the article and author metadata fully and accurately; otherwise, the article will not be considered for further processing. All submitted manuscripts are checked with Turnitin to prevent unacceptable levels of plagiarism. Reference management should preferably be performed using Mendeley, following the Vancouver superscript style. All keywords must be chosen based on terms included in MeSH. Starting February 2023, the Padjadjaran Journal of Dentistry adopted new templates for different article types: the updated research article template can be downloaded here; templates for systematic reviews can be downloaded here; and the case report template can be downloaded here. All submitted manuscripts undergo an initial editorial assessment, double-blind peer review, and editorial reviews. All editorial practices of the Padjadjaran Journal of Dentistry follow the ICMJE's Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals. The double-blind peer-review process follows the principles of RDDA (Related Discipline, Different Affiliation), under the Reviewer Guidelines of the Padjadjaran Journal of Dentistry. Our policies and publication practices are fully aligned with and strictly follow COPE’s publication ethics standards.
Starting March 2026, Padjadjaran Journal of Dentistry (PJD) has updated its licensing policy. All published articles are now licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0), replacing the previous Creative Commons Attribution 4.0 International License (CC BY 4.0). This license permits others to distribute, remix, adapt, and build upon the material in any medium or format for non-commercial purposes, provided appropriate credit is given to the original author(s).Padjadjaran Journal of Dentistry (PJD) is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. Authors who publish with Padjadjaran Journal of Dentistry agree to the following terms: The journal allows the author(s) to hold the copyright of the article without restrictions. The journal allows the author(s) to retain publishing rights without restrictions. The legal formal aspect of publication accessibility refers to the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0). This license requires that reusers give appropriate credit to the creator. It allows others to distribute, remix, adapt, and build upon the material in any medium or format for non-commercial purposes only, provided proper attribution is given to the original author(s) and the source.
Correlation between age and DMFT score in an urban community: a cross-sectional study
Introduction: Dental caries remains a major public health problem affecting adolescents and adults, particularly in urban populations. The Decayed, Missing, and Filled Teeth (DMFT) index is widely used to assess caries experience. Understanding the correlation between age and DMFT scores is important for developing targeted preventive strategies. This study aimed to analyze the correlation between age and DMFT score among adolescents and adults in an urban community. Methods: This analytic observational study employed a cross-sectional design involving 150 participants aged 15–40 years from Kelurahan Pegirian, Surabaya. Participants were selected using purposive sampling based on predefined eligibility criteria. Dental caries experience was assessed using the DMFT index through clinical examination. Age was analyzed as both a continuous variable and categorized into three groups (15–18, 19–30, and 31–40 years). Statistical analysis included the Spearman rank correlation test and the Kruskal–Wallis test, with a p-value <0.05 considered statistically significant. Results: The overall mean DMFT score was 4.13 ± 3.19. The mean DMFT scores were 5.20 ± 3.90 in the 15–18 years group, 4.90 ± 3.00 in the 19–30 years group, and 2.80 ± 2.60 in the 31–40 years group. A weak negative correlation was observed between age and DMFT scores (r=−0.20, p=0.015). Significant differences in DMFT scores were found between age groups (p=0.021), with lower scores observed in the 31–40 years group compared to the younger age groups. Conclusion: Dental caries experience showed variation across age groups and tended to be higher in adolescents and young adults. The weak negative correlation suggests that factors beyond age may play a more important role in influencing caries experience. Strengthening preventive strategies during early life stages may help reduce the long-term disease burden.
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Biomolecular and bioinformatics characterization of salivary matrix metalloproteinase-9 as oral cancer potential targeted therapy
Introduction: Oral cancer is the 11th most common cancer worldwide. Previous studies have reported that saliva contains biomarkers for oral cancer. MMP-9, found in saliva, is a marker that indicates and facilitates tumor development. However, comprehensive biomolecular and bioinformatics characterization of salivary MMP-9 remains limited. This study aimed to analyze the biomolecular and bioinformatics characteristics of salivary MMP-9 as an oral cancer biomarker and a potential target for therapy because it plays an important role in tumor development and management. Methods: The features of MMP-9 were obtained from the NCBI database (www.ncbi.nlm.nih.gov). Protein analyses were performed using Protparam site, PROTSCALE, TMM application, PEPTIDE CUTTER, NETNGLYC and TARGETTP. The protein model and structure of MMP-9 were evaluated using SWISSMODEL. Results: Based on the study, it showed that MMP-9 is located on 20q13.12. It is involved in extracellular matrix breakdown, and this enzyme degrades type IV and V collagens. Based on the instability index (II), the protein was found to be unstable. The hydrophobicity range of the MMP-9 protein was 0–7654. Among the 20 amino acids analyzed, the hydrophobicity of arginine was -4.500, while isoleucine was 4.500. Transmembrane helix analysis indicated the MMP-9 protein isoform is predominantly located outside of the cell. The predicted N-glycosylation site was at the 28th amino acid. The structural model analysis indicated that the protein model was of good quality. Conclusion: Biomolecular and bioinformatics characterization of salivary MMP-9 demonstrates strong potential as an oral cancer biomarker. The biomolecular and bioinformatics characteristics identified in this study support the potential utility of MMP-9 as an oral cancer biomarker and provide a foundation for future studies investigating its therapeutic relevance.
Mandibular gonial angle characteristics for age and sex estimation: a cross-sectional study
Introduction: The mandibular gonial angle is a craniofacial parameter that reflects anatomical adaptation influenced by growth processes, masticatory function, and sexual dimorphism, making it relevant for age and sex estimation. This parameter has been widely applied in dental and craniofacial studies. However, evidence from community based Indonesian populations remains limited. Population specific data are important for improving the accuracy and applicability of craniofacial indicators. This study aimed to evaluate mandibular gonial angle characteristics for age and sex estimation in Semampir District, Surabaya. Methods: This analytical observational study employed a cross-sectional design involving 100 adults aged 21–50 years from Semampir District, Surabaya, consisting of 50 males and 50 females. Mandibular gonial angle measurements were obtained from digital panoramic radiographs using standardized anatomical landmarks. Bilateral measurements were averaged for analysis. Descriptive statistics were used to summarize gonial angle values, while inferential statistical tests were applied to evaluate differences related to age and sex. Results: Descriptive analysis showed variation in mandibular gonial angle values across different age groups without a consistent age-related pattern. In contrast, a clear difference in mean gonial angle values was observed between the sexes, with female subjects demonstrating higher mean values than male subjects. Statistical analysis showed a statistically significant difference in gonial angle values according to sex (p<0.001), while no statistically significant association was found between age and gonial angle measurements (p>0.05). Conclusion: The mandibular gonial angle demonstrates pronounced sexual dimorphism but limited applicability for adult age estimation in the studied population. These findings suggest that the gonial angle may serve as a supportive craniofacial indicator for sex estimation, while its role in age estimation should be interpreted with caution. Population-specific, community-based data are important for strengthening the forensic and dental applications of craniofacial parameters in Indonesian populations.
Changes of oral health motivation and knowledge following the implementation of the android-based quitee educational application among children aged 8–11 years: a pre-experimental study
Introduction: Motivation and oral health knowledge among elementary school children remain suboptimal. Interactive digital educational applications, such as the Android-Based Quitee Educational Application, have been developed as engaging learning tools for oral health through visuals, animations, and game-based elements that are appropriate for children’s characteristics. This study aimed to evaluate changes in oral health motivation and knowledge following the implementation of the Android-Based Quitee Educational Application among children aged 8–11 years. Methods: This study employed a pre-experimental one-group pretest-posttest time-series design. The sample size was calculated using the Slovin formula, resulting in 126 participants selected through proportionate stratified random sampling from SD Negeri Tamamaung 1 Makassar. Oral health motivation and knowledge were measured before the intervention and at three post-intervention time points following the implementation of the Android-Based Quitee Educational Application. Data were analyzed using the Friedman test, followed by post hoc Wilcoxon signed-rank tests. Results: Oral health motivation and knowledge scores increased across all post-intervention assessments compared with baseline measurements. The median motivation score increased from 14.0 at pretest to 19.0 at the third posttest, whereas the median knowledge score increased from 9.0 to 12.0. All pairwise comparisons were statistically significant (p<0.001), with Wilcoxon effect sizes indicating large effects for motivation (r=0.63–0.87) and moderate-to-large effects for knowledge (r=0.33–0.84), demonstrating the magnitude of the observed improvements. Conclusion: The implementation of the Android-Based Quitee Educational Application was associated with significant improvements in oral health motivation and knowledge among elementary school children. However, the findings should be interpreted cautiously due to the absence of a control group.
Effect of sandblasted large grit acid etching and ultraviolet-c photofunctionalization of titanium on osteoblast cell viability: an in vitro study
Introduction: Sandblasted Large Grit Acid Etching (SLA) is a widely used titanium implant surface modification technique that enhances osseointegration. Ultraviolet C (UV-C) photofunctionalization is a method that modifies the physicochemical properties of titanium surfaces by removing hydrocarbon contaminants and increasing hydrophilicity. However, the combined effects of these modification techniques on MC3T3-E1 osteoblast cell viability require further investigation. Therefore, this study aimed to analyze the effect of SLA treatment and its interaction with UV-C irradiation on MC3T3-E1 osteoblast cell viability on titanium disks. Methods: This in vitro experimental study used titanium disks (10 mm in diameter and 1 mm in thickness), which were divided into SLA-treated and non-SLA groups. Each group was further subdivided according to UV-C irradiation (90 W, 254 nm) into four subgroups: non-UV (control), 10 minutes, 30 minutes, and 48 hours (n = 4 per subgroup). MC3T3-E1 osteoblasts (1.2×104 cells/well) were seeded onto disk surfaces and cultured for 24 hours. Cell viability was assessed using the MTT assay. Data normality was evaluated using the Shapiro-Wilk test, homogeneity using the Brown-Forsythe test, and differences between groups using two-way ANOVA, with statistical significance set at p <0.05. Results: Two-way ANOVA revealed that UV irradiation had no significant effect on cell viability (F=2.388; p=0.093). Similarly, SLA treatment showed no significant effect (F= 1.679; p = 0.207), and no significant interaction was observed between SLA treatment and UV-C irradiation (F=0.041; p=0.988). The highest mean cell viability was observed in the non-SLA group exposed to UV-C irradiation for 10 minutes (88.53 ± 25.22), whereas the lowest mean cell viability was found in the SLA group without UV-C irradiation (45.55 ± 16.29). Conclusion: Neither UV-C irradiation nor SLA treatment significantly affected MC3T3-E1 osteoblast cell viability, and no significant interaction was observed between the two treatments.
Effect of apatite cement on osteoblast cell numbers in alveolar sockets after tooth extraction in rabbits: an experimental study
Introduction: Tooth extraction damages soft and hard tissues, followed by alveolar bone resorption, which can interfere with the healing process and prosthetic rehabilitation. One effort to minimize alveolar bone resorption is the use of graft materials such as apatite cement, which is biocompatible and osteoconductive. This study aimed to analyze the effect of apatite cement on osteoblast cell numbers during alveolar socket healing following tooth extraction in rabbits. Methods: This study used a true experimental design with a post-test-only control group design. The study objects were biological materials placed in the alveolar sockets of New Zealand White rabbits, which were divided into a control group, a tooth extraction group without apatite cement administration, and a tooth extraction group with apatite cement administration. Histological observations were conducted on days 3, 7, and 14, representing the inflammatory, proliferative, and early remodeling phases of rabbit socket healing, respectively. The data were analyzed statistically using normality and homogeneity tests, followed by the one-way ANOVA statistical test. Results: The mean osteoblast cell counts in the apatite cement group were significantly higher than those in the control group on days 3, 7, and 14. The highest osteoblast count was observed on day 14, with mean values of 28.93 ± 3.57 cells/field in the apatite cement group compared with 0.80 ± 0.35 cells/field in the control group (p < 0.05). One-way ANOVA demonstrated significant differences among the experimental groups. Conclusion: Apatite cement administration increased osteoblast cell numbers in the alveolar socket after tooth extraction in rabbits, suggesting its potential to promote early osteogenic activity during the initial stages of socket healing.
The association between maternal knowledge, stunting severity, and dental caries among stunted children: a cross-sectional study
Introduction: Stunting remains a significant public health problem in Indonesia, including in Banyuasin Regency, South Sumatra, where the prevalence is 24.8%, exceeding the national average. Maternal knowledge may influence children's dietary practices, oral hygiene, and preventive care, thereby affecting the risk of dental caries. Stunting may also impair oral development and increase the risk of dental caries in children. This study aimed to analyze the association between maternal knowledge, stunting severity, and dental caries among stunted children Methods: This observational analytical study used a cross-sectional design. A total of 65 stunted toddlers were included using total sampling at Mariana Community Health Center, South Sumatra, between August and December 2025. Data were obtained from community health center records, and maternal knowledge regarding stunting was assessed using a questionnaire. Dental caries was measured using the def-t index. The associations between maternal knowledge regarding stunting, stunting severity and dental caries was analyzed using the Chi-square test. Results: Among the stunted children, 60.0% (n=39) were moderately stunted and 40.0% (n=26) were severely stunted. Most mothers had poor knowledge regarding stunting, with 58 respondents (89.23%) categorized as having poor knowledge (score <55). No significant association was found between maternal knowledge and stunting severity (p=0.073), while stunting severity was significantly associated with dental caries (p = 0.037). Conclusion: Maternal knowledge was not associated with stunting severity, whereas stunting severity was significantly associated with dental caries. Oral health assessment may be considered as a component of the comprehensive management of children with stunting.
Patient perceptions of the professionalism of dental co-assistants and dental residents at a university dental hospital: a cross-sectional study
Introduction: Professionalism in dentistry, encompassing clinical competence, communication, and ethical practice, critically influences patient satisfaction and quality of care. Despite its importance, patient perceptions of dental students’ professionalism remain understudied in Indonesian teaching hospitals. This research aims to assess patient perceptions of the professionalism of dental co-assistants and dental residents at a university dental hospital. Methods: This cross-sectional study administered questionnaires via Google Forms to 226 patients, including patients treated by co-assistants and residents. The questionnaire consisted of four indicators of professionalism in dentistry, namely excellence, humanism, accountability, and altruism; each indicator comprised five questions assessed using a Likert scale. The results were analyzed using univariate analysis. Results: A total of 226 patients participated in this study, including patients treated by co-assistants (n=111) and residents (n=115). Most participants were adults and predominantly female, with the majority having an undergraduate education. Patients received various dental treatments across multiple polyclinics, and most had visited the dental clinic three times or more. Patient perceptions of the professionalism of co-assistants were categorized as good (100%). Meanwhile, patient perceptions of the professionalism of residents showed an average of 1.7% in the deficient category, 1.55% in the sufficient category, and 96.75% in the good category. Conclusion: Patient perceptions of the professionalism of dental co-assistants and dental residents at the university dental hospital showed generally good scores. However, some aspects of the professionalism indicators require attention for further improvement.
Antimicrobial activity of hydroxyapatite toothpaste against staphylococcus aureus and candida albicans: an experimental study
Introduction: Hydroxyapatite is widely used in toothpaste formulations because of its biocompatibility and its role in supporting enamel remineralization; however, its direct antimicrobial activity against oral microorganisms remains unclear. This study aimed to analyze the antimicrobial activity of hydroxyapatite toothpaste against Staphylococcus aureus and Candida albicans. Methods: An in vitro experimental study was conducted using the well diffusion method. The tested materials included hydroxyapatite toothpaste at concentrations of 1%, 3%, and 5%, sterile distilled water as a negative control, commercial toothpaste as a positive control, and chloramphenicol 100 ppm and nystatin 5,000 mg/L as comparator controls for S. aureus and C. albicans, respectively. Inhibition zones were measured after incubation for 24 hours at 37 °C. Results: Hydroxyapatite toothpaste at all tested concentrations did not produce inhibition zones against either Staphylococcus aureus or Candida albicans, whereas the comparator controls demonstrated clear inhibitory effects. Statistical analysis using the Kruskal-Wallis test revealed significant differences among treatment groups for Staphylocossus aureus (p = 0.0005) and Candida albicans (p = 0.028). Conclusion: Hydroxyapatite toothpaste did not demonstrate direct antimicrobial activity against Staphylococcus aureus and Candida albicans when assessed using the well diffusion method. These findings indicate that hydroxyapatite is not optimal as a sole antimicrobial agent and should be combined with other active ingredients to enhance antimicrobial effectiveness
Differences in the mechanical performance of type II glass ionomer cement modified with hydroxyapatite in terms of diametral tensile strength and compressive strength: an experimental study
Introduction: Glass ionomer cement (GIC) is widely used because of its chemical adhesion to tooth structure, fluoride release, and biocompatibility. However, its low tensile strength and brittleness limit its application in stress-bearing restorations. Hydroxyapatite (HA) has been investigated as a bioactive filler to improve the mechanical properties of GIC. This study aimed to analyze the differences in the mechanical performance (diametral tensile strength and compressive strength) of Type II GIC modified with hydroxyapatite. Methods: The materials used in this research were Type II GIC (Fuji IX) and pure hydroxyapatite (Sigma Aldrich's). Twenty-eight specimens were allocated into four groups for the diametral tensile strength (DTS) test, and another twenty-eight specimens for the compressive strength (CS) test (n= 7 per group): a control group (K, conventional GIC without modification) and three treatment groups modified with 1% (P1), 3% (P2), and 5% (P3) of hydroxyapatite powder. Mechanical evaluation was performed using a Universal Testing Machine (UTM) at a crosshead speed of 0.5 mm/min. Statistical analysis comprised tests of data normality and variance homogeneity, followed by one-way analysis of variance (ANOVA) and the Least Significant Difference (LSD) post hoc test (p=0.05). Results: The addition of HA altered mechanical performance in a highly concentration-dependent and stress-specific manner. The highest DTS was observed in Group P1, with a value of 9.5300 ± 4.0896 MPa, which was significantly higher than those of the control and all other groups (p<0.05). Conversely, CS was highest in Group P2 (66.7114 ± 11.8779 MPa), which was significantly higher than that of the control group (43.3614 ± 10.6778 MPa, p=0.002). Higher mass loading in Group P3 resulted in a pronounced decline in both tensile and compressive performance. Conclusion: There are differences in the mechanical performance (diametral tensile strength and compressive strength) of Type II glass ionomer cement (GIC) modified with hydroxyapatite. Hydroxyapatite integration enhances the mechanical properties of Type II GIC, with 1% HA improving DTS and 3% HA producing the highest CS.
Influence of determinant factors on Jambi medical students’ awareness of seeking oral health information on social media: a cross-sectional study
Introduction: Social media has become an effective and easily accessible means of acquiring oral health literacy in the digital era 5.0. Therefore, this study aimed to analyze the influence of determinant factors affecting Jambi medical students’ awareness of seeking oral health information on social media. Method: This analytical cross-sectional study analyzed the association between determinant factors affecting Jambi medical students' awareness of seeking oral health literacy on social media. A total of 292 participants were selected using purposive sampling. The instrument was divided into five sections. The second and fifth sections were measured using a Likert scale and analyzed using multiple linear regression. Results: The higher the frequency of seeking oral and dental health information through social media, the greater the awareness of seeking oral health information on social media (regression coefficient=0.581; t=10.248; p<0.001). A higher level of trust was also associated with greater awareness of seeking oral and dental health information on social media (regression coefficient=0.431; t=10.314; p<0.001). Respondents with good oral and dental health maintenance behavior were more likely to be positively influenced by oral and dental health information and content on social media (regression coefficient=0.344; t=8.255; p<0.001). Conclusion: Social media plays an important role in shaping individual awareness, particularly when users have high levels of trust and actively seek relevant oral and dental health information. Trust was identified as a key determinant in influencing awareness of oral health literacy on social media.
Effectiveness of an augmented reality-based HI Bogi application in improving toothbrushing skills among elementary school children: a quasi-experimental study
Introduction: Oral health is an essential component of overall quality of life; however, the prevalence of dental caries in Indonesia remains high, particularly among elementary school children, partly due to inadequate toothbrushing skills. Various digital educational innovations, including mobile health applications and augmented reality (AR)-based interventions, have demonstrated positive effects on oral health education and behavioral change. Nevertheless, evidence regarding the effectiveness of the HI Bogi AR-based application, especially in improving children’s toothbrushing skills, remains limited. Therefore, this study aimed to analyze the effectiveness of the augmented reality-based HI Bogi application in improving toothbrushing skills among elementary school children using a quasi-experimental design. Methods: This study employed a quasi-experimental design with a one-group pre- and post-test design. A total of 170 elementary school students aged 9–12 years from Cimahi City were recruited using simple random sampling. The intervention involved the use of the HI Bogi AR-based application for 21 days. The research instrument was an observational questionnaire comprising 13 indicators of toothbrushing skills. Data were analyzed using a paired t-test for normally distributed data and the Wilcoxon signed-rank test for non-normal data. Results: Toothbrushing skills improved significantly following the intervention (Wilcoxon signed-rank test: Z = −15.192, p < 0.001). The mean toothbrushing skill score increased from 4.40 ± 3.77 at baseline to 12.62 ± 0.71 after the intervention, representing an average improvement of 8.22 points. These findings indicate that the HI Bogi AR application substantially improved children’s toothbrushing skills. Conclusion: The HI Bogi application integrated with augmented reality (AR) proved effective in improving proper toothbrushing skills among children aged 9–12 years in Cimahi City. This innovation has the potential to serve as an alternative, promotive, and preventive oral health education tool to support school-based oral health programs.
Correlation between the number of teeth in older adults and nutritional status and cognitive function: a cross-sectional study
Introduction: Aging is associated with various changes in body tissues and organs, including the oral cavity, among older adults. A common oral problem among older adults is tooth loss. The number of teeth in older adults is related to nutritional status and cognitive function. Previous studies examining the relationship between the number of remaining teeth, nutritional status, and cognitive function among older adults have reported mixed findings. While some studies have identified an association among these variables, others have reported different results. These inconsistencies indicate that the relationship among these variables warrants further investigation. In this study, oral health was assessed based on the number of remaining teeth, while cognitive function was evaluated using the Mini-Cog and Clock Drawing Test. Therefore, this study aimed to analyze the correlation between oral health, nutritional status, and cognitive function among older adults. Methods: This analytical observational study employed a cross-sectional design and included 110 older adults aged ≥ 60 years with varying numbers of remaining teeth. Participants were selected using purposive sampling according to predefined inclusion and exclusion criteria. Participants underwent an intraoral examination to determine the number of remaining teeth. Nutritional status was assessed using the Mini Nutritional Assessment (MNA) Long Form and classified as good nutritional status, at risk of malnutrition, or malnourished. Cognitive function was assessed using the Mini-Cog and Clock Drawing Test and classified as normal cognitive function or cognitive impairment. Spearman's correlation test was used to analyze the correlation between the number of remaining teeth among older adults and nutritional status and cognitive function. Results: Among older adults with ≥ 20 remaining teeth, most had good nutritional status and normal cognitive function. The number of remaining teeth was significantly and positively correlated with nutritional status (Spearman’s ρ = 0.327, p < 0.001). A significant positive correlation was also observed between the number of remaining teeth and cognitive function (Spearman’s ρ = 0.534, p < 0.001). Conclusions: The number of remaining teeth was correlated with nutritional status and cognitive function among older adults.
Effect of Averrhoa bilimbi L. extract gel as a natural enamel etching agent on the tensile bond strength of composite resin: an in vitro study
Introduction: Composite resin is a restorative material that bonds to tooth structure through micromechanical interlocking. Etching removes the smear layer and creates microporosities, enhancing mechanical retention. Although 37% phosphoric acid is the gold standard, it may cause inflammatory cell infiltration. Averrhoa bilimbi L. contains citric, oxalic, and lactic acids, which may serve as a natural alternative etching agent for enamel. This study aimed to analyze the effect of Averrhoa bilimbi L. extract gel as a natural enamel etching agent on the tensile bond strength of composite resin restorations. Methods: This was an in vitro laboratory true experimental study that employed a post-test-only control group design. Twenty-eight extracted human premolars were divided into four groups (n = 7): three experimental groups etched with 2.5%, 5%, and 7.5% Averrhoa bilimbi L. extract gel, and one control group etched with 37% phosphoric acid. After etching, bonding agent and microhybrid composite resin were applied. Tensile bond strength was tested using a Universal Testing Machine, and data were analyzed using the Shapiro–Wilk, Levene’s, and Kruskal–Wallis tests. Results: The highest mean tensile bond strength was observed in the 37% phosphoric acid group (7.56 ± 3.87 MPa), followed by 7.5% (6.71 ± 1.71 MPa), 5% (6.17 ± 1.39 MPa), and 2.5% (6.04 ± 3.01 MPa) Averrhoa bilimbi L. extract groups. The Kruskal-Wallis test showed p=0.874, indicating no statistically significant difference between the groups. Conclusion: Averrhoa bilimbi L. extract gel demonstrated a tensile bond strength comparable to that of 37% phosphoric acid. The extract gel demonstrated promising potential as a natural etching agent; however, further laboratory and clinical studies are required before it can be recommended for clinical application.
Oral health knowledge and associated factors among office workers who use electronic cigarettes: a cross-sectional study
Introduction: The prevalence of electronic cigarette use is increasing; however, public understanding of their ingredients and associated health risks remains inconsistent. Persistent misconceptions contribute to inaccurate perceptions of product safety, especially regarding oral health. This study aimed to analyze oral health knowledge and associated factors among office workers who use electronic cigarettes. Methods: An analytical cross-sectional study was conducted among 100 office workers who used electronic cigarettes at a state-owned enterprise in Jakarta, Indonesia, between September and October 2025. Participants were recruited using purposive sampling. Data were collected using a structured questionnaire assessing respondents’ demographic characteristics and knowledge of electronic cigarette contents and their oral health effects. Data were analyzed using descriptive statistics, cross-tabulation, and the chi-square test. Results: Overall, 58% of respondents demonstrated good knowledge of oral health, whereas 42% had poor knowledge. High levels of awareness were observed regarding nicotine content (86%) and the addictive potential of electronic cigarettes (65%), while misconceptions persisted regarding carbon monoxide, tooth discoloration, and halitosis. Knowledge level was significantly associated with gender, with female respondents demonstrating higher knowledge than male respondents (p=0.014). No significant associations were observed between knowledge level and education level, smoking status, motivation for electronic cigarette use, or duration of use (all p>0.05). Conclusion: Although most electronic cigarette users demonstrated good overall oral health knowledge, important misconceptions remained regarding carbon monoxide production, tooth discoloration, and halitosis. These findings highlight the need for targeted oral health education focusing on specific misconceptions related to the oral health effects of electronic cigarettes.
The association between frequency of consumption of gluten-containing foods and caries index in children with ADHD: A cross-sectional study
Introduction: Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity, which may influence dietary behaviors and oral health, particularly the risk of dental caries. Gluten-containing foods are commonly consumed by children and may contribute to cariogenic exposure, especially in children with ADHD who tend to have irregular eating habits and may have poorer oral hygiene, including less frequent toothbrushing. In addition, stimulant medications commonly prescribed for ADHD may reduce salivary flow and potentially affect salivary buffering capacity. This study aimed to assess the association between the frequency of consumption of gluten-containing foods and caries index in children with ADHD. Methods: A cross-sectional study involving 34 children aged 6–12 years diagnosed with ADHD was conducted in special needs schools in Surabaya. The frequency of consumption of gluten-containing foods was assessed using a semi-quantitative Food Frequency Questionnaire, while dental caries was assessed using the DMF-T index based on WHO criteria. Data analysis was performed using Spearman’s rank correlation test to determine the association between the frequency of consumption of gluten-containing foods and caries index. Results: The majority of children demonstrated a moderate level of consumption of gluten-containing foods and a moderate to high caries index. Statistical analysis revealed a strong and significant positive correlation between the frequency of consumption of gluten-containing foods and caries index (r = 0.989; p < 0.05), indicating that more frequent consumption of gluten-containing foods was associated with higher dental caries index in children with ADHD. Conclusion: This study showed a significant association between the frequency of consumption of gluten-containing foods and caries index in children with ADHD, suggesting that dietary habits may contribute dental caries. These findings support the importance of integrating dietary management and oral hygiene education into preventive strategies for children with ADHD.
A clinical innovation in complete denture fabrication using a modified impression technique for a flat ridge with flabby tissue: A case report
Background: Alveolar ridge resorption is a common complication in edentulous patients, often resulting in flat ridges with flabby tissue, especially in long-term denture wearers. These soft tissues are mobile and easily displaced, compromising denture retention, stability, and support. Conventional impression techniques may lead to distorted impressions and ill-fitting dentures. This case report aims to demonstrate the effectiveness of a modified impression technique combining selective pressure and closed-mouth approaches to manage flat ridges with flabby tissue. Case Report: A 59-year-old male presented with difficulty chewing due to ill-fitting complete dentures. Clinical examination revealed completely edentulous arches with flat ridges and flabby tissue in the anterior regions of both jaws. A modified selective pressure technique was employed. For the maxilla, a custom tray with a window was used to record the flabby area using light-body polyvinyl siloxane (PVS), while medium-body PVS was applied to the stress-bearing areas. For the mandible, a closed-mouth technique was used during the preliminary impression to accurately record the retromolar pad and retromylohyoid area. A double-spacer tray with escape holes was then used during the final impression with light-body PVS to minimize tissue displacement. Conclusion: The modified selective pressure and closed-mouth techniques may effectively minimize soft-tissue distortion in flat ridges with flabby tissue. Proper tray design and material selection may enhance denture retention and stability, while accurate recording of mandibular extension, especially the retromylohyoid area, may further improve the performance of mandibular denture.
Managing trauma-induced multiple gingival recessions associated with canine malposition using a modified tunneling technique and subepithelial connective tissue graft: A case report
Introduction: Managing multiple gingival recessions in the aesthetic zone presents a clinical challenge, particularly in cases involving tooth malposition, extrusion, and irregular bone loss resulting from trauma. These factors complicate treatment selection. The Laterally Closed Tunnel (LCT) and Modified Coronally Advanced Tunnel (MCAT), both modified tunneling techniques, offer several advantages when combined with a Subepithelial Connective Tissue Graft (SCTG), including enhanced blood supply, improved graft nutrition, and reduced postoperative morbidity due to minimal vertical incisions and limited flap extension. This case report aims to demonstrate the effectiveness of this combined technique in treating multiple gingival recessions. Case report: A 20-year-old male patient presented with hypersensitivity and aesthetic concerns following accidental trauma. Clinical examination revealed Miller Class III/RT2 Cairo gingival recession on the buccal aspect of left maxillary canine and Miller Class I/RT1 Cairo gingival recession on the left maxillary first premolar, associated with canine malposition and extrusion, a recession depth of up to 7 mm, and inadequate keratinized tissue. The patient was treated using a combination of LCT and MCAT with SCTG. At the 3-month follow-up, substantial root coverage, increased soft tissue thickness, and improved gingival aesthetics were achieved, along with resolution of dentine hypersensitivity. Conclusion: The combination of LCT, MCAT, and SCTG techniques appears to be an effective treatment option for managing complex trauma-induced multiple gingival recessions associated with tooth malposition, providing favourable root coverage and improved soft tissue aesthetics.
The role and effectiveness of mobile health apps in oral health promotion programs: A rapid review
Introduction: Oral diseases remain a major public health challenge worldwide despite ongoing preventive efforts, with dental caries and poor oral hygiene continuing to affect a large proportion of the population. Mobile health (mHealth) applications have emerged as a promising approach to oral health promotion by delivering accessible, interactive, and user-centered educational interventions that incorporate behavior change techniques to support sustained oral hygiene practices. This study aims to determine the role and effectiveness of mobile health apps in oral health promotion programs. Methods: This study employed a rapid review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles were searched in PubMed, Scopus, ScienceDirect, and Google Scholar for studies published between 2020 and 2025 using Boolean operators. Articles were screened according to predefined inclusion and exclusion criteria, and study quality was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for randomized controlled trials (RCTs). Results: A total of nine RCTs met the eligibility criteria. All included studies reported that mHealth apps functioned as interactive educational media used by children, adolescents, and parents. Applications incorporating behavior change techniques through interactive features demonstrated positive effects on users' oral health behavior compared with conventional methods. Conclusion: Mobile health apps are effective adjunctive tools for oral health promotion by enhancing oral health knowledge, supporting positive oral hygiene behaviors, and improving short-term clinical outcomes. Their effectiveness appears to be enhanced by integrating interactive behavior change features that encourage sustained user engagement.
Theoretical frameworks for explaining dental health service utilization: A scoping review
Introduction: Oral diseases remain a major global public health challenge, contributing to disability, reduced quality of life, and increased healthcare costs. Although regular dental attendance improves oral health outcomes, the utilization of dental health services remains unequal across population due to complex individual, social, structural, and policy-related factors. Theoretical models are essential for understanding these determinants and informing interventions to improve access and equity, yet a comprehensive synthesis of these models is lacking. This scoping review aimed to identify, map, and synthesize theoretical models used to explain dental health service utilization. Methods: A scoping review was conducted in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Eight electronic databases (PubMed, Scopus, ProQuest, Cochrane Library, ScienceDirect, SpringerLink, JSTOR, and Emerald Insight) were searched, supplemented by manual screening of reference lists. English-language publications from 1960 to 2025 that proposed, adapted, or conceptualized theoretical models of dental health service utilization were included. Study selection, duplicate removal, and screening were performed using Rayyan.ai, followed by a narrative synthesis of study characteristics, theoretical foundations, and model components. Results: Of the 1,037 records identified, 25 studies met the inclusion criteria. Most were published after 2000 and originated from high-income countries, particularly Europe and the United States, with limited evidence from middle-income settings. Models were applied across diverse populations, including children, adults, older adults, women, migrants, rural communities, and other vulnerable groups. Most were adaptations of established health service utilization frameworks, while fewer proposed novel or context-specific models. Determinants were consistently grouped into five domains: individual characteristics, enabling and structural factors, need-related factors, psychosocial influences, and broader contextual and policy determinants. Conclusion: This review provides the a comprehensive synthesis of theoretical models explaining dental health service utilization. The findings offer a conceptual foundation for future research and support evidence-informed policies and interventions to improve equitable access to dental health services.