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   Table of Contents - Current issue
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September-December 2020
Volume 4 | Issue 3
Page Nos. 73-147

Online since Saturday, October 17, 2020

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REVIEW ARTICLE  

The Pathogenicity of Actinomyces naeslundii is associated with polymicrobial interactions: A systematic review p. 73
Nurul Alia Risma Rismayuddin, Wan Nur Fatihah Wan Mohd Kamaluddin, Mohd Hafiz Arzmi, Ahmad Faisal Ismail, Edre Mohammad Aidid, Noratikah Othman
DOI:10.4103/SDJ.SDJ_31_20  
The aim of this systematic review was to demonstrate how the oral pathogenicity of Actinomyces naeslundii is associated with its interactions with other microbes in the oral microbiome. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA-P) 2015 protocol was used for this review. Articles published between January 2010 and February 2020 were searched in the PubMed, Web of Science, Science Direct, and Scopus databases. Articles included in the final analysis mainly discuss the symbiotic relationship of A. naeslundii with other oral microbes. The findings show that A. naeslundii is not directly involved in oral pathogenesis; instead, initial tooth surface colonization is promoted by polymicrobial interactions in the oral microbiome in which A. naeslundii participates.
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ORIGINAL ARTICLES Top

Clinical evaluation of mineral trioxide aggregate in the surgical management of degree I and degree II furcation defects p. 79
Rajneesh Parimoo, Baljeet Singh, Rajesh Gupta
DOI:10.4103/SDJ.SDJ_22_20  
Background: Mineral trioxide aggregate (MTA) is known as a strong bioactive material which induces hard tissue formation. It does not get contaminated with tissue fluids or blood and has low cytotoxicity with good antibacterial effects. Objectives: This study aims to evaluate the clinical effectiveness of MTA in the surgical management of Degree I and Degree II furcation defects. Methods: Individuals were 15 patients exhibiting clinical and radiographic evidence of Degree I and Degree II furcation defects. The pocket probing depth, plaque index, gingival index, relative vertical clinical attachment level, relative horizontal clinical attachment level, and gingival recession level of subjects were recorded at baseline, 3 months, and 6 months. Data were analyzed at a significance level of P < 0.05 using paired t-test. Results: The purpose of this study was to maintain furcation involved teeth with the use of MTA. Regeneration of periodontal attachment apparatus by MTA was not the goal of the treatment technique used in this study. However, MTA application results improvement in the recorded clinical parameters. Conclusion: MTA is effective in obliterating the Degree I and Degree II furcation defects. There are no signs and symptoms of any adverse effect to this treatment.
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The effect difference of chitosan nanoparticles, chitosan microparticles, and casein phosphopeptide–amorphous calcium phosphate in reducing enamel demineralization p. 84
Mohammad Chair Effendi, Delvi Fitriani, Mutiara Fauzia Nurmawlidina
DOI:10.4103/SDJ.SDJ_41_20  
Background: Chitosan has been shown to inhibit free radicals that cause tooth enamel demineralization. Nano-sized chitosan can penetrate cell membranes that larger particles cannot penetrate. Objective: This study aimed to determine the difference between chitosan nanoparticles, chitosan microparticles, and casein phosphopeptide–amorphous calcium phosphate (CPP-ACP) in preventing tooth enamel demineralization. Methods: We used 0.2% chitosan nanoparticles. A total of 50 mL of chitosan solution was stirred and added in tripolyphosphate to prepare a nanoparticle suspension. It was then stirred for 1 h to generate crosslinking. The nanoparticles' size was 57.6 nm. The demineralization solution consisted of 2.2 mM/L CaCl2, 2.2 mM/L KH2PO4, and 50 mM of acetate buffer. Its acidity was regulated to a pH of 4.06. The sample consisted of 27 maxillary first premolar teeth post extraction due to orthodontic treatment needs divided into three groups: a chitosan microparticle treatment group, a chitosan nanoparticle treatment group, and a CPP-ACP treatment group used as a positive control. A scanning electron microscope with ×5000 magnification was used to observe the enamel surface morphology and mineral release. Results: The mean value of enamel surface microhardness in the chitosan nanoparticle group (233.39 HV) was significantly greater than those in the chitosan microparticle (153.192 HV) and CPP-ACP groups (152.626 HV) (P < 0.05). Moreover, the chitosan nanoparticle treatment resulted in the lowest enamel porosity. Conclusions: Chitosan nanoparticles are more effective than chitosan microparticles and CPP-APP in preventing enamel demineralization.
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The effect of tea tree oil in inhibiting the adhesion of pathogenic periodontal biofilms in vitro p. 88
Abdul Gani Soulissa, Jeni Afifah, Herryawan, Armelia Sari Widyarman
DOI:10.4103/SDJ.SDJ_33_20  
Background: Tea tree (Melaleuca alternifolia) oil (TTO) is known to have anti-inflammatory, antibacterial, antifungal, and antiviral properties. Objectives: The aim of this study was to determine the effects of TTO on the ability of Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans biofilms to adhere to enamel surfaces in vitro. Methods: P. gingivalis and A. actinomycetemcomitans were cultured in brain heart infusion (BHI) broth at 37°C for 24 h in anaerobic conditions. Eighteen premolar teeth were inoculated and incubated for 48 h to form biofilms on enamel surfaces. Subsequently, TTO in 6.25%, 12.5%, 25%, and 50% concentrations was added and incubated for 1 and 3 h. Chlorhexidine (0.2%) and BHI broth were used as positive and negative controls, respectively. The remaining biofilm colonies were counted using an enzyme-linked immunosorbent assay reader (490 nm). The teeth were placed in microtubes containing phosphate-buffered saline and vortexed for 20 s. Subsequently, biofilms were cultured in BHI agar for 24 h. The colonies in each concentration were estimated as colony-forming units per milliliter. Statistical analysis was performed using one-way analysis of variance. The level of statistical significance was set to P < 0.05. Results: Treatment with all concentrations of TTO significantly reduces biofilm adhesion compared to the negative control after both incubation periods (P < 0.05). The concentration that most effectively inhibited the adhesion of P. gingivalis was 12.5% after 1 h incubation. The concentration that most effectively inhibited the adhesion of A. actinomycetemcomitans was 25% after 1 h incubation. Conclusion: TTO inhibits the adhesion of P. gingivalis and A. actinomycetemcomitans biofilms to enamel surfaces and may be useful as a treatment for oral diseases. Further studies should examine its efficacy in vivo.
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Patient satisfaction towards composite and amalgam restorations in IIUM dental polyclinic p. 93
Anisa Kusumawardani, Susi Sukmasari, Norhazayti Ab Halim, Raja Hazwani Binti Raja Nhari, Siti Aisah Binti Abdul Habi
DOI:10.4103/SDJ.SDJ_37_20  
Background: Dentistry continues to evolve with the development of restorative materials. Patient satisfaction is an increasingly significant issue in dental practice; therefore, knowledge of the level of patient satisfaction with restorative materials is important. Objectives: The objective was to assess patient satisfaction with composite and amalgam restorations carried out by International Islamic University Malaysia (IIUM) dental students and the criteria that influence satisfaction. Methods: This cross-sectional study involved 42 patients treated by year 4 and 5 dental students of the Kulliyyah of Dentistry, IIUM. Sampling was conducted using a single proportion formula, and patients were reviewed 2 weeks following placement of amalgam and composite restorations. Satisfaction was assessed using a self-administered five-point Likert scale questionnaire previously validated by a pilot study involving ten patients. Data were analyzed using independent sample t-tests and the Chi-square tests. Results: Patients were more satisfied with composite restorations than with amalgam restorations in terms of color and esthetics (P < 0.001). Other criteria, such as operator skills, treatment procedures, and external factors, had no significant effect on patient satisfaction with the restoration (P > 0.05). Overall, patient satisfaction with amalgam (81.0%) and composite restoration (88.1%) did not differ when restorations were placed by IIUM dental students. Conclusion: Most patients were satisfied with the amalgam and composite restorations placed by IIUM dental students. The color and esthetic value were the major criteria affecting patient satisfaction. Treatment procedures, operator skills, and external factors did not significantly influence patient satisfaction. Hence, in terms of satisfaction, amalgam remains a reliable material for use in restorative dentistry.
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The effect of nanofilled resin coating on the hardness of glass ionomer cement p. 97
Michael William Handoko, Rosalina Tjandrawinata, Octarina
DOI:10.4103/SDJ.SDJ_5_20  
Background: Glass ionomer cement (GIC), a dental material that is constantly being developed and improved, is a biocompatible restorative material with physical, mechanical, and chemical properties that resemble teeth. This material is often used in dentistry because it can release fluoride. However, it has low wear resistance and is very sensitive to moisture, which can reduce the hardness. Objectives: The aim of this research is to evaluate the influence of applying nano-filled resin coatings on GIC to increase the hardness, especially after 24 h. Methods: This research is a pre-posttest laboratory experiment with a control group design. In this study, GIC Type II (EQUIA Forte® Fil, GC, Japan) was mechanically manipulated and inserted into molds to produce twenty samples of 6.0 ± 0.3 mm in diameter and 3.0 ± 0.2 mm in height. The GIC samples were divided into two groups: ten samples that were not coated with nano-filled resin formed the control group, while the other ten samples that were coated with nano-filled resin (EQUIA Forte Coat, GC, Japan) were the treatment group. The GIC samples were tested immediately using the Vickers hardness (VHN) test and then immersed in sterile distilled water in a 37°C incubator. After 24 h, the GIC samples were tested for their final hardness value. Results: The group that received the coating had a greater hardness value (131.14 ± 36.15 VHN) that was statistically significantly higher (t-test, P < 0.05) than that of the group with no coating (13.56 ± 4.28 VHN). Conclusion: Nano-filled resin coating applications on GIC significantly increase the hardness after 24 h.
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Effectiveness of brewed green tea and mouthwash containing green tea extract against Streptococcus mutans and Porphyromonas gingivalis in Saliva p. 101
Mita Juliawati, Marta Juslily, Abdul Gani Soulissa, Armelia Sari Widyarman, Elly Munadziroh
DOI:10.4103/SDJ.SDJ_39_20  
Background: Green tea is known to exert an antibacterial effect against cariogenic pathogens. Objectives: This study aimed to determine the effect of brewed green tea as mouth rinse against Streptococcus mutans and Porphyromonas gingivalis in saliva and compare it to the effect of a commercial mouthwash containing green tea extract. Methods: Saliva of 30 healthy individuals aged 19–40 years was collected before treatment, 1 min after gargling, and 1 week after daily treatment with brewed green tea as a mouth rinse or commercial mouthwash containing green tea. Bacterial DNA was extracted from salivary samples and evaluated using quantitative polymerase chain reaction. The total number of DNA targets was analyzed using SYBR Green and 16S ribosomal RNA gene-specific primers for S. mutans and P. gingivalis. The data were statistically analyzed using a paired t-test. The level of significance was set to P < 0.05. Results: Green tea mouth rinse and mouthwash containing green tea extract significantly reduced the number of S. mutans and P. gingivalis in the participants' saliva after 1 week of use (P < 0.05). There was no significant difference between the effects of brewed green tea mouth rinse and commercial mouthwash containing green tea. Conclusion: The use of mouthwash containing green tea and brewed green tea mouth rinse reduces the number of S. mutans and P. gingivalis in saliva. Brewed green tea can be used as a mouth rinse with effects comparable to those of commercial mouthwash containing green tea. Further studies are warranted to explore its effects on other oral pathogens.
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Eugenia polyantha (Wight) infusion against oral microorganisms on toothbrushes p. 105
Neneng Nurjanah, Eliza Herijulianti, Megananda Hiranya Putri, Susi Sukmasari
DOI:10.4103/SDJ.SDJ_38_20  
Background: Toothbrushes could get contaminated with pathogenic bacteria from inside or outside the oral cavity. Eugenia polyantha (Wight) has been reported to exhibit antibacterial activity. Objectives: The objective was to assess the potential of E. polyantha infusion to inhibit the growth of oral microorganisms on used toothbrushes. Materials and Methods: Fresh E. polyantha leaves were washed, drained, sliced, boiled in distilled water, and filtered. The filtrate was diluted to 60%, 70%, 80%, 90%, and 100% concentrations with distilled water. Each participant (n = 4) brushed their teeth properly under supervision. The bacterial solution from the used toothbrushes was inoculated into tryptic soy broth (TSB) and incubated. Following this, the bacterial suspension in TSB was evenly inoculated on Muller–Hinton agar plates and incubated. Both the incubations were stored at 37°C for 24 h under aerobic conditions. The diameter of the inhibition zone around the disc containing E. polyantha was measured. Results: The mean diameters of the inhibition zones at 0%, 60%, 70%, 80%, 90%, and 100% concentrations of E. polyantha infusion were 6.10, 13.85, 14.47, 14.61, 15.18, and 15.57 mm, respectively. The inhibition zone at an E. polyantha concentration of 0% statistically significantly differed from those concentrations of 60%, 70%, 80%, 90%, and 100% (P < 0.05 for all). There was no significant difference of measurement growth zone among the different concentrations; there was no inhibition in the control plate. Conclusion: Our results revealed that E. polyantha infusion has the potential to inhibit the growth of oral microorganisms on used toothbrushes; however, this effect is not concentration dependent.
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Tensile strength differences between nickel-titanium and titanium molybdenum alloy orthodontic archwire after immersion in detergent toothpaste p. 110
Hilda Fitria Lubis, Calvint
DOI:10.4103/SDJ.SDJ_29_20  
Background: Titanium-based alloys, such as nickel-titanium (NiTi) and titanium molybdenum alloy (TMA), have gained immense popularity in the last decades. Some toothpaste ingredients can negatively affect orthodontic procedures. Objective: The objective of this study was to examine the differences in tensile strength between NiTi and TMA orthodontic wires after immersion in detergent toothpaste. Methods: Six treatment groups were established, with NiTi and TMA wires immersed in 25 g detergent toothpaste for 4, 8, and 12 h. Tensile strength measurements were carried out using a Tensilon RTF-1350 universal testing machine. Results: The P values of the NiTi and TMA wires were as follows: 0.000 after 4 h, 0.000 after 8 h, and 0.002 after 12 h. These results showed that there were significant differences between the tensile strength of NiTi and TMA orthodontic wires after immersion in detergent toothpaste for increasing periods of time. Conclusion: The tensile strength of NiTi wire was greater than the tensile strength of TMA archwire. However, detergent toothpaste did not have a significant effect on change in tensile strength of NiTi and TMA wire.
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Differences in apical vapor lock formation after sodium hypochlorite irrigation with and without surfactant using two needle types p. 115
Delly, Wiena Widyastuti, Aryadi, Adi Hidayat
DOI:10.4103/SDJ.SDJ_51_19  
Background: Endodontic irrigation with 5.25% sodium hypochlorite (NaOCl) solution using single side-vented and double side-vented needles is commonly used. Surfactant is added to reduce high surface tension of the NaOCl solution. Apical vapor lock, or air entrapment inside closed-end root canal system, lowers the efficacy of irrigants. Thus, the irrigants are hindered in penetrating the root canal system and can lead to risk of reinfection. Objective: The objective is to analyze the difference of 5.25% NaOCl solution with and without surfactant using two types of irrigation needle in the formation of apical vapor lock. Methods: Forty lower premolars were prepared and randomly divided into four groups (n = 10 per group) then irrigated with 5.25% NaOCl solution with and without surfactant using a single side-vented or double side-vented needle. Contrast medium was added so that the measurement of the apical vapor lock could be performed using a digital radiograph. Analysis was done with two-way analysis of variance and the Tukey method. Results: 5.25% NaOCl solution with a single side-vented needle showed a significant difference from 5.25% NaOCl solution with a double side-vented needle. 5.25% NaOCl solution with a surfactant using a single side-vented needle showed a significant difference from 5.25% NaOCl solution using a double side-vented needle, likewise NaOCl 5.25% using double side-vented needle group from NaOCl 5.25% with surfactant using single side-vented needle group. Conclusion: Minimal formation of an apical vapor lock resulted from the use of 5.25% NaOCl solution with a surfactant using a single side-vented needle.
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Efficacy of eucalyptus oil (Eucalyptus globulus), sweet orange oil (Citrus sinensis), and grapefruit oil (Citrus paradisi) as bioceramic sealer solvents p. 120
Christy Tanujaya, Aryadi, Nadia Hardini
DOI:10.4103/SDJ.SDJ_7_20  
Background: Essential oil–based gutta-percha solvents have been extensively studied due to their nontoxicity and effectiveness compared to conventional solvents. These solvents can also be used to remove different types of endodontic sealers. Bioceramic-based sealers have become increasingly popular; however, they are difficult to dissolve. Objective: The aim is to examine the differences in efficacy between eucalyptus oil (Eucalyptus globulus), sweet orange oil (Citrus sinensis), and grapefruit oil (Citrus paradisi) as bioceramic sealer solvents. Methods: Thirty-two bioceramic sealer samples were placed in cylindrical stainless steel molds 1.5 mm in height and 8 mm in internal diameter and were placed in an incubator to set. After 72 h, the sealer samples were weighed to obtain their initial weights. Then, they were divided into three groups of ten, which were immersed in 1 ml of eucalyptus, sweet orange, or grapefruit oil for 1 min, and one group of two, used as negative controls. The sealer samples were placed in an incubator for 24 h to dry and weighed once more to obtain their final weights. The differences in weight were calculated and analyzed using one-way analysis of variance. Results: The analysis of the initial and final weight differences of the sealer samples immersed in the three essential oils revealed no statistically significant differences between them. Conclusions: The three essential oils have comparable efficacies as bioceramic sealer solvents.
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CASE REPORTS Top

Nonsurgical approach for torus palatinus management in full denture rehabilitation p. 124
Niko Falatehan, Gracia Anfelia
DOI:10.4103/SDJ.SDJ_21_20  
Background: Tooth loss in individuals more commonly occurs with increasing age. In a dental practice, many patients present with torus palatinus, which is usually caused by problems and complications resulting from denture fabrication. Therefore, a nonsurgical approach in which horseshoe-shaped complete dentures are fabricated is considered to be a viable option to address torus palatinus. Case Report: A 59-year-old edentulous male came to the Prosthodontic Department, Faculty of Dentistry, Trisakti University, with a chief complaint of the instability of his maxillary complete dentures, and he requested new dentures. The patient had been wearing the dentures for approximately 5 years. Based on the intraoral examination, the patient had a large, single lobule torus palatinus that extended posteriorly through the junction between the hard palate and the soft palate (AH line). It was covered with thin mucosal tissue, and it did not interfere with his speech, his ability to chew, or other oral functions without the dentures. After the problems were thoroughly diagnosed and corrected, horseshoe-shaped complete dentures were chosen as the appropriate solution, and the dentures were fabricated. Conclusion: Torus palatinus tends to have very thin mucosa that causes discomfort and irritation during routine usage of acrylic dentures. Therefore, the horseshoe-shaped dentures facilitated good retention and stability, and they did not irritate the torus palatinus.
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Deep bite correction with an anterior bite plate in a growing patient p. 129
Dwita Pratiwi, Miesje K Purwanegara
DOI:10.4103/SDJ.SDJ_24_20  
Background: Deep bites represent one of the most difficult cases in orthodontic treatment. In growing patients, strategies for deep bite correction include extrusion of posterior teeth and intrusion of incisors, which can be achieved using anterior bite plates. This case report presents the treatment of a deep bite in a growing patient using an anterior bite plate. Case Report: A 13-year-old female presented with a convex profile, short lower facial height, a Class II skeletal relationship, a deep bite (6 mm overbite), a 6 mm overjet, and severe crowding on both arches. The patient was treated with a removable anterior bite plate in conjunction with a fixed appliance. A normal overbite (2 mm) was achieved, severe crowding was corrected on both arches, the lower facial height was increased, the interincisal angle remained favorable, the mandibular incisors were well positioned in the basal bone, and the smile esthetics improved. Conclusion: The use of an anterior bite plate in combination with fixed appliances is effective in treating deep bites in a growing patient.
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Revascularization of nonvital immature incisor with asymptomatic apical periodontitis Highly accessed article p. 134
Doni, Ema Mulyawati, Pribadi Santosa, Tunjung Nugraheni
DOI:10.4103/SDJ.SDJ_25_20  
Background: The management of immature central incisors with nonvital pulp is a challenge for dentists because the goals and criteria for successful root canal treatment are difficult to achieve. A necrotic immature root canal system accompanied by apical periodontitis cannot be disinfected by standard protocols with the aggressive use of endodontic files. This case report demonstrated the advantages of pulp revascularization as a treatment method for necrotic immature teeth based on clinical and radiographic outcomes. Case Report: The patient was an 11-year-old boy with a history of trauma to the upper left central incisor who was treated with a revascularization procedure. Clinical and radiographic evaluations showed nonvital pulp, asymptomatic apical periodontitis, and mucogingival swelling before treatment. At the 1-, 3-, and 6-month follow-up visits, the patient's teeth remained asymptomatic and well-functioning. There was a slight thickening of the tooth wall and loss of lesions, although total closure of the apical foramen was observable. Longer clinical and radiographic controls are needed to evaluate the success of this case.Conclusion: Revascularization is a procedure that promotes thickening of the dentinal wall and closure of the apical foramen, thereby preventing teeth from becoming weak. The minimum expectation of revascularization treatment is the absence of undesirable signs and symptoms, but the ultimate goal is full regeneration of the pulp complex and ideal root development.
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Association of oral health status with the risk of malnutrition and pneumonia in geriatric patients p. 142
Firstine Kelsi Hartanto, Tenny Setiani Dewi
DOI:10.4103/SDJ.SDJ_42_20  
Background: Older persons are at risk of compromised oral conditions, including dental infections, periodontal problems, tooth loss, benign mucosal lesions, xerostomia, oral candidiasis, and oral cancer. Poor oral hygiene has contributed to increase the risk of aspiration pneumonia, as well as malnutrition, in geriatric patients. We described cases of poor oral health status associated with increased risk of malnutrition and pneumonia in geriatric. Case Report: The patients were an 80-year-old female and a 61-year-old male who were referred from the Internal Medicine Department to the Oral Medicine Clinic at the Dr. Hasan Sadikin Hospital, Bandung, for the evaluation and management of oral health problems. Their medical histories revealed that they had low nutritional intake prior to being hospitalized. Clinically, both patients had pale conjunctiva and appeared underweight. Anthropometry measurements of the female patient showed her body weight was 36 kg, height was 150 cm, and upper-arm circumference measurement was 20 cm, whereas the male patient was measured at 43 kg, 174 cm, and 20 cm, respectively. The nutritional status based on percentage upper-arm circumference measurement method or called % Lingkar Lengan Atas of both patients were 66.8%. Intraoral findings showed coated tongues, multiple gangrene radix at all regions, plaque, and calculus seen on most tooth surfaces, and a lack of saliva. A thorax radiography examination found the patients had pneumonia. A diagnosis of community-acquired pneumonia, severe malnutrition, xerostomia, and periodontitis was made for each patient. The management of the patients included administering systemic antibiotics, promoting their nutritional status gradually with adequate intake, and improving their oral health status with an antiseptic mouthwash and the rehabilitation of malfunctioning teeth. Conclusion: Oral health status has a close relationship with the risk of malnutrition and pneumonia in geriatric patients. Therefore, comprehensive management is needed to improve the quality of life of geriatric patients.
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