Noninvasive diagnosis of vulnerable coronary plaque

Myocardial infarction and sudden cardiac death are frequently the first manifestation of coronary artery disease.For this reason,screening of asymptomatic coronary atherosclerosis has become an attractive field of research in cardiovascular medicine.Necropsy studies have described histopathological changes associated with the development of acute coronary events.In this regard,thin-cap fibroatheroma has been identified as the main vulnerable coronary plaque feature.Hence,many imaging techniques,such as coronary computed tomography,cardiac magnetic resonance or positron emission tomography,have tried to detect noninvasively these histomorphological characteristics with different approaches.In this article,we review the role of these diagnostic tools in the detection of vulnerable coronary plaque with particular interest in their advantages and limitations as well as the clinical implications of the derived findings.

Helicobacter pylori in dental plaque and stomach of patients from Northern Brazil

AIM: To establish whether virulence factor genes vacA and cagA are present in Helicobacter pylori (H. pylori) retrieved from gastric mucosa and dental plaque in pa-tients with dyspepsia. METHODS: Cumulative dental plaque specimens and gastric biopsies were submitted to histological exami-nation, rapid urease test and polymerase chain reac-tion (PCR) assays to detect the presence of cagA and vacA polymorphisms.RESULTS: Detection of H. pylori from dental plaque and gastric biopsy samples was greater by PCR com-pared to histological examination and the rapid ure-ase test. DNA from H. pylori was detected in 96% of gastric mucosa samples and in 72% of dental plaque samples. Sixty-three (89%) of 71 dental plaque sam-ples that were H. pylori-positive also exhibited identical vacA and cagA genotypes in gastric mucosa. The most common genotype was vacAs1bm1 and cagA positive, either in dental plaque or gastric mucosa. These viru-lent H. pylori isolates were involved in the severity of clinical outcome.CONCLUSION: These pathogenic strains were found simultaneously in dental plaque and gastric mucosa, which suggests that gastric infection is correlated with the presence of H. pylori in the mouth.

Role of dental plaque,saliva and periodontal disease in Helicobacter pylori infection

Helicobacter pylori (H. pylori) infection is one of the most common bacterial infections in humans. Although H. pylori may be detected in the stomach of approximately half of the world’s population, the mechanisms of transmission of the microorganism from individual to individual are not yet clear. Transmission of H. pylori could occur through iatrogenic, fecal-oral, and oral-oral routes, and through food and water. The microorganism may be transmitted orally and has been detected in dental plaque and saliva. However, the role of the oral cavity in the transmission and recurrence of H. pylori infection has been the subject of debate. A large number of studies investigating the role of oral hygiene and periodontal disease in H. pylori infection have varied significantly in terms of their methodology and sample population, resulting in a wide variation in the reported results. Nevertheless, recent studies have not only shown that the microorganism can be detected fairly consistently from the oral cavity but also demonstrated that the chances of recurrence of H. pylori infection is more likely among patients who harbor the organism in the oral cavity. Furthermore, initial results from clinical trials have shown that H. pylori-positive dyspeptic patients may benefit from periodontal therapy. This paper attempts to review the current body of evidence regarding the role of dental plaque, saliva, and periodontal disease in H. pylori infection.

Study of Helicobacter pylori genotype status in saliva,dental plaques,stool and gastric biopsy samples

AIM:To compare genotype of Helicobacter pylori(H.pylori) isolated from saliva,dental plaques,gastric biopsy,and stool of each patient in order to evaluate the mode of transmission of H.pylori infection.METHODS:This cross-sectional descriptive study was performed on 300 antral gastric biopsy,saliva,dental plaque and stool samples which were obtained from patients undergoing upper gastrointestinal tract endoscopy referred to endoscopy centre of Hajar hospital of Shahrekord,Iran from March 2010 to February 2011.Initially,H.pylori strains were identified by rapid urease test(RUT) and polymerase chain reaction(PCR) were applied to determine the presence of H.pylori(ureC) and for genotyping of voculating cytotoxin gene A(vacA) and cytotoxin associated gene A(cagA) genesin each specimen.Finally the data were analyzed by using statistical formulas such as Chi-square and Fisher's exact tests to find any significant relationship between these genes and patient's diseases.P < 0.05 was considered statistically significant,RESULTS:Of 300 gastric biopsy samples,77.66% were confirmed to be H.pylori positive by PCR assay while this bacterium were detected in 10.72% of saliva,71.67% of stool samples.We were not able to find it in dental plaque specimens.The prevalence of H.pylori was 90.47% among patients with peptic ulcer disease(PUD),80% among patients with gastric cancer,and 74.13% among patients with none ulcer dyspepsia(NUD) by PCR assay.The evaluation of vacA and cagA genes showed 6 differences between gastric biopsy and saliva specimens and 11 differences between gastric and stool specimens.94.42% of H.pylori positive specimens were cagA positive and all samples had amplified band both for vacA s and m regions.There was significant relationship between vacA s1a/m1a and PUD diseases(P = 0.04),s2/m2 genotype and NUD diseases(P = 0.05).No statically significant relationship was found between cagA status with clinical outcomes and vacA genotypes(P = 0.65).The evaluation of vacA and cagA genes showed 6 differences between gastric biopsy and saliva specimens and 11 differences between gastric and stool specimens,CONCLUSION:Regard to high similarity in genotype of H.pylori isolates from saliva,stomach and stool,this study support the idea which fecal-oral is the main route of H.pylori transmission and oral cavity may serve as a reservoir for H.pylori,however,remarkable genotype diversity among stomach,saliva and stool samples showed that more than one H.pylori genotype may exist in a same patient.

Analysis of a New Toothbrushing Technique through Plaque Removal Success

Background/Aims: Determining the levels of oral health and the quality of dental care are fundamental to building concepts of oral health. This study aims to assess toothbrushing techniques using a technical and physical model, clarifying how children and pre-adults learn to brush their teeth. Materials and Methods: Data were recorded from 23 participants, both male and female of various ages, using a proposed electronic toothbrush equipped with X-Y-Z axes pathways. The data, collected before and after training experiments, were processed with MATLAB to generate plots for the three axes. Results: The study revealed that most parameter values, such as Mean Difference Between Amplitudes (MAV, 6.00), Wilson Amplitude (WAMP, 179.419), and Average Amplitude Coupling (AAC, 1.270), decreased from before to after the experiments. Furthermore, the average overall epoch lengths (AVG) showed a 75% reduction in movement amplitude between the two experiments. Conclusion: Dentist observations indicated which brushing methods were acceptable or not. Analytical values suggest that individuals learn the toothbrushing technique effectively, and medical observations clearly demonstrate the success of the proposed method.

Isolation of Dental Caries Bacteria from Dental Plaque and Effect of Tooth Pastes on Acidogenic Bacteria

Destruction of calcified tissue was caused by acids which are by product of carbohydrate metabolism of acidogenic bacteria consequent to dental caries. The purpose of this study was to assess the existence of acidogens potentially causing the dental caries and comparatively evaluation of efficacy of different toothpastes. The dental plaques of fifty persons belong to three age groups (1 - 20, 21 - 40, 41 - 60 year and above) were examined to identify microorganisms by the culture method. Thirty nine bacteria were isolated by spread plate method on BSMY I minimal media. Thirteen out of thirty nine, acidogens colonized in the dental plaques. Seven potentially acidogens CD17, CD26, CD27, CD28, CD29, CD34 and CD35 were treated with five different toothpastes. Inhibition effect of Triclosan and Fluoride containing tooth pastes were found more efficient. The results of the present study revealed that bacteria that commonly cause dental caries colonized in dental plaques of children and alcoholic person. Therefore, dental plaques must be considered a specific reservoir of colonization and subsequent dental caries. To reduce the dental problem triclosan and fluoride containing product should be recommended.

Dental Plaque Streptococci and Their Amoxicillin Resistance in Children with Congenital Heart Anomalies: Results of a Prospective Study

Children with congenital heart diseases (CHD) are considered to be at higher risk of development of a Bacterial Endocarditic (BE) from infectious diseases of the oral cavity and following dental treatments. They represent the largest group of patients with special medical needs who appear in the daily dental practice. Maintenance of oral health and oral hygiene is suitable to reduce the incidence of bacteremia. Oral hygiene is more important in reducing the risk of BE than the administration of antibiotic-prophylaxis before dental procedures. The purpose of this study was to identify the strains of streptococci viridians group from dental plaque and their amoxicillin resistance at children with congenital heart disease. The study was carried out in University Dentistry Clinical Center of Kosova, Department of Pediatric Dentistry in cooperation with the Micro-biologic Department. Participants in this study (n = 90) were children between 6 - 15 years old, divided in the control group of healthy children (n = 30), and two study groups, first group, children with CHD who have not taken antibiotics within last three months (n = 30) and second group, children with CHD who have taken antibiotics within three months (n = 30). The gram positive cocci were identified using the automated system, VITEK 2 (BioMerux), while for determining amoxicillin resistance cocci the disc diffusion method was used. By analyzing the three groups of children regarding isolated dental plaque streptococci, in general the Viridans group of streptococci (VGS) has dominated our results, with a higher percentage of streptococcus Mitis group (37.2%). The highest resistance of VGS against amoxicilin was in the group of children with CHD, which have been using antibiotics within 3 months (23.3%). In the other two groups the resistance against amoxicillin was found in a lower percentage (3.3%). Based on the results of our study we can conclude that frequent use of amoxicillin may result in an increasing antimicrobial resistance of streptococci.

Clinical Assessment of a Pharmaceutical Polyphenol Fruit Extract Gel to Inhibit Dental Plaque

Oral bacteria (e.g. Porphyromonas gingivalis) are associated and potentially co-causative in several medical conditions including Alzheimer’s disease and increased cardiovascular risk. Naturally occurring polyphenols are a developing class of antimicrobial pharmaceutical agents. The use of plant-based polyphenol compounds is an attractive area of medical and dental research due to their high safety factor from their presence in vegetables and fruits. This preliminary study evaluated polyphenols found in berries to reduce bacterial dental plaque accumulation. The study was an in vivo single blind randomized controlled trial of seven subjects with a novel tooth gel using validated measurements. Results showed a significant reduction in plaque accumulation (p = 0.005) and a non-significant trend to reduce gingivitis (p = 0.08). The bioactive gel showed no local or systemic adverse effects and was well tolerated by subjects.

Diagnosis of Dental Caries Using Terahertz Technology

Recently,the diagnoses of dental caries and other dental issues are in a queue as only X-ray-based techniques are available in most hospitals around the world.Terahertz(THz)parametric imaging(TPI)is the latest technology that can be applied for medical applications,especially dental caries.This technology is harmless and thus suitable for biological samples owing to the low energy of THz emission.In this paper,a developed TPI system is used to investigate the two-dimensional(2 D)and three-dimensional(3D)images of different samples from human teeth.After analyzing the measured images of human teeth,the results suggest that the THz parametric technology is capable of investigating the inner side structure of the teeth.This technique can be useful in detecting the defects in all types of human and animal teeth.The measurement and analytical calculations have been performed by using the TPI system and MATLAB,respectively,and both are in good agreement.The characteristics of THz waves and their interactions with the tooth samples are summarized.And the available THz-based technologies,such as TPI,and their potential applications of diagnoses are also presented.

Expert System for the Diagnosis and Prognosis of Common Dental Diseases Using Bayes Network

Expert systems are being utilized increasingly in medical fields for the purposes of assisting diagnosis and treatment planning. Existing systems used few symptoms for dental diagnosis. In Dentistry, few symptoms are not enough for diagnosis. In this research, a conditional probability model (Bayes rule) was developed with increased number of symptoms associated with a disease for diagnosis. A test set of recurrent cases was then used to test the diagnostic capacity of the system. The generated diagnosis matched that of the human experts. The system was also tested for its capacity to handle uncommon dental diseases and the system portrayed useful potential.

Daily Lifestyle Habits as Risk Factors for Plaque-Induced Gingivitis and Periodontitis Severity and Grading among Samples of Dental Students at King Khalid University

Objective: To assess daily lifestyle habits as risk factors for plaque-induced gingivitis and periodontitis severity and grading among samples of dental students at King Khalid University. Material and Methods: This study included 150 male participants. They were divided according to the levels into three equal groups: levels 5, 6, and 7 (group I), levels 8, 9, 10 (group II) and levels 11, 12, and interns (group III). This study consisted of questions related to age, gender, educational level, father’s education, mother’s education, home ownership, brushing teeth more than or twice a day, in addition to daily lifestyle habits that were daily smoking, daily use of sugary drinks, and daily use of sugary foods. Some clinical parameters of plaque-induced gingivitis and periodontitis and the percentage of radiographic bone loss were recorded. All data were collected and analyzed using Tukey’s test and Chi-square test. A P-value of less than 0.5 (p Results: One hundred fifty male dental students of different levels in the college of dentistry at King Khalid University participated in the study in three groups (I, II, and III). The mean age of group III is more than that of group II and group I, with highly statistically significant differences (p 30%) were more among the participants in group I than the participants in groups III and II. There was an increase in the percentage of affected participants with stages III and IV of clinical attachment loss (CAL), periodontal pocket depth (PPD), radiographic bone loss (%RBL), tooth mobility, as well as glycated hemoglobin (HbA1c) test values (>7%), and the number of cigarettes smoked per day (>10 cigs) in group III more than in group II and I. Conclusion: We conclude that the severity and grading of plaque-induced gingivitis were higher among the participants in group I, while the severity and grading of periodontitis were higher among the participants in group III due to the different impact of their daily lifestyle habits.

Effects of Adjunctive Daily Blue Light Toothbrushing on Dental Plaque and Gingival Inflammation—A Randomized Controlled Study

Phototherapy with blue light emitting diodes (LEDs) is gaining interest because of the efficient antimicrobial benefits reported in several studies in the last decade. The aim in this study was to investigate if a toothbrush with incorporated blue light used in daily oral care can reduce dental plaque and gingival inflammation. An 8-week single-blinded randomized controlled clinical study including 48 subjects compared effects of toothbrushes with/without 450 nm blue LED light emission, on clinical parameters (plaque index, gingival index, bleeding on probing), and on inflammatory markers in saliva and gingival crevicular fluid. Significant reductions in dental plaque and gingival inflammation (p < 0.001), and in some inflammatory markers (p ≤ 0.05), matrix metalloproteinase (MMP)-8, tissue inhibitor metalloproteinase inhibitor (TIMP)-1, interleukin (IL)-1β and interleukin (IL)-8, were detected within both groups from baseline to follow-up. For all subjects dental plaque was reduced with 57%, and a reduction in gingival inflammation was demonstrated by a decrease in gingival index (GI) with 46% and in bleeding on probing (BOP) with a decrease of 15%. No significant differences were found between the groups at a level of p = 0.05. However, the amount of plaque was reduced by 62% in the blue light group and 51% in the control group, a difference established at a level of p = 0.058. A toothbrush with a 450 nm LED did not show any statistical significant adjunctive effect of toothbrushing regarding reduction in measurements of dental plaque and gingival inflammation.

Multislice computed tomography angiography in the diagnosis of coronary artery disease

Multislice CT angiography represents one of the most exciting technological revolutions in cardiac imaging and it has been increasingly used in the diagnosis of coronary artery disease. Rapid improvements in multislice CT scanners over the last decade have allowed this technique to become a potentially effective alternative to invasive coronary angiography in patients with suspected coronary artery disease. High diagnostic value has been achieved with multislice CT angiography with use of 64- and more slice CT scanners. In addition, multislice CT angiography shows accurate detection and analysis of coronary calcium, characterization of coronary plaques, as well as prediction of the disease progression and major cardiac events. Thus, patients can benefit from multislice CT angiography that provides a rapid and accurate diagnosis while avoiding unnecessary invasive coronary angiography procedures. The aim of this article is present an overview of the clinical applications of multislice CT angiography in coronary artery disease with a focus on the diagnostic accuracy of coronary artery disease; prognostic value of coronary artery disease with regard to the prediction of major cardiac events; detection and quantification of coronary calcium and characterization of coronary plaques. Limitations of multislice CT angiography in coronary artery disease are also briefly discussed, and future directions are highlighted.

Cholesterol crystal embolization following plaque rupture： a systemic disease with unusual features

Cholesterol crystal embolic （CCE） syndrome is often a clinically challenging condition that has a poor prognostic implication. It is a result of plaque rupture with release of cholesterol crystals into the circulation that embolize into various tissue organs. Plaque rupture seems to be triggered by an expanding necrotic core during cholesterol crystallization forming sharp tipped crystals that perforate and tear the fibrous cap. Embolizing cholesterol crystals then initiate both local and systemic inflammation that eventually lead to vascular fibrosis and obstruction causing symptoms that can mimic other vasculitic conditions. In fact, animal studies have demonstrated that cholesterol crystals can trigger an inflammatory response via NLRP3 inflammasome similar to that seen with gout. The diagnosis of CCE syndrome often requires a high suspicion of the condition. Serum inflammation biomarkers including elevated sedimentation rate, abnormal renal function tests and eosinophilia are useful but non-specific. Common target organ involvement includes the skin, kidney, and brain. Various testing including fundoscopic eye examination and other non-invasive procedures such as trans-esophageal echocardiography and magnetic resonance imaging may be helpful in identifying the embolic source. Treatment includes aspirin and clopidogrel, high dose statin and possibly steroids. In rare cases, mechanical intervention using covered stents may help isolate the ruptured plaque. Anticoagulation with warfarin is not recommended and might even be harmful. Overall, CCE syndrome is usually a harbinger of extensive and unstable atherosclerotic disease that is often associated with acute cardiovascular events.

A Study of Plaque Adhesion during Implant Treatment of Missing Molars

Purpose: In implant treatment, the abutments and superstructures form a transmucosal area. In addition to providing appropriate cleaning instructions to patients, its material properties must be carefully considered. It is not clear how much plaque adhesion occurs at each site during treatment process, and the effect of materials on plaque adhesion. Methods: In this study, 33 patients, 13 maxillary cases and 20 mandibular cases, who had implants placed in the missing molars were evaluated for the plaque adhesion of provisional restorations made of acrylic resin and monolithic zirconia final restoration after a period of more than 4 weeks. In addition, oral hygiene instructions were thoroughly given for 12 cases at the time of staining after the provisional restorations, and re-evaluated in 4 weeks. Results: About 20% of the buccal-lingual area of the prosthetic device fabricated with acrylic resin showed plaque staining, whereas about 40% of the area of the mesial and distal. On the other hand, for the zirconia final restorations, the percentage of staining was about 5% for buccal and lingual surface and 10% for mesial and distal surface. The stained area ratio of the provisional restoration correlated with the zirconia superstructure area ratio. Even with careful oral hygiene, it became clear that the amount of plaque adhesion due to the difference in materials could not be overcome. Conclusion: The zirconia superstructure is extremely good from the viewpoint of plaque adhesion, but cases with a large stained area at the time of provisional restoration should be carefully followed up.

Classification and detection of dental images using meta-learning

Meta-learning of dental X-rays is a machine learning technique that can be used to train models to perform new tasks quickly and with minimal input.Instead of just memorizing a task,this is accomplished through teaching a model how to learn.Algorithms for meta-learning are typically trained on a collection of training problems,each of which has a limited number of labelled instances.Multiple Xray classification tasks,including the detection of pneumonia,coronavirus disease 2019,and other disorders,have demonstrated the effectiveness of meta-learning.Meta-learning has the benefit of allowing models to be trained on dental X-ray datasets that are too few for more conventional machine learning methods.Due to the high cost and lengthy collection process associated with dental imaging datasets,this is significant for dental X-ray classification jobs.The ability to train models that are more resistant to fresh input is another benefit of meta-learning.

血清游离脂肪酸和心型脂肪酸结合蛋白表达与2型糖尿病病人动脉粥样硬化斑块的关系研究

目的探讨血清游离脂肪酸(FFA)和心型脂肪酸结合蛋白(H-FABP)表达与2型糖尿病(T2DM)病人动脉粥样硬化斑块(CAP)的关系研究。方法选取2020年6月至2022年6月保定市第四中心医院接收的T2DM病人302例为研究对象。通过颈动脉超声检查进一步将研究对象分为CAP组(165例)和无CAP组(137例)。采用酶联免疫吸附测定(ELISA)检测血清FFA、H-FABP水平;采用logistic多因素回归分析CAP发生的影响因素;采用Spearman法分析血清FFA、H-FABP水平及与临床资料的相关性分析;采用受试者操作特征曲线(ROC曲线)评价血清FFA、H-FABP及其联合对CAP发生的诊断效能。结果相较于无CAP组,CAP组年龄、高血压史、C反应蛋白(CRP)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL)、载脂蛋白A(ApoA)、FFA、H-FABP[(4.63±1.43)μg/L比(3.68±1.05)μg/L]水平显著上升(P<0.05),LPa水平显著下降(P<0.05)。logistic分析显示,年龄、CRP、TG、LDL、FFA、H-FABP均是T2DM病人CAP发生的独立危险因素(P<0.05)。T2DM合并CAP病人血清FFA与H-FABP、年龄、CRP、TG、LDL水平呈正相关(rs=0.61、0.59、0.52、0.57、0.55,P<0.05)。血清H-FABP与年龄、CRP、TG、LDL水平呈正相关(rs=0.58、0.53、0.57、0.54,P<0.05)。ROC曲线结果显示血清中FFA、H-FABP水平及二者联合预测T2DM病人CAP发生的AUC分别为0.71、0.74、0.84,其中联合预测AUC显著高于二者单独预测AUC(Z=3.65、2.68,P<0.05)。结论FFA、H-FABP水平在T2DM合并CAP病人血清中升高,与年龄、CRP、TG、LDL关系密切,均有望成为T2DM病人CAP发生的诊断因子。

Dental caries and first permanent molar pit and fissure morphology in 7-to 8-year-old children in Wuhan,China

To obtain the caries experience and, plaque accumulation severity and pit and fissure morphology in first permanent molars in 7-8 children in Wuhan, as a reasonable prediction of caries risk and preventive attention in the future, a convenient sample of five primary schools in the vicinity of the Wuhan University School and Hospital of Stomatology was drawn. Two calibrated examiners orally examined all present grade 2 children in the classroom, using standard caries plaque and tooth morphology criteria. Dental caries was scored at enamel （D2） and dentine （D3） for tooth and surface level. Independent variables were age, gender and school. Data analysis used analysis of variance and t-test. The sample comprised 1 043 7- and 8-year-olds. The prevalence of dental caries in permanent dentition was 8.7% and in primary dentition, 68.7%. Mean Decayed, Missing, Filled Teeth/S （DMFT/S） scores were 0.1 1 and . 14, respectively. Mean dmft/s scores were 2.8 and 5.0. The d-component constituted 75% of the d3mft index, while enamel carious lesions constituted 36% of the total number of carious lesions （d2,3-component）. Prevalence of medium and deep pits and fissures was 84.6%. Prevalence of medium and severe plaque accumulation was 67.4%. Prevalence of dental caries in the deciduous and permanent dentitions of 7- to 8-year-old children was high. Deed oits and fissures in high caries risk children should be sealed_

Dental evaluation is helpful in the differentiation of functional heartburn and gastroesophageal reflux disease

BACKGROUND Heartburn is identically the key symptom of both,gastroesophageal reflux disease(GERD)and functional heartburn(FHB),making the differential diagnosis resource-intensive.Oral manifestations of GERD can be easily examined;therefore,their exploration might be a cheap,widely available,and useful tool in the differentiation of GERD and FHB.AIM To evaluate the prevalence of dental erosions(DE)and periodontal diseases(PD)in patients with heartburn and their association with GERD and FHB.METHODS A total of 116[M/F:51/65,mean age:54(17-80)years]consecutive patients with heartburn were enrolled for detailed esophageal function and orodental examinations.RESULTS Dental disorders were detected in 89%(103/116).Patients with PD+DE had significantly more often pathologic reflux(90.0%vs 27.8%;P<0.05),higher esophagitis scores(1.8 vs 0.9;P<0.05),and a significantly different mean impedance curve(P=0.04)than those without any dental diseases.The opposite approach established that patients with GERD had significantly higher prevalence of DE and PD,especially if both were present(28.9%vs 2.0%;P<0.01),more severe PD(1.5 vs 1.0;P<0.01),and longer history of heartburn(15 years vs 9 years;P<0.01)than those with FHB.CONCLUSION The dental evaluation of patients with heartburn seems to be useful in the differential diagnosis of GERD and FHB.Among the studied parameters,the co-appearance of DE and PD seems to be the best predictor of GERD,whereas the absence of dental disorders was mostly observed in FHB.

Reliability of Sawai's classification for dental cervical abrasions:A pilot study

AIM To test the reliability of the Sawai’s classification for dental cervical abrasions.METHODSIntraoral photographs of 70 teeth from 23 patients with tooth abrasions were taken by the first examiner MS.The teeth were marked and the photos were maintained in a soft copy sequentially.Two other examiners FA and SC were trained in the use of the classification and any clarifications needed were provided at the beginning of the study.Each examiner was then given the soft copy of the complied photographs and was asked to classify the dental cervical abrasion according to their understanding of the Sawai’s classification.They were given sheets to write their responses for every marked tooth.All the examiners were blinded to each other’s observations which were then tested for inter-rater agreement among the three examiners.RESULTSThe 70 teeth with tooth abrasions from 23 patients were examined by 3 investigators(MS,FA and SC)to test the reliability of the Sawai’s classification system for tooth abrasion.Each examiner marked their responses in separate sheets which were blinded to each other.The kappa statistics were performed for inter-rater agreement among the three examiners.The level of agreement was evaluated according to the six-level nomenclature given by Landis and Koch.ICC and 95%CI between two examiners,i.e.,the inter-rater agreement among 1^(st) examiner(MS) and 2^(nd) examiner(FA) was 0.89.The inter-rater agreement among 1^(st) examiner(MS) and 3^(rd) examiner(SC) was 0.89.And the inter-rater agreement among 2^(nd) examiner(FA) and 3^(rd) examiner(SC) was 0.83.All the three comparisons show an almost perfect agreement between them.CONCLUSIONThere is an almost perfect agreement between multiple observers for classifying dental cervical abrasions using Sawai’s classification.Hence,this classification is reliable.