Descriptive study of 896 Oral squamous cell carcinomas from the only University based Oral Pathology Diagnostic Service in Sri Lanka

Prevalence and Influencing Factors of Rubber Dam Use among Tunisian Dentists: A Cross-Sectional Study

Context

Despite its undeniable advantages, the rubber dam (RD) is still struggling to claim its rightful place as the most effective used isolation tool in endodontics. The study aimed to estimate the prevalence of RD use during endodontic treatment and to identify factors associated with its use by Tunisian dentists.

Materials and Methods

A cross-sectional study was conducted. An online Google Form was emailed to a sample of Tunisian dentists, randomly selected from the National Dental Council register. It contains 33 questions divided into five parts: demographic characteristics, general endodontic practice, clinical applications of RD, reasons for not using RD, and alternative methods. The sample size, comprising 300 dentists, was calculated considering a previous prevalence. Chi-square/Fisher exact tests and t test have been used to investigate factors influencing RD use. For the multivariable analysis, we used binary logistic regression.

Results

Among the 174 respondents, 56.3% were women, with a mean age of 37.7 ± 6.6 years. Seventy-three percent did not have postgraduate training on RD placement. Seventy-one percent reported never using RD for root canal treatments (RCTs) during undergraduate study. Forty-four percent used it with variable frequencies. In the univariable analysis, the number of RCTs per week, years of experience, duration of endodontic sessions, age, pre-endodontic buildup, and undergraduate training were associated with RD use. In the logistic regression, the duration of endodontic sessions [adjusted odds ratio (OR) = 1.053; 95% confidence interval (CI) = 1.023-1.083; P < 10-3] and the undergraduate training (adjusted OR = 4.625; 95% CI = [1.88-11.378]; P = 0.001) were associated with RD use.

Conclusion

The use of RD by Tunisian dentists during endodontic procedures is not common. RD application is associated with the duration of the endodontic session and the undergraduate training. Greater emphasis should be placed on the application of RD at dental school and in clinical practice through continuous dental education programs.

Application of periodontal tissue regeneration combined with orthodontics in oral prosthodontics and its influence and significance on the expressions of IL-1β, TNF-α and IL-5 in periodontal tissue

The aim is to investigate the application of periodontal tissue regeneration combined with orthodontics in oral restoration, and explore its effect and significance on the expressions of Interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α) and interleukin-5 (IL-5) in periodontal tissue. The patients in observation group were treated with orthodontics combined with periodontal tissue regeneration, and the control group was treated with periodontal tissue regeneration. The total effective rate, adverse reactions, recurrence rate and treatment satisfaction were compared. The masticatory function, language function, aesthetic level, VAS score, quality of life, gingival index (GI), plaque index (PLI), periodontal pocket probing depth (PD), sulcus bleeding index (SBI), IL-1β, TNF-α and IL-5 levels were compared. The recurrence rate of observation group was lower than control group, while the treatment satisfaction was higher after treatment. After treatment, the scores of masticatory, language, aesthetics, physiological, social, emotional, cognitive, and emotional functions and overall health score were higher than before treatment. After treatment, the scores of masticatory and language functions, aesthetics and quality of life of observation group were significantly higher than control group. After treatment, the VAS score, GI, PLI, SBI, PD, IL-1β, TNF-α and IL-5 levels were lower than before. The VAS score, GI, PLI, SBI, PD levels, IL-1β, TNF-α and IL-5 levels of observation group were lower after treatment. Orthodontics combined with periodontal tissue regeneration can help improve the periodontal condition of patients with periodontitis, reduce inflammatory response, improve the level of efficacy and overall safety, and further improve patients' quality of life and treatment satisfaction.

The Expression of PDL-1 and PD1 in the Microenvironment of Oral Squamous Cell Carcinoma

OBJECTIVE

Immune checkpoint proteins, especially PD-1/PD-L1, play a vital role in controlling the intensity and duration of the immune response. However, cancer cells often over-expression PDL-1 on their surfaces, which leads to the permanent activation of the PD-1/PDL-1 pathway and exhaustion of T cells and creates a resistant tumor microenvironment. This study aimed to analyze PD-1, PD-L1 expression in tumor cells (PDL-1/TC) and in Tumor-Infiltrating Lymphocytes (PDL-1/TILS) of OSCC patients and associated with and to correlate it with histologic grade of malignancy and clinicopathologic parameters.

METHODS

The sample consisted of 43 archived specimens of 43 patients of OSCC with Clinical features (gender, age, smoking, clinical stage) collected from medical records between 2014-2021. The intensity of PD-1, PDL-1/TC, PDL-1/TILS, positive cells were assessed by immunohistochemistry.

RESULT

PDL-1/TILS and PDL-1/TC were observed in all specimens except two cases in well-differentiated were negative. PDL-1/TILS was significant between histological grades(P=0.004<0.05). There was no significant between PDL-1/TC and PDL-1/TILS and between poorly differentiated and moderately differentiated groups' ROC P values (P=0.133, 0.340>0.05) respectively. There is a difference between PDL-1/TC and PDL-1/TILS between poorly differentiated and well-differentiated groups ROC P value (0.005, 0.028), Sensitivity (0.857, 0.857), specificity (0.765, 0.824) respectively and there is a difference between and PDL-1/TILS moderate differentiated and well-differentiated groups ROC P value (0.133,) Sensitivity (0.737), specificity (0.765). No differences between PDL-1/TC and moderate and well-differentiated groups P value (0.173). There is a significant correlation between PDL-1/TC and PDL-1/TILS with an age P>65 value (0.032) in the well-differentiated group. PDL-1/TC and PDL-1/TILS with the depth of invasion (DOI) in the well-differentiated group. No significant correlation was obtained between PDL-1/TC and PDL-1/TILS and smoking, clinical stage, and gender. No significant correlation was obtained between PD1 and the histological grades or clinicopathologic characteristics.

CONCLUSION

PDL-1/TILS and PDL-1/TC are independent prognostic factors in OSCC and PDL1-/TILS has an important role.

Profiling of Oral Squamous Cell Carcinoma of Lower Assam Region - A Hospital-Based Retrospective Study

Background

Oral cancer is one of the ten most common cancers worldwide and the sixth most common type of all cancer in India. Among the oral malignancies, oral squamous cell carcinoma (OSCC) is the most common, accounting for more than 90% of oral cancer and hence a significant public health concern.

Aim

The aim of this study was to evaluate clinicopathological and demographic profiling of OSCC in a district and adjacent area of lower Assam.

Settings and Design

This was a retrospective observational study.

Materials and Methods

A total of 140 histologically confirmed OSCC patients diagnosed at the Regional Cancer Centre in the district between the period 2022 April and 2023 October constitute our study sample size in this study. The duration of the study was 1½ years.

Statistical Analysis

The clinical and histopathological features were analyzed using descriptive statistics. Statistical Package for the Social Science (SPSS) version 23.0 was used.

Results

OSCC constitutes 23.97% of head-and-neck cancer. The incidence of OSCC was higher in males. The highest number of patients was in the age group of 50-59. The most common site of OSCC was the buccal mucosa followed by the tongue. Most of the cases were well differentiated, the number being 82 (58.57%). Most of the patients were in Stage III and Stage IV.

Conclusions

The present study highlights that in the lower Assam region, the majority of the OSCC patients are middle-aged male patients with advanced stages of OSCC. The findings from the present study can be used to compare the scenario of OSCC in other parts of Assam and North East India and also can be used for a follow-up study.

Effect of relaxing sounds on anxiety levels in patients undergoing dental extraction: A randomized clinical trial

Introduction

The study was conducted to observe the effect of using relaxing sounds as a nonpharmacological intervention on anxiety levels and vital signs among patients who underwent extraction.

Materials and Methods

A randomized clinical trial was conducted, and patients with an indication of dental extraction, who were physically and mentally healthy, were invited to voluntarily participate in the study. Dental anxiety was assessed by measuring blood pressure, heart rates, and respiratory rates as well as with the help of the Modified Dental Anxiety Scale (MDAS) questionnaire before and after the procedure. Each participant was asked to choose a sound they preferred. All the statistical analyses were performed using SPSS Software version 23, and the statistical significance level was fixed at P ≤ 0.05.

Results

Among the patients who underwent simple extraction, only the respiratory rate showed a statistically significant difference. The mean respiratory rate decreased from 19.24 to 17.59 after simple extraction. Among all the study variables, the MDAS score showed a statistically significant difference between the groups.

Conclusions

The music group reported much less postoperative anxiety than the control group. These findings confirm the notion that the use of music selected by the patient during surgical extraction of an IMTM reduces anxiety substantially.

Mind the gap: an administrative data analysis of dental treatment outcomes and severe mental illness

BACKGROUND

Oral health of people with severe mental illness (SMI) remains an important public health issue, despite evidence pointing suboptimal dental health outcomes in this population.

AIMS

We test the hypotheses that individuals with SMI have lower contact with dental services and higher levels of fillings and extractions. We also examine effect modification by age-group.

METHODS

We used linked administrative data from general practitioner (GP), hospital and dental records to examine dental service use and treatments (extractions, fillings, crowns and x-rays) among the Northern Ireland hospital population between January 2015 and November 2019 (N = 798,564).

RESULTS

After adjusting for available socio-demographic characteristics, analysis indicated lower levels of dental service use (OR = 0.80, 95% CI = 0.77, 0.84), including lower likelihood of fillings (OR = 0.81, 0.77, 0.84) and x-rays (OR = 0.77, 0.74, 0.81), but higher levels of extractions (OR = 1.23, 1.18, 1.29) among patients with SMI. We also found effect modification by age-group, with older individuals with SMI less likely to have each of the four dental treatments.

CONCLUSIONS

We suggest that in the general area of physical healthcare for people with SMI, oral healthcare is neglected. There is a need for improved understanding of the barriers to routine care and treatment, and development of psychoeducational interventions.

Remineralization potential of apacider gel on enamel and cementum surrounding margin of ceramic restoration

Background

Modern management of carious lesions has been targeted upon using remineralizing agents. This study investigated the remineralization potential of apacider gel (AG) and casein phosphopeptide-amorphous calcium fluoride phosphate (CA) on enamel and cementum around the cavosurface area of the ceramic margin.

Material and Methods

Seventy-five extracted human mandibular molars were sectioned at 0.8 mm above and below the cemento-enamel junction (CEJ) to remove the CEJ portions and replaced them with glass ceramic disks by bonding them to the crown and root portions with resin cement. The enamel and cementum area of 4x4 mm2 surrounding ceramic was demineralized with Carbopol-907. The demineralized surfaces were treated with either AG or CA, while one group was left with no treatment (NT) and served as control. Vickers microhardness was determined before-, after demineralization, and after remineralization. The percentage of hardness recovery (%HR), and remineralization potential (%RP) were analyzed with ANOVA and Bonferroni's test (α=0.05). Polarized light microscopy (PLM) was assessed for lesion depth. Scanning electron microscopy (SEM) was investigated for surface alterations.

Results

Significant differences in remineralization were found upon various remineralizing agents compared to NT for both enamel and cementum (p<0.05). No significant difference in %HR and %RP was observed between AG and CA (p>0.05). However, AG signified greater decrease in lesion depth and better improvement in surface characteristics for both enamel and cementum than CA.

Conclusions

AG possesses comparable remineralization ability to CA. However, decreasing in carious lesion depth was evinced with using AG more than CA. AG was recommended as a potential remineralization material for handling initial caries for both enamel and cementum. Key words:Apacider, artificial carious lesion, CCP-ACFP, remineralizationCare Team.

Remineralization potential of apacider mangosteen adhesive pastes on artificial carious lesions

Background/purpose

Attention to caries administration has altered toward an early finding of lesions and targeted to noninvasive management with a remineralizing agent. This study compared the remineralization potential of apacider mangosteen adhesive pastes (AMAP), 500-ppm fluoride toothpaste (FT500), and 1000-ppm fluoride toothpaste (FT1000) on artificial caries.

Materials and methods

Artificial caries were generated to enamel of eighty extracted human premolars. The specimens were allocated to four groups and subjected to pH-cycling with the application of testing agents (2 min each, for 10 days): (1) AMAP, dairy, (2) FT500, twice a day, (3) FT1000, twice a day, and (4) no treatment (NT). The surface microhardness was determined before demineralization, after demineralization, and after application of pH-cycling. The hardness, percent of hardness recovery (%HR), and percent of remineralization potential (%RP) were analyzed with ANOVA and Bonferroni's test (α = 0.05). Polarized light microscopy (PLM) was assessed for lesion depth.

Results

Significant differences in remineralization were observed upon various agents compared to NT (P < 0.05). A significant difference in remineralization was found among AMAP, FT1000, and FT500 (P < 0.05). No significant difference in %HR and %RP was observed between AMAP and FT1000 (P > 0.05). PLM signified greater decrease in depth for AMAP, compared to FT1000 and FT500, but no depth reduction for NT.

Conclusion

AMAP possesses comparable remineralization ability to FT1000. However, decreasing in depth of carious lesions was evinced with using AMAP more than FT1000 and FT500. AMAP was recommended as a potential remineralization material for handling initial caries.

Comparison the salivary streptococcus mutans levels between caries-active and caries-free children from Birjand, Iran: A case-control study

Objective

Dental plaque bacteria, including Streptococcus mutans (SM), play a role in the pathogenesis of the dental caries. There are conflicting results regarding the association of salivary SM level and dental caries susceptibility. Our aim was to compare salivary SM levels in colony-forming units (CFU) between children with active caries and caries-free children in Birjand, Iran.

Methods

This case-control study included 61 six-year-old children referred to health centers in Birjand city, Iran, in 2022. The children were divided into two groups: case (dmft/DMFT>0 with active caries) (including 31 children) and control (dmft/DMFT = 0 [caries-free]) (including 30 children). Demographic information and dental history were recorded. Oral examinations were also performed by the dentist. Unstimulated saliva samples were collected from children. The number of salivary SM colonies was determined using the microbial culture and confirmed using the polymerase chain reaction (PCR). The data were analyzed using Chi-square and T-tests at a significance level of p < 0.05.

Results

The mean number of SM colonies was 126.24 ± 92.78 CFU/ml and 92.38 ± 75.34 CFU/ml in case and control groups, respectively. No significant difference was found in salivary SM levels between case and control groups (P = 0.125). No significant association was observed between caries experience with gender (P = 0.363), type of school (public/private) (P = 0.296), receiving oral health education (P = 0.072) and frequency of tooth brushing (P = 0.935). The mean gingival index (P = 0.001) and plaque index (P = 0.025) in case group were significantly higher than control group.

Conclusion

There is no significant difference in salivary SM levels between caries-active and caries-free children in Birjandi children.

Association of Site and Recurrence in Oral Squamous Cell Carcinoma Patients Visiting Private Hospital in Chennai: A Retrospective Study

BACKGROUND

Oral squamous cell carcinoma (OSCC) is the most common malignant neoplasms of the oral cavity. Tongue, buccal mucosa, and gingivobuccal sulcus are the most commonly involved sites for the local recurrence of OSCC. The site of the tumor can be a critical parameter in relation to the recurrence of OSCC because of the varied action of tumor cells in different tumor macro and microenvironments. Hence, the current study aims to evaluate the correlation between the site and recurrence of OSCC among patients visiting private oral cancer hospitals.

MATERIALS AND METHODS

Details of n=300 OSCC cases reported during 2019-2023, which included primary and recurrent OSCC, were collected. The sample population selected includes 261 primary and 39 recurrent oral squamous cell carcinoma cases. The demographic and clinicopathological data were retracted from the institution's common clinical database and transported to IBM-SPSS 23 software for statistical analysis. Chi-square was done to evaluate the association between site and recurrence status, and p<0.05 was considered statistically significant.

RESULTS

Males have a high predilection for OSCC, and the recurrent cases account for 13% of the sample population. The buccal mucosa was the most commonly affected site in primary and recurrent OSCC cases. However, the association between the site of the lesion and the status of recurrence was found to be statistically significant, with a p-value of 0.001.

CONCLUSION

Even though buccal mucosa was the most common site for recurrent OSCC(p value-0.001), the present study carries a small sample size and a location-specific sampling. Hence, further studies must be conducted with a large sample size to test the significant correlation between the site and recurrence rate among patients diagnosed with OSCC.

Contribution of public oral pathology services to the diagnosis of oral and oropharyngeal cancer in Brazil

This study aimed to evaluate the contribution of oral and maxillofacial pathology laboratories (OMPLs) in Brazilian public universities to the diagnosis of lip, oral cavity, and oropharyngeal squamous cell carcinoma (SCC). A cross-sectional study was performed using biopsy records from a consortium of sixteen public OMPLs from all regions of Brazil (North, Northeast, Central-West, Southeast, and South). Clinical and demographic data of patients diagnosed with lip, oral cavity, and oropharyngeal SCC between 2010 and 2019 were collected from the patients' histopathological records. Of the 120,010 oral and maxillofacial biopsies (2010-2019), 6.9% (8,321 cases) were diagnosed as lip (0.8%, 951 cases), oral cavity (4.9%, 5,971 cases), and oropharyngeal (1.2%, 1,399 cases) SCCs. Most cases were from Brazil's Southeast (64.5%), where six of the OMPLs analyzed are located. The predominant profile of patients with lip and oral cavity SCC was Caucasian men, with a mean age over 60 years, low schooling level, and a previous history of heavy tobacco consumption. In the oropharyngeal group, the majority were non-Caucasian men, with a mean age under 60 years, had a low education level, and were former/current tobacco and alcohol users. According to data from the Brazilian National Cancer Institute, approximately 9.9% of the total lip, oral cavity, and oropharyngeal SCCs reported over the last decade in Brazil may have been diagnosed at the OMPLs included in the current study. Therefore, this data confirms the contribution of public OMPLs with respect to the important diagnostic support they provide to the oral healthcare services extended by the Brazilian Public Health System.

Salivary lactate dehydrogenase and salivary total protein as potential biomarkers for screening periodontal disease

Background

Timely diagnosis of periodontal disease is crucial for restoring healthy periodontal tissue and improving patients' prognosis. There is a growing interest in using salivary biomarkers as a noninvasive screening tool for periodontal disease. This study aimed to investigate the diagnostic efficacy of two salivary biomarkers, lactate dehydrogenase (LDH) and total protein, for periodontal disease by assessing their sensitivity in relation to clinical periodontal parameters. Furthermore, the study aimed to explore the impact of systemic disease, age, and sex on the accuracy of these biomarkers in the diagnosis of periodontal health.

Materials and methods

A total of 145 participants were categorized into three groups based on their basic periodontal examination index, with 20 in the periodontally healthy group, 50 in the gingivitis group, and 75 in the periodontitis group. Salivary LDH was measured using the rate of nicotinamide adenine dinucleotide (NADH) oxidation, to measure the kinetics of LDH activity, while total protein was measured using the Lowry method. Descriptive and analytical statistical analyses were performed to examine the associations between the variables and biomarkers.

Results

The results of the study demonstrated that salivary LDH was 72% sensitive, while salivary total protein was 78% sensitive in correlation to clinical periodontal parameters. The accuracy of the test was not influenced by sex, but age had a significant effect on both biomarkers, particularly LDH. Systemic disease was another factor that significantly affected the accuracy of the test.

Conclusions

Although salivary LDH and total protein show promise as biomarkers for screening periodontal disease, their interpretation may be impacted by age and systemic disease. To enhance the accuracy of periodontal disease detection, the study suggests combining these biomarkers with more specific indicators and diagnostic tools.

Endodontic Tissue Regeneration: A Review for Tissue Engineers and Dentists

The paradigm shift in the endodontic field from replacement toward regenerative therapies has witnessed the ever-growing research in tissue engineering and regenerative medicine targeting pulp-dentin complex in the past few years. Abundant literature on the subject that has been produced, however, is scattered over diverse areas of knowledge. Moreover, the terminology and concepts are not always consensual, reflecting the range of research fields addressing this subject, from endodontics to biology, genetics, and engineering, among others. This fact triggered some misinterpretations, mainly when the denominations of different approaches were used as synonyms. The evaluation of results is not precise, leading to biased conjectures. Therefore, this literature review aims to conceptualize the commonly used terminology, summarize the main research areas on pulp regeneration, identify future trends, and ultimately clarify whether we are really on the edge of a paradigm shift in contemporary endodontics toward pulp regeneration.

The Remineralization Effect of Calcium Glycerophosphate in Fluoride Mouth Rinse on Demineralized Primary Enamel: An in vitro Study

Aim

To evaluate the remineralization effect of a fluoride mouth rinse containing calcium glycerophosphate in fluoride mouth rinse based on the surface microhardness of demineralized primary enamel.

Materials and Methods

40 sound primary incisors were placed into self-curing acrylic resin and subjected to a demineralizing solution for 5 days, resulting in the formation of artificial caries. The teeth were categorized into four groups (n = 10): group I artificial saliva, group II sodium fluoride, group III sodium fluoride + sodium monofluorophosphate, and group IV sodium monofluorophosphate + calcium glycerophosphate. The specimens received a pH cycling procedure and were submerged twice in their assigned groups for 7 days. The baseline, after demineralization, and after remineralization surface microhardness values were determined. One-way analysis of variance (ANOVA) was used to analyze the mean surface microhardness between groups and one-way repeated measures ANOVA for the mean surface microhardness within each group and Bonferroni's for multiple comparisons at 95% confidence level. The percentage recovery surface microhardness was determined by calculating the average surface microhardness.

Results

After demineralization, the mean surface microhardness in all groups significantly decreased. After remineralization, group I had the lowest surface microhardness values and the percentage recovery surface microhardness (P value < 0.001), and group IV had the highest surface microhardness values and the percentage recovery surface microhardness (P value < 0.001). No significant difference was found between groups II and III (P value = 0.365).

Conclusions

Fluoride mouth rinse containing calcium glycerophosphate has a remineralization effect on demineralized primary enamel.

Salivary Interleukin Levels in Oral Squamous Cell Carcinoma and Oral Epithelial Dysplasia: Findings from a Sri Lankan Study

The incidence of oral squamous cell carcinoma (OSCC), and its precursor, oral epithelial dysplasia (OED), is on the rise, especially in South Asia. OSCC is the leading cancer in males in Sri Lanka, with >80% diagnosed at advanced clinical stages. Early detection is paramount to improve patient outcome, and saliva testing is a promising non-invasive tool. The aim of this study was to assess salivary interleukins (lL1β, IL6, and IL8) in OSCC, OED and disease-free controls in a Sri Lankan study cohort. A case-control study with OSCC (n = 37), OED (n = 30) patients and disease-free controls (n = 30) was conducted. Salivary lL1β, IL6, and IL8 were quantified using enzyme-linked immuno-sorbent assay. Comparisons between different diagnostic groups and potential correlations to risk factors were assessed. Salivary levels for the three tested interleukins increased from disease-free controls through OED, and were highest in OSCC samples. Furthermore, the levels of IL1β, IL6, and IL8 increased progressively with OED grade. The discrimination between patients (OSCC and OED) and controls, as assessed by AUC of receiver operating characteristic curves, was 0.9 for IL8 (p = 0.0001) and 0.8 for IL6 (p = 0.0001), while IL1β differentiated OSCC from controls (AUC 0.7, p = 0.006). No significant associations were found between salivary interleukin levels and smoking, alcohol, and betel quid risk factors. Our findings suggest that salivary IL1β, IL6, and IL8 are associated with disease severity of OED, and are potential biomarkers for predicting disease progression in OED, and the screening of OSCC.

Awareness and knowledge of oral manifestations in cardiovascular diseases among the general public

Cardiovascular diseases (CVDs) are disorders affecting the heart and blood vessels. Periodontal problems, bleeding gums, dry mouth, and gingival hyperplasia are common oral manifestations seen in cardiovascular-related problems. To assess the extent of awareness and knowledge, the general public has toward the oral manifestation related to that of CVDs. A questionnaire was distributed among the general public in relation to that of the extent of awareness and knowledge of oral manifestations with regard to CVD. A total of 161 responses were collected from the survey. The collected data were compiled and analyzed by the SPSS software; the Pearson Chi-square test was done where P < 0.05 was considered statistically significant. The study showed that 65.22% of the population is aware of the types of CVD. About 59.63% of the population do not know that periodontal problems lead to cardiovascular problems. About 39.75% have vague knowledge about the maintenance of poor oral health causing cardiovascular problems. The study concluded that the general public is not much aware of the oral manifestations related to that of CVDs.

Effect of fixed orthodontic appliances on gingival status and oral microbiota: a pilot study

Background

This pilot study aimed to investigate how fixed orthodontic appliances simultaneously applied on the upper and lower arches affect the oral environment in the medium term.

Methods

The oral status of 30 orthodontic patients was evaluated using the number of decay-missing-filled teeth (DMFT), plaque (PI), and gingival indices (GI) before bonding of fixed orthodontic appliances (T0) and during the therapy (T1). Besides, the gingival crevicular fluid (GCF) and a dental plaque were collected. Samples were analyzed for selected Candida sp. and for 10 selected oral bacteria using mass spectroscopy and multiplex polymerase chain reaction, respectively.

Results

In 60% of patients, deterioration of the oral status (demonstrated by the increase in PI) was recorded (p < 0.05). Moreover, the changes in PI correlated with those of GI (p < 0.001). At the T1 time point, the mean representation of Actinomyces sp. in the total prokaryotic DNA in GCF and dental plaque of individual patients increased compared to T0 (p < 0.05). The probability of finding any of the 7 selected periodontal bacteria combined with Candida sp. was 10 times higher in patients in whom PI deteriorated between T0 and T1 (p < 0.01).

Conclusions

Changes in the oral microbial diversity and an increase in PI were observed in the medium term after bonding of orthodontic appliance. Our study highlights the importance of a complex approach in this type of research as the association between clinical characteristics and combined microbial parameters is higher than when evaluated separately.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02511-9.

Recruitment and retention of the rural podiatry workforce in Aotearoa New Zealand: a qualitative descriptive study of podiatrist perceptions

Background

Past research into the Aotearoa New Zealand (NZ) podiatry workforce has indicated a shortage of podiatrists, particularly in rural NZ. However, there has been no research investigating the characteristics of the NZ rural podiatry workforce. This study aimed to explore the factors which contribute to recruitment and retention of primary care podiatrists in rural NZ.

Methods

A qualitative descriptive approach was implemented for data collection and analysis. Semi-structured interviews were conducted with 15 podiatrists who currently, or previously, worked in a rural podiatry practice. Manifest content analysis was used to analyse participant’s responses. A deductive approach was used where data were identified and coded according to predetermined themes from the literature.

Results

Four themes that influenced recruitment and retention were derived from the interviews: (1) professional factors, (2) economic factors, (3) social factors, and (4) external factors. Interviews revealed that clinical inexperience, a sole practice environment, professional and social isolation, and workload pressures combined to affect recruitment and retention. Strong community bonds, family ties, and a rural background were crucial to thrive in the rural setting.

Conclusion

A sustainable rural podiatry workforce is required to reduce health disparities that exist in NZ rural communities. The study identified that most practitioners entered the rural workforce into self-employed positions, often shortly following graduation from university. They soon reported feelings of professional isolation due to limited support networks. Practitioners established in the rural workforce noted significant workload stresses. Stresses stemming from an inability to source locums, take time away from work, or recruit new staff to fill vacant positions. Research examining support mechanisms for inexperienced practitioners and targeted strategies to grow the rural workforce and reduce attrition is required.

[Accuracy of the Cameriere's method and its variant the European Formula for age estimation in subadult peruvian population]

Objective

To determine the accuracy of the Cameriere method and its variant, the European Formula, in a sub-adult Peruvian population; and determine a chronological age predictor equation.

Materials and methods

Descriptive, observational, cross-sectional and retrospective study. It was used 257 digital panoramic radiographs of patients in mixed dentition from 5 to 12 years of age belonging to the "Dental Cientifica" Dental Center of the Universidad Cientifica del Sur in the city of Lima, Peru. All morphological variables and gender of the subjects were used as predictor variables for age estimation. To evaluate the accuracy of each estimation method, the age of each individual was compared with the estimated age using the mean prediction error. Multiple linear regression was used to generate the predictive equation for chronological age.

Results

It was found that the mean prediction error between the chronological age with respect to the age estimated by the Cameriere method Formula and the European Formula was 0.73±0.55 years and 0.77±0.57 years, respectively. A model was generated whose predictor variables for age were s and N0, both variables were statistically significant and the Adjusted R2 for the number of variables was 75.96%.

Conclusion

It was determined that Cameriere's Formula was more accurate than the European Formula; however, there was no statistically significant difference between the two. Additionally, it was possible to establish a specific linear regression formula for a Peruvian population aged 5 to 12 years with an adequate predictive capacity.

Effects of Methamphetamine Withdrawal on the Volume and pH of Stimulated Saliva

STATEMENT OF THE PROBLEM

As a stimulant drug of the central nervous system, methamphetamine reduces salivary secretion by stimulating inhibitory α2-receptors in the sympathetic system. The acidity of this substance reduces the salivary pH and causes severe dental caries and erosion in the cervical region of teeth, appearing as "meth mouth".

PURPOSE

This study aimed to determine the effects of methamphetamine withdrawal on the volume and pH of stimulated saliva in patients under treatment at rehabilitation centers.

MATERIALS AND METHOD

This descriptive cross-sectional study was conducted on a total of 20 individuals at the rehabilitation centers of Gorgan, Iran. The volume and pH of stimulated saliva were measured at three intervals: before withdrawal, four days after withdrawal, and 30 days after withdrawal. Data analysis was performed using ANOVA test in SPSS.

RESULTS

The results showed a significant difference in the mean volume of saliva before and after withdrawal (p< 0.05). Thirty days after withdrawal, the mean volume of saliva was significantly different from the mean volume after four days (p< 0.05). Moreover, the mean pH of saliva after withdrawal was significantly different from the mean pH before withdrawal (p< 0.001). On the other hand, the mean salivary pH at 30 days after withdrawal was not significantly different from the mean pH on the fourth day after withdrawal (p> 0.05).

CONCLUSION

It seems that methamphetamine withdrawal influences the volume and pH of stimulated saliva in patients under treatment at rehabilitation centers.

Determinants of oral-health-related quality of life among adult people in Iran

BACKGROUND

Oral health-related quality of life (OHRQoL) assesses the subjective perception of oral health and its impact on the quality of life. The aim of this study is to measure the OHRQoL and its determinants among adult people living in Kerman, Iran.

MATERIALS AND METHODS

In this cross-sectional study, a total of 5657 adult people (18-64 years) residing in the Kerman district, both in the rural and urban areas, were enrolled in the study between September 2014 and April 2018. The Oral Health Impact Profile (OHIP-14) and the oral health indices, such as the total decayed, missing, filled teeth (DMFT), community periodontal index (CPI), gingival index (GI), and xerostomia, were measured by an experienced dentist. The demographic variables of gender, age, educational status, and marital status were also recorded. The impact of the studied variables on OHRQoL was evaluated with multiple logistic regression.

RESULTS

Participants were 2239 (39.58%) men, and average age was 45.39. The mean scores for OHRQoL, DMFT, CPI and GI were respectively: 24.07 (7.76), 10.7 (6.86), 0.76 (0.96), 0.63 (0.8). The frequency of people with xerostomia was 37.4. 301 (53.3%) of people had poor quality of life related to oral health. In multivariable analysis, there was a statistically significant increase in OHRQoL with an increase in the DMFT (P < 0.001), xerostomia (P < 0.001), CPI, (P < 0.001). Men had a significantly higher OHIP score than women (P < 0.001).

CONCLUSION

According to the results of this study, DMFT, xerostomia, and CPI scores are strongly related to OHIP scores. In addition, between CPI and GI scores, the CPI score is the better predictor.

Effect of Calcium Hydroxide and Nano Calcium Hydroxide on Push-out Bond Strength of Epoxy Resin Sealer to Root Canal Dentin

Introduction

The goal of this paper was to determine the impact of calcium hydroxide (CH) and nano-calcium hydroxide (NCH) on the push-out bond strength of an epoxy resin-based sealer.

Materials and Methods

A total of 48 mandibular premolars were decoronated in vitro and instrumented by a ProTaper rotary system up to F4. The specimens then were randomly allocated into 3 groups (n=16). The two intervention groups were treated with either CH or NCH and one control group which did not receive any intracanal medicament. After one week of medicament placement, the specimens were irrigated by 10 mL 17% EDTA, followed by 10 mL 2.5% NaOCl and an ultimate flushing by 5 mL sterile saline. The samples were obturated using AH-Plus Jet sealer and gutta-percha by lateral condensation technique. Push-out test was done by a universal test machine to evaluate the bond strength among the sealer and the root canal dentin. Repeated measurement analysis followed by Tukey's HSD and Bonferroni post-hoc tests were used for data analysis.

Results

The control group showed a higher push-out bond strength in comparison to the specimens in the CH and NCH groups (P<0.05). In spite of the greater push-out bond strength of the samples treated with NCH in comparison to those in CH group, no statistically notable difference was found among them (P>0.05). Additionally, irrespective of the kind of medicament, the bonding at the apical level of the root canal was stronger compared to the coronal third (P<0.001).

Conclusion

According to the present in vitro study, application of CH and NCH resulted in a significant reduction of the bond strength between the epoxy resin-based sealer and dentinal walls. Although, application of these medicaments resulted in reduction of bonding of epoxy resin-based sealers root canal dentin significantly.

Machine learning assisted Cameriere method for dental age estimation

Background

Recently, the dental age estimation method developed by Cameriere has been widely recognized and accepted. Although machine learning (ML) methods can improve the accuracy of dental age estimation, no machine learning research exists on the use of the Cameriere dental age estimation method, making this research innovative and meaningful.

Aim

The purpose of this research is to use 7 lower left permanent teeth and three models [random forest (RF), support vector machine (SVM), and linear regression (LR)] based on the Cameriere method to predict children's dental age, and compare with the Cameriere age estimation.

Subjects and methods

This was a retrospective study that collected and analyzed orthopantomograms of 748 children (356 females and 392 males) aged 5–13 years. Data were randomly divided into training and test datasets in an 80–20% proportion for the ML algorithms. The procedure, starting with randomly creating new training and test datasets, was repeated 20 times. 7 permanent developing teeth on the left mandible (except wisdom teeth) were recorded using the Cameriere method. Then, the traditional Cameriere formula and three models (RF, SVM, and LR) were used to estimate the dental age. The age prediction accuracy was measured by five indicators: the coefficient of determination (R²), mean error (ME), root mean square error (RMSE), mean square error (MSE), and mean absolute error (MAE).

Results

The research showed that the ML models have better accuracy than the traditional Cameriere formula. The ME, MAE, MSE, and RMSE values of the SVM model (0.004, 0.489, 0.392, and 0.625, respectively) and the RF model (− 0.004, 0.495, 0.389, and 0.623, respectively) were lower with the highest accuracy. In contrast, the ME, MAE, MSE and RMSE of the European Cameriere formula were 0.592, 0.846, 0.755, and 0.869, respectively, and those of the Chinese Cameriere formula were 0.748, 0.812, 0.890 and 0.943, respectively.

Conclusions

Compared to the Cameriere formula, ML methods based on the Cameriere’s maturation stages were more accurate in estimating dental age. These results support the use of ML algorithms instead of the traditional Cameriere formula.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01996-0.

Salivary pH changes under the effect of stainless steel versus elastomeric ligatures in fixed orthodontic patients: a single-center, randomized controlled clinical trial

BACKGROUND

Fluctuations in pH of saliva during a prolonged treatment course influences the enamel demineralization progress, which is one of the complications of fixed orthodontic treatment. This randomized clinical trial aimed to evaluate and compare the short-term effects of stainless steel (SS) versus elastomeric (EM) ligatures on salivary pH in patients scheduled for fixed orthodontic treatment.

METHODS

Seventy participants were enrolled in the study (54 female, 16 male) aged 19-36 years who met specific inclusion criteria. They were randomly selected and allocated into two equal groups through computer-generated randomization. All patients received fixed orthodontic treatment using conventional orthodontic brackets. Two commonly used archwire ligature methods were used: SS and EMs. An unstimulated (resting) salivary sample was collected before tying of the ligatures at T0 (baseline), 2 weeks, 6 (weeks), and 12 (weeks). Salivary pH was measured using a digital pH meter. The level of significance was set at p value < 0.05.

RESULTS

The salivary pH level was stable between T0 and T1 (6.72 ± 0.14), then significantly and progressively increased from T1 to T2 (6.78 ± 0.13) and from T2 to T3 (6.81 ± 0.14) with (p < 0.05) in the SS group. In the EM group, the salivary pH level was significantly decreased in all follow-up periods; T0 (6.77 ± 0.16), T1 (6.72 ± 0.14), T2 (6.67 ± 0.13) and T3 (6.64 ± 0.13).

CONCLUSION

The EM ligatures showed a significant decrease in salivary pH to an unfavorable level, which increased the risk of enamel demineralization. Therefore, EMs as ligature material is preferably should not be recommended in patients with high caries index or inadequate oral hygiene. Trial registration ANZCTR.org. (ACTRN12618001647224) http://www.anzctr.org.au/ACTRN12618001647224.aspx . Registration Date: 5/10/2018, "Retrospectively registered".

Diagnostic salivary biomarkers in oral cancer and oral potentially malignant disorders and their relationships to risk factors - A systematic review

INTRODUCTION

Oral squamous cell carcinoma (OSCC) and oral potentially malignant disorders (OPMD) are a significant health burden globally. Smoking, alcohol, and betel quid are the main risk factors. Lack of screening methods has been highlighted as a significant challenge in management. Salivary biomarkers are proposed as noninvasive diagnostic tools. The aim of this systematic review was to study salivary biomarkers reported in OSCC and OPMD. Specific objectives were to select a salivary biomarker panel suitable for early detection of OSCC and OPMD and to assess relationships between salivary biomarkers and risk factors.

METHODS

Electronic literature search was conducted in academic databases (Scopus, Medline, Embase and Web of Science) without any restrictions. Following calibration, two blinded reviewers screened the studies and extracted data. A risk of bias assessment was conducted using Newcastle Ottawa scale. 295 studies were included with descriptive data analysis.

EXPERT OPINION

A salivary biomarker panel including Interleukin (IL) 1β, IL6, and IL8 was selected for OSCC and OPMD. Reported relationships between salivary biomarkers and risk factors are discussed and research gaps are highlighted. Future research should be directed to assess potential salivary biomarkers and their relationships to risk factors in order to understand the biomarker's role in disease initiation.

Impact of Planning Method (Conventional versus Virtual) on Time to Therapy Initiation and Resection Margins: A Retrospective Analysis of 104 Immediate Jaw Reconstructions

Simple Summary

Computer-aided design and manufacturing of osseous reconstructions are currently widely used in jaw reconstructive surgery, providing an improved surgical outcome and decreased procedural stumbling block. However, data on the influence of planning time on the time-to-surgery initiation and resection margin are missing in the literature. This retrospective, monocentric study compares process times from the first patient contact in hospital, time of in-house or out-of-house biopsy for tumor diagnosis and surgical therapy of tumor resection, and immediate reconstruction of the jaw with free fibula flaps (FFF). Two techniques for reconstruction are used: Virtual surgical planning (VSP) and non-VSP. A total of 104 patients who underwent FFF surgery for immediate jaw reconstruction from 2002 to 2020 are included. The study findings fill the gaps in the literature and obtain clear insights based on the investigated study subjects.

Abstract

Virtual surgical planning (VSP) and patient-specific implants are currently increasing for immediate jaw reconstruction after ablative oncologic surgery. This technique contributes to more accurate and efficient preoperative planning and shorter operation time. The present retrospective, single-center study analyzes the influence of time delay caused by VSP vs. conventional (non-VSP) reconstruction planning on the soft and hard tissue resection margins for necessary oncologic safety. A total number of 104 cases of immediate jaw reconstruction with free fibula flap are included in the present study. The selected method of reconstruction (conventionally, non-VSP: n = 63; digitally, VSP: n = 41) are analyzed in detail. The study reveals a statistically significant (p = 0.008) prolonged time to therapy initiation with a median of 42 days when the VSP method compared with non-VSP (31.0 days) is used. VSP did not significantly affect bony or soft tissue resection margin status. Apart from this observation, no significant differences concerning local tumor recurrence, lymph node, and distant metastases rates are found according to the reconstruction method, and affect soft or bone tissue resection margins. Thus, we conclude that VSP for immediate jaw reconstruction is safe for oncological purposes.

Analytical Study of Etiopathological Factors Responsible for Oral Squamous Cell Cancer in Bihar Population

Background

Squamous cell carcinoma (SCC) of maxillofacial region is the most usual form of neoplasia causing malignancies in India and Asian continent. An increased prevalence of mortality rate by cancer of maxillofacial region was observed in various parts of the world.

Objectives

Our aim was to correlate age and gender with etiopathological factors contributing to oral squamous cell carcinoma (OSCC) in the urban population of Patna in 2 years.

Materials and Methods

Data were extracted from hospital records. A total of 236 cases of histologically confirmed mild to advance stage of OSCC in either gender of 15-80 years of age range were evaluated.

Results

Out of 236 histopathologically confirmed patients with OSCC, 172 were male and 64 were female. Insignificant difference was found in all age-groups and in all locations. Most common site was found to be buccal mucosa in both genders. Bony invasion was found to be least common. In our study, it was found that habits of chewing areca nuts, nicotine smoke addiction, consumption of alcohol, combination of chewing nuts and nicotine smoke addiction, and combination of alcohol and nicotine smoke addiction are significantly related to the development of OSCC. No significant association was found between histopathological conclusion and gender in all the four groups, and the prevalence was directly proportional to advancement of age.

Conclusion

We concluded that the OSCC do not have any significant relation with the age and gender. The habit of nicotine and areca nut chewing, nicotine smoke addiction, and combination of nicotine smoke addiction and alcohol and chewing nut and nicotine smoke addiction has significant relationship in the development of OSCC.

Awareness About Medication-Related Osteonecrosis of the Jaw Among Dental Professionals: A Multicentre Study

PURPOSE

Bisphosphonates and non-bisphosphonate antiangiogenic and antiresorptive agents are widely used in the management of bone diseases and cancer. A subset of patients receiving these drugs can manifest with medication-related osteonecrosis of the jaw (MRONJ) and it is one of the major complications faced in dental practice. Dentoalveolar and periodontal surgery are the major risk factors associated with it. Therefore, a dentist must have adequate knowledge to promptly identify patients at risk and efficiently manage the condition. This multicentre study was designed with an aim to assess the level of knowledge and awareness regarding MRONJ among dentists from six dental schools.

METHODS AND MATERIALS

An online self-administered questionnaire was sent to all the dentists from six dental schools through Google forms. The results obtained were statistically analysed. The Kolmogorov-Smirnov test was performed to check for normality of data, while the Mann-Whitney U-test and chi-square test were used to compare the responses to each question.

RESULTS

The questionnaire was sent to 570 dentists, out of which 234 responses were obtained. The majority of participants were aware of the term 'MRONJ' (83.3%), clinical indications of bisphosphonates (61.5%) and its mechanism of action (72.2%). However, 68.4% and 61.5% of dentists had no knowledge about the 'drug holiday' concept and risk factors associated with MRONJ, respectively.

CONCLUSION

Although most of the participants had knowledge regarding certain aspects of MRONJ, such as mechanism of action and clinical indications of bisphosphonates, there was a lack of awareness about the drug holiday concept and drug-associated risk factors. This emphasises the need to spread awareness among the dental community, not only in tertiary healthcare centres, but also among private dentists and dental interns to prevent cases of MRONJ.

m-Health for Early Detection of Oral Cancer in Low- and Middle-Income Countries

Background: Up to 86% of oral cancer (OC) patients present at the late stage where survival is dismal. Limited access to specialist diagnosis is a significant factor for late presentation. The increasing use of smartphones presents an opportunity to use digital technology to facilitate early detection of OC. Aim: To evaluate the feasibility of using Mobile Mouth Screening Anywhere (MeMoSA^®) to facilitate early detection of OC. Methods: A mobile phone app named MeMoSA was developed and the feasibility of integrating this for documentation of oral lesions, and communication between dentists and specialists for management decisions were evaluated. The experience of dentists and specialists in using MeMoSA was determined using qualitative questionnaires. Results: Communication between specialist and dentists using MeMoSA stratified cases and streamlined referral of patients. Twelve of 48 patients were found to have oral lesions or signs suspicious of cancer and 3 required referrals. The patient's compliance for referral was tracked with MeMoSA. All dentists agreed that MeMoSA could facilitate early detection of OC and believed that MeMoSA could assist in the identification of oral mucosal lesions through direct communication with specialists and continuous learning in the recognition of high-risk lesions. Conclusions: MeMoSA has the potential to be used to promote equitable health care and streamline patient management that could result in early detection of OC.

The role of adjuvant treatment in early-stage oral cavity squamous cell carcinoma: An international collaborative study

BACKGROUND

Up to half of patients with oral cavity squamous cell carcinoma (OCSCC) have stage I to II disease. When adequate resection is attained, no further treatment is needed; however, re-resection or radiotherapy may be indicated for patients with positive or close margins. This multicenter study evaluated the outcomes and role of adjuvant treatment in patients with stage I to II OCSCC.

METHODS

Overall survival (OS), disease-specific survival, local-free survival, and disease-free survival rates were calculated with Kaplan-Meier analysis.

RESULTS

Of 1257 patients with T1-2N0M0 disease, 33 (2.6%) had positive margins, and 205 (16.3%) had close margins. The 5-year OS rate was 80% for patients with clear margins, 52% for patients with close margins, and 63% for patients with positive margins (P < .0001). In a multivariate analysis, age, depth of invasion, and margins were independent predictors of outcome. Close margins were associated with a >2-fold increase in the risk of recurrence (P < .0001). The multivariate analysis revealed that adjuvant treatment significantly improved the outcomes of patients with close/positive margins (P = .002 to .03).

CONCLUSIONS

Patients with stage I to II OCSCC and positive/close margins have poor long-term outcomes. For this population, adjuvant treatment may be associated with improved survival. Cancer 2018;124:2948-55. © 2018 American Cancer Society.