Oral Manifestations: A Reliable Indicator for Undiagnosed Diabetes Mellitus Patients

OBJECTIVES

 This article identifies undiagnosed DM (UDM) cases in the Pakistani population by perceiving the signs and symptoms of DM and associating them with oral manifestations.

MATERIAL AND METHODS

 In this cross-sectional study, patients showing at least three or more classical or warning signs like polydipsia, polyuria, polyphagia, and general weakness were considered UDM cases. Detailed oral examination for gingivitis, periodontitis, halitosis, xerostomia, and tongue manifestations was done followed by the hemoglobin A1c (HbA1c) analysis.

RESULTS

 Out of 5,878 patients, 214 UDM cases were identified, where 31.8% and 39.7% of the patients were diagnosed as prediabetics and diabetics, respectively, based on HbA1c analysis. Prevalence of gingivitis (97.6%), fissured tongue (91.8%), generalized periodontitis (85.9%), thick saliva (87.1%), xerostomia (84.7%), burning mouth syndrome (63.5%), yellow discoloration of tongue (57.6%), and ecchymosis/ulcers (43.5%) were more in diabetics as compared to prediabetic patients and normal population.

CONCLUSION

 The oral manifestations can be crucial for identifying UDM cases. Dentists can play a pivotal role by taking detailed history and thorough oral examination. If three or more symptoms as concluded above are present, an HbA1c analysis should be conducted to prevent preop and postop complications associated with DM.

Dental aesthetic related popularity and peer pressure, a survey of adolescents in Pakistan

OBJECTIVES

Most research has focused on determining how popularity and peer pressure impact behaviours, rather than identifying a key feature such as dental aesthetics and studying its impacts in relation to popularity and peer pressure.

METHODS

A cross sectional study was conducted on a sample of 527 children from four schools located in Lahore, Pakistan. A 14-point questionnaire was developed, using existing measures of peer pressure, and popularity. The selected questions were modified to investigate the issues of dental aesthetics and integrated into the WHO oral health questionnaire for children.

RESULTS

More than 50 % of the participants indicated popularity issues regarding dental aesthetics. 63.5 % of the responses indicated an influence of relatives and friends, whereas 38 % responses reported of harassment and bullying at schools. Regression analysis shows that the females were 1.99 times more likely to get comments from relative or friends about their teeth and 2.17 times more likely to be bullied or harassed at school due to their teeth when compared to the males. Fathers with a higher education brought about higher popularity and peer pressure issues. Mothers with a higher education were less likely to cause popularity and peer pressure issues than mothers with a lower education. Popularity and peer pressure were both significantly related to higher dental visitation.

CONCLUSIONS

Popularity and peer pressure have a direct link to dental aesthetics in an individual and are impacted by gender, family relatives and parental influences. The area of popularity and peer pressure related to dental aesthetics can be targeted in health education programs to empower children to adopt better oral health behaviours.

Impact of Harvesting Method and Donor Age on the Behavior of Human Osteoblast-Like Cells

Autogenous particulate bone grafts are being utilized in oral implantology for minor grafting procedures. This study aimed to investigate the influence of the bone-harvesting technique, donor age, and donor site on proliferation and differentiation of human primary osteoblast-like cells in the cell culture. Autogenous bone particles (20 samples) were harvested from the maxilla and mandible during surgery using two different protocols, and two types of particulate bone grafts were collected: bone chips and bone sludge. Bone samples were cultured in growth medium and, after 2 to 3 weeks, the cells that grew from bone grafts were cultured in the normal and osteogenic medium for 0, 4, 7, and 20 days. DNA, alkaline-phosphatase (ALP), calcium-content measurements, and Alizarin red/toluidine blue staining were performed. Data were analyzed by repeated-measures analysis of variance with Bonferroni test. The level of statistical significance was set at 5% (P < .05). Total DNA, ALP, and calcium content were significantly higher for the bone chip samples compared to the bone sludge samples. Total DNA and ALP content were significantly higher for the patients in age group 1 (≤ 60 years) compared to age group 2 (> 60 years) and was significantly higher for mandibular samples than maxillary samples on day 20. However, the calcium measurement showed no significant difference concerning donor age and donor site. Data analysis revealed that harvesting technique (bone chips vs bone sludge), donor age (≤ 60 years vs > 60 years), and donor site (maxilla vs mandible) influenced the osteogenic potential of the collected particulate bone graft. The bone chips were superior in terms of osteogenic efficacy and should be considered a suitable option for particulate bone graft collection.

Prevalence of periodontitis based on retrospective radiographic evaluation at dental hospital in Eastern Province of Saudi Arabia: A retrospective study

Objectives

The contemporary information on the prevalence of periodontitis and associated risk factors is deficient in the Kingdom of Saudi Arabia. Our aim was to measure the prevalence of periodontitis and associated risk factors among the Saudi population in the Eastern Province of Saudi Arabia who visited the University Dental Hospital.

Methods

In this retrospective study, the demographic data and medical and dental records of 700 subjects were examined. Bitewing radiographs were analyzed to measure the alveolar bone loss in posterior teeth by measuring the distance between the cementoenamel junction and the crest of the alveolar bone. A chi-square test was performed to compare the severity of periodontitis. A comparison of multivariate mean bone loss was performed using a t-test. Logistic regression analysis was used to evaluate the predictors of periodontitis. A P-value equal to or under 0.05 reflected statistical significance.

Results

Among 700 cases, the patients' mean age was 35.6 ± 12.1; 52.6 % were male and 47.4 % were female. Overall periodontitis prevalence was 52.1 %. The distribution of mild, moderate, and severe periodontitis prevalence was 36.1 %, 14.1 %, and 1.8 %, respectively. The severity of periodontitis was statistically similar between males and females (p = 0.148); however, significantly more Saudi than non-Saudi patients had moderate periodontitis. Higher proportions of severe periodontitis were seen in the age group of over 50-years-old (p < 0.001) and in patients with poor oral hygiene (p < 0.001), diabetes mellitus (p < 0.005), and hypertension (p < 0.002). Six total predictors of periodontitis were depicted, i.e., age > 50 years (OR = 3.73), poor OH status (OR = 2.24), BOP (OR = 3.35), presence of plaque (OR = 2.61), diabetes mellitus (OR = 3.19), and hypertension (OR = 3.62).

Conclusion

The primary factors associated with the prevalence of periodontitis were age, nationality, diabetes, hypertension, BOP, plaque, and OH status. However, no association was observed between gender or cardiovascular disease and the prevalence of periodontitis in the studied population.

Safe protocol of resuming routine dental procedures in a tertiary care hospital setting post COVID-19 lockdown

BACKGROUND: The outbreak of the COVID-19 pandemic greatly affected dentistry. Dental procedures are considered one of the modes of transfer of COVID-19 infection due to generation of aerosols. To prevent transmission of this virus through dental procedures, guidelines were issued by the World Health Organisation (WHO), Centers for Disease Control and Prevention (CDC) and Ministry of Health of each country. OBJECTIVE: The aim of this study is to establish a safe protocol for performing dental procedures in a crisis capacity situation of personal protective equipment (PPE). METHODS: A strategy for performing the dental procedures was formulated in accordance with the guidelines provided by the Ministry of Health, Pakistan before vaccination of HCPs against COVID-19. These guidelines also accorded the strategies provided by the WHO and CDC. 40 health care professionals (HCPs) participated in the study and were divided in two groups. Group A performed non-aerosol generating procedures (non- AGPs) and group B performed aerosol generating procedures (AGPs). A total of 6372 aerosol generating procedures were performed from 1 August 2020 to 31 March 2021. The safety of this protocol was established by the number of HCPs contracting COVID-19 infection. RESULTS: Only 1 HCP contracted COVID-19 infection preceding the AGPs from group B following the formulated strategy. CONCLUSION: Reported strategy based on the dental system in Pakistan is considered safe to be implemented worldwide during the COVID-19 pandemic.

Estimation of the risk of COVID-19 transmission through aerosol-generating procedures

BACKGROUND

The outbreak of the coronavirus disease 2019 (COVID-19) pandemic was associated with the provision of multiple guidelines for the dental profession. All elective procedures were restricted, and only emergency procedures were performed. There was fear and anxiety among dentists while performing aerosol-generating procedures (AGPs), as they were considered to pose a high risk of COVID-19 transmission.

OBJECTIVES

The aim of this study was to assess the risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during AGPs, and to examine the association between risk severity and the number of AGPs performed per day. The efficacy of personal protective equipment (PPE) was also assessed.

MATERIAL AND METHODS

This cross-sectional cohort study was based on an online questionnaire form completed by 629 general and specialized dentists between January 1 and February 28, 2021. The collected data referred to the sources of COVID-19 infection, the type of PPE used and the number of AGPs performed each day by dental healthcare professionals (DHCPs). For each question, the absolute numbers of responses as well as percentages were calculated.

RESULTS

Among the 629 DHCPs, 113 (17.97%) contracted COVID-19. The risk of contracting COVID-19 during AGPs was the same as in the case of non-AGPs, and the infection risk was not associated with the number of AGPs performed per day. The efficacy of a surgical mask with a face shield/eye goggles was higher in comparison with all other types of PPE. Differences in the infection risk across the different types of PPE used were statistically significant (p < 0.001).

CONCLUSIONS

The risk of COVID-19 transmission during AGPs is the same as in the case of non-AGPs. Thus, restrictions on the performance of elective AGPs should be lifted. On the other hand, the best protection during AGPs is provided by a surgical mask with a face shield/eye goggles.

A Prospective Randomized Clinical Trial on Radiographic Crestal Bone Loss Around Dental Implants Placed Using Two Different Drilling Protocols: 12-Month Follow-up

PURPOSE

There is a substantial need to perform studies to evaluate crestal bone loss (CBL) and implant success when using a newly introduced low-speed drilling protocol. Therefore, this study aimed to evaluate the mean CBL and implant success rate by placing implants utilizing two drilling protocols, ie, standard and low-speed drilling protocols.

MATERIALS AND METHODS

A randomized controlled clinical trial was carried out in patients who required dental implants to restore their esthetics and function. The patients were recruited from a university hospital (Academic Centre for Dentistry Amsterdam [ACTA], the Netherlands). Based on the inclusion criteria, patients were randomized to two study groups: (1) control group, standard drilling protocol; and (2) test group, low-speed drilling protocol without saline irrigation. The mean CBL and the implant success rate were evaluated after 12 months of implant placement.

RESULTS

Twenty-three patients (15 men and 8 women with a mean age of 57.5 ± 10.7 years) contributed to the study. Forty Camlog screw-line implants were placed (20 implants per study group). After 12 months of implant placement, the mean CBL of implants placed with the standard protocol and the low-speed protocol was 0.206 ± 0.251 mm and 0.196 ± 0.178 mm, respectively. No statistically significant difference could be recorded among both groups (P = .885). Concerning implants placed in the maxilla, the standard drilling group and low-speed drilling group showed a mean CBL of 0.252 ± 0.175 mm and 0.251 ± 0.175 mm, respectively, compared with 0.173 ± 0.210 mm and 0.141 ± 0.172 mm in the mandible, with no significant difference. The success rate of dental implants at 12 months was 95% in the control group and 90% in the test group.

CONCLUSION

Within the limitations of this study, it can be concluded that implants placed with the low-speed drilling protocol without saline irrigation exhibited a similar CBL compared with implants placed with the standard drilling protocol. However, a higher success rate was recorded especially in type 1-quality bone for the control group compared with the test group. Further randomized clinical trials with greater sample sizes and extended follow-up times should be performed to obtain stronger evidence and a better understanding of the influence of drilling speed on mean CBL and long-term implant success.

Prevalence of Xerostomia and Associated Systemic Risk Factors in Riyadh, Saudi Arabia: A Cross-sectional Study

Purpose: Xerostomia is a feeling of dry mouth and may result in poor oral hygiene, dental caries, mucosal lesions and burning mouth syndrome. Medication, systemic diseases and stress are common etiological factors of xerostomia. The present study investigated the prevalence of xerostomia and explored the possible risk factors associa­ted with this condition among Saudi population. Methods: The present cross-sectional study was conducted on 418 participants visiting at Maxillofacial clinic, at secondary care hospital, Riyadh.  Demographic data and complete medical history were obtained from participants. All participants were requested to fill the Xerostomia-Inventory (XI) questionnaire. Comparisons between mean scores of XI-inventory and categorical variables like gender, comorbid conditions were made with students t-test or Wilcoxon test. Chi-square or Fischer’s Exact test were used for comparison between categorical variables like gender and responses to XI-items (No/Yes). P value of <0.05 was considered significant. All analysis was done on JMP-version-12. Results: Total 418-participants with mean age (41.1 ± 12.8 years) were included in the study in which 302-participants (72.2%) were female and 116-participants (27.8%) were male. Xerostomia’s prevalence was 24.7% and it was higher in males (34%) as compared to females (21%). A statistically-significant association was found between xerostomia and participant’s age (P < 0.0001). The participants with systemic illness showed a significantly higher mean Xerostomia Inventory (XI) score as compared to the healthy patients. In our study population common comorbid conditions were hypertension and diabetes. Conclusion: The prevalence of xerostomia increases with increasing age and it has strong positive co-relation with chronic systemic diseases.

Assessing Knowledge, Attitude and Practices for Oral Squamous Cell Carcinoma among Health Care Professionals in Princess Nourah University, Riyadh, KSA

Background:

Oral Squamous Cell Carcinoma (OSCC) is a growing public health problem affecting 2.2 million of the world’s population per year and the rates are increasing annually. The disease is usually diagnosed in later stages, and carries high morbidity and mortality rates worldwide. Proper awareness among health care professionals (HCP) is the most significant factor for ensuring early diagnosis and treatment. They should have thorough knowledge to identify all suspicious lesions or otherwise to seek specialist opinion when unsure. The present study aimed to assess the knowledge, attitude, and practices (KAPs) of OSCC among dental and medical undergraduate students along with general practitioners and specialists of both disciplines.

Materials and Methods:

The present cross-sectional study was conducted at Princess Nourah Bint Abdulrahman University and its affiliated hospital. A total of 332 participants filled a close-ended online questionnaire. Responses to the questionnaire were analyzed using descriptive and analytical statistics.

Results:

Of the 450 health care professionals approached, 332 filled the questionnaire with a response rate of 73.77.%. It was observed that the mean knowledge index was higher among dental participants (10.96 ± 1.85). The attitude index was higher at medical side (6.89 ± 1.11), and the practice index was also higher among the dental participants (4.95 ± 0.91). Most of the health care professionals had knowledge regarding risk factors associated with OSCC. HCPs indicated their lack of training as the main barrier for conducting a comprehensive examination for OSCC. Interestingly, the vast majority of HCPs expressed their interest to have further educational and training sessions regarding this malignancy.

Conclusion:

The study puts forward, the need for intensive training and workshops for awareness and improvement of the abilities of the HCPs, (including dental and medical undergraduate students along with practitioners and specialists) to diagnose OSCC.

Imaging of cerebral complications of extracorporeal membrane oxygenation in infants with congenital heart disease - ultrasound with multimodality correlation

Cranial ultrasound on neonatal intensive care units is generally performed by intensive care physicians, but radiologists often provide this crucial bedside test to children on specialist paediatric cardiac intensive care units. On a paediatric cardiac intensive care unit, complex congenital cardiac conditions are commonly encountered in both pre- and postoperative scenarios, often with the use of extracorporeal membrane oxygenation (ECMO), which both increases the risks of a number of neurologic complications and results in significant changes in vascular physiology. The aim of this pictorial essay is to discuss cranial ultrasound technique, demonstrate the changes in Doppler flow profiles resulting from veno-arterial extracorporeal membrane oxygenation and congenital cardiac conditions, and illustrate commonly encountered intracranial complications of extracorporeal membrane oxygenation support in congenital cardiac care.

The HIV manifestations within the gastrointestinal tract: A pictorial review

The aim of the pictorial review are to review the HIV manifestations within the gastrointestinal tract. We have detailed five conditions, with reference to the patients’ CD4 count – gastrointestinal tuberculosis, Kaposi’s sarcoma, small bowel lymphoma, cytomegalovirus colitis and anal carcinoma.

Primary central nervous system lymphoma presenting as multiple space-occupying lesions in advanced human immunodeficiency virus infection

A 31-year-old man presented with seizures and cerebellar symptoms on a background of weight loss and lethargy. He was found to be infected with human immunodeficiency virus (HIV) and following radiological imaging, was commenced on treatment for presumed cerebral toxoplasmosis. Due to a lack of response, both clinically and on interval imaging, a positron-emission tomography-computed tomography and brain biopsy were undertaken, which demonstrated high-grade primary central nervous system lymphoma (PCNSL). Awareness amongst both clinicians and radiologists of the multifarious patterns of intra-cranial involvement in patients with HIV is, therefore, of utmost importance, as the treatment and prognosis of these entities are entirely different.

Unusual complication and successful high-dose chemotherapy treatment of advanced Burkitt’s lymphoma in an adult HIV-positive patient

Adult Burkitt’s lymphoma emerged as an AIDS-defining condition in the 1980s. We describe a case of HIV-associated adult Burkitt’s lymphoma diagnosed and treated with high-dose chemotherapy in our institution, complicated by unusual bilateral renal vein tumour thrombi and tumour lysis syndrome. We believe this unique case highlights the need for early recognition of current and potential complications on staging computed tomography imaging, as well as successful use of a high-dose chemotherapy regimen.

Radiology examination as a diagnostic aid in presentations with wide differential diagnoses: Case report of new Hodgkin's lymphoma on a background of poorly controlled HIV

Hodgkin's lymphoma and disseminated Mycobacterium avium complex (MAC) infection share similar clinical features; both may affect human immunodeficiency virus (HIV)-positive individuals. We discuss a patient with poorly controlled HIV-infection presenting with chest sepsis, dyspnoea and weight loss. Whilst the initial working diagnosis was that of MAC infection, pathology results had not met diagnostic criteria. Lymph node biopsy instead revealed classical Hodgkin's lymphoma. We discuss the role of radiological examination in cases of diagnostic uncertainty.

Delayed migration of a peripherally inserted central venous catheter to the azygos vein with subsequent perforation

Peripherally inserted central venous catheters (PICCs) are often used for infusion of chemotherapeutic agents, long-term antibiotics or total parenteral nutrition (TPN). We present a case of delayed migration of a PICC inserted for TPN from the superior vena cava into the azygos vein that was not initially recognized on chest radiographs or CT scan. This subsequently led to azygos perforation and extravasation of the TPN solution into the mediastinal, pleural and pericardial spaces. Several anatomical and procedural factors predispose to PICC migration. In this patient, the risk of PICC migration was increased by left-sided insertion and variant azygos anatomy. If a curve in the distal tip of a PICC is seen on a frontal chest radiograph, azygos malposition should be suspected and confirmed with a lateral radiograph, CT scan or catheter injection. This is because azygos malposition increases the risk of venous perforation and needs to be corrected.

Ethnic differences in correlates of microalbuminuria in NIDDM. The role of the acute-phase response

OBJECTIVE

To investigate whether microalbuminuria is associated with markers of the acute-phase response in NIDDM and whether there are ethnic differences in this association among the three main racial groups in Malaysia.

RESEARCH DESIGN AND METHODS

NIDDM patients of Chinese, Indian, and Malay origin attending a diabetic clinic in Kuala Lumpur, Malaysia, were matched for age, sex, diabetes duration, and glycemic control (n = 34 in each group). Urinary albumin-to-creatinine ratio was measured in an early morning urine sample. Biochemical measurements included markers of the acute-phase response: serum sialic acid, triglyceride, and (lowered) HDL cholesterol.

RESULTS

The frequency of microalbuminuria did not differ among the Chinese, Indian, and Malay patients (44, 41, and 47%, respectively). In Chinese patients, those with microalbuminuria had evidence of an augmented acute-phase response, with higher serum sialic acid and triglyceride and lower HDL cholesterol levels; and urinary albumin-to-creatinine ratio was correlated with serum sialic acid and triglyceride. The acute-phase response markers were not different in Indians, with microalbuminuria being high in even the normoalbuminuric Indians; only the mean arterial blood pressure was correlated with urinary albumin-to-creatinine ratio in the Indians. Malay NIDDM subjects had an association of microalbuminuria with acute-phase markers, but this was weaker than in the Chinese subjects.

CONCLUSIONS

Microalbuminuria is associated with an acute-phase response in Chinese NIDDM patients in Malaysia, as previously found in Caucasian NIDDM subjects. Elevated urinary albumin excretion has different correlates in other racial groups, such as those originating from the Indian subcontinent. The acute-phase response may have an etiological role in microalbuminuria.