Barriers and facilitators for oral health screening among tobacco users: a mixed-methods study.

OBJECTIVES: Tobacco consumption adversely affects general and oral health and is considered one of the significant public health burdens globally. The present study aims to assess the barriers and facilitators for attending oral and dental health screening among tobacco users who seek cessation advice. METHODOLOGY: The present mixed-methods study used group concept mapping (GCM) to identify the facilitators/barriers to attending oral health screening among young adults attending face-to-face and virtual Tobacco Cessation Clinic at King Saud University (Riyadh, Saudi Arabia) between September 2022 and April 2023. Study investigators included healthcare social workers, dental interns, and oral and maxillofacial medicinists. Information about demographics, general health, oral/dental health and tobacco use were collected using self-completed questionnaires. The barriers and facilitators were assessed following GCM by brainstorming, sorting, rating, and interpretation activities. Descriptive, multidimensional scaling and hierarchical cluster analysis were used to describe the study participants and produce concept maps of the generated statements. RESULTS: The study included 148 participants who generated 67 statements summarised into 28 statements as facilitators or barriers. Based on a 5-point importance scale, the participants indicated the importance of facilitators under health-related cluster [e.g. when I feel pain] as the highest, followed by personal [e.g. to maintain my mouth hygiene], social [e.g. the quality of treatment] and financial clusters [e.g. the reasonable cost]. Concerning barriers, financial factors [e.g. high cost] acted as the highest-rated barrier, followed by personal [e.g. lack of dental appointments] and health-related [e.g. worry that dental problems will worsen]. The social factors were the least considerable barrier [e.g. lack of time]. Clustering these facilitators/barriers on the concept map indicated their conceptual similarity by an average stress value of 0.23. CONCLUSION: Pain was the most important facilitator to attending oral health screening by young adults seeking tobacco cessation advice. Notable barriers included the high cost of dental treatment and the lack of scheduled appointments. Thus, oral health care providers need to consider scheduling periodic and timely dental check-ups to prevent and reduce the burden of tobacco-associated and pain-causing oral diseases.

Self-perceived preparedness of new dental graduates from a Middle Eastern university.

INTRODUCTION: Preparedness for independent clinical practice is a core goal of undergraduate dental education. The aim of this study was to evaluate the self-reported preparedness for the dental practice among new dental graduates from a University in the Middle East. METHODS: Following ethics approval, a purposive sampling techniques were used to invite newly qualified dental graduates at a Middle Eastern University. A validated research instrument, namely the Dental Undergraduate Preparedness Assessment Scale (DU-PAS), was used to evaluate the self-perceived preparedness of the participants. Data collection was undertaken online using Google Forms and data were analysed to compute the descriptive statistics, reliability and demographic differences among the participants. RESULTS: A total of 82 participants provided their response yielding a response rate of 68%. The participants included 49 males and 33 females. The overall reliability of DU-PAS was excellent. (α = 0.93). The participants included less than 40% of participants were able independently to prescribe medications, assess orthodontics needs and perform endodontic treatment on multirooted teeth. In addition, more than 65% indicated low confidence in evaluating new dental materials and products, interpreting new research findings and behavioural management of children. CONCLUSION: The present findings identified strengths and weaknesses of new dental graduates from a Middle Eastern university. The participants were confident in basic clinical skills but lower confidence was reported for complex dental procedures. The findings highlight the learning needs of new dental graduates and can serve to inform the undergraduate curriculum to enhance the preparedness of future cohorts of dental graduates.

Clinicohistological Characteristics of Patients with Oral Lichenoid Mucositis: A Retrospective Study for Dental Hospital Records.

Oral lichenoid mucositis (OLM) of the oral mucosa is a histological diagnosis mainly characterised by a band of inflammatory infiltrate in lamina propria and basal cell degeneration. These features describe oral lichen planus or oral lichenoid reaction. However, it could be seen in oral dysplasia. The study aimed to assess the demographics and clinicohistological characteristics of patients with OLM and their relevance to dysplastic changes in the oral mucosa. This was a cross-sectional and retrospective study of archived and electronic records of individuals with histological confirmation of OLM at King Saud University Medical City, Saudi Arabia. The descriptive and correlation assessments were used to describe the demographics and clinicohistological characteristics and their associations, respectively [p < 0.05]. The analysis included 140 records of patients with histological confirmation of OLM with a mean age of 47 (±13), and 57% (n = 81) were females. Notably, 40% of patients had at least one medical condition, mainly diabetes mellitus, 74% were asymptomatic, and 52% had lesions in the buccal mucosa. Dysplasia was seen in 18 (12%) of the 140 reviewed records. Regarding the associations between study variables, dysplastic changes were associated with the male gender [p = 0.024] and were of no significance with increased age [p = 0.594]. Moreover, having oral symptoms was associated with older age [p < 0.001], medical history of diabetes [p = 0.0132] and hypertension [p < 0.001]. The present study findings could help indicate the individuals with histologically confirmed OLM who suffer the most from the clinical disease and have an increased risk of dysplastic changes. Therefore, symptomatic management and long-term follow-up can be planned accordingly.

Association of Oral and General Health with Nutritional Status of Older Adults Attending Two Medical Centers in Riyadh, Saudi Arabia: A Cross-Sectional Study.

Malnutrition could profoundly affect older adults' oral health and quality of life, whereas oral health might, in turn, impact dietary intake and nutritional status. The present study aimed to investigate the association between general and oral health and nutritional status among older adults attending nutrition clinics at two main medical centers in Riyadh, Saudi Arabia. A cross-section study was carried out among adult patients (≥60 years) who attended a geriatric clinic or nutrition clinic at King Khalid University Hospital or King Abdulaziz Medical City, Riyadh. A validated clinician's Mini Nutritional Assessment Short-Form (MNA-SF), Oral Health Impact Profile-5 (OHIP-5), and 36-Item Short Form Survey (SF-36) were collected from each participant. A total of 261 participants with a mean age of 72.14 (±8.97) years were recruited. Diabetes (71%) and hypertension (80%) were present in the majority of patients. The overall MNA-SF score was (10 ± 3). Based on the categorization of the MNA-SF score, 65.9% were classified as malnourished or at risk of malnutrition. Participants with OHIP-5 scores higher than the median (>5) were more likely to be malnourished than those with scores at or lower than 5 (p < 0). The adjusted odd ratio for the MNA-SF score categories indicated that for a one-unit increase in the total SF-36 score, the odds of the malnourished category are 0.94 times less than the risk of malnutrition and normal nutritional status, with OR 0.97 (95% CI 0.94-0.95). Malnutrition or being at risk of malnutrition is likely associated with poor general and oral health. Healthcare providers need to incorporate dietitians into care plans to promote the nutritional health of older adults.

Patient and clinician perspectives of information needs concerning oral epithelial dysplasia.

OBJECTIVES: Individuals diagnosed with a chronic oral disease that increase the risk of mouth cancer, such as oral epithelial dysplasia (OED), require appropriate knowledge to make informed decisions. The present study aimed to assess whether patient information needs of a group of patients concerning dysplasia were met and to what degree clinicians agree with patients on 'important' topics. SUBJECTS AND METHODS: This represented secondary analyses of a cross-sectional study to assess the information needs of 86 patients diagnosed with dysplasia compared with those of 77 clinicians using the validated OED Information Needs Questionnaire. Descriptive, concordance and regression analyses were performed for the collected data. RESULTS: The mean and median total scores for all items in the amount of information received subscale were 2.33 and 2.44, indicating overall unmet needs concerning dysplasia. Clinicians were generally able to predict topics of greatest importance to patients, although their scores were mainly lower than those of patients (k = 0.06). There was a higher agreement between patients (k = 0.25) than clinicians (k = 0.09). CONCLUSION: Clinicians are encouraged to assess a patient's information needs to ensure tailored and patient-centred communication concerning OED during all clinical consultations.

Elongated styloid syndrome mimicking temporomandibular joint disorders: a case report and short literature review.

Elongated styloid syndrome (ESS) can present with myriad symptoms that mimic common features of orofacial pain, such as temporomandibular joint disorders (TMJDs), often causing a challenge and delay in diagnosis. We report the case of a 52-year-old male with a three-year history of non-painful clicking during jaw movement initially diagnosed as TMJD-related internal derangement. The patient presented with a history of annoying jaw sounds for three years, described as a popping sound without bilateral clicking or crepitation. Tinnitus and progressive hearing loss were observed in the right ear, and a hearing aid was recommended by an otolaryngologist. The patient was initially diagnosed with TMJD and managed accordingly; nevertheless, his symptoms persisted. Imaging revealed prominent bilateral styloid process elongation that exceeded the recognized cut-off level of >30 mm for elongation. The patient was informed of his diagnosis and its treatment but opted only for further swallowing and auditory assessments of his ear and nose symptoms. Clinicians should consider including ESS as a differential diagnosis in patients presenting with non-specific chronic orofacial symptoms for timely diagnosis and favorable clinical outcomes.

Proliferative verrucous/multifocal leukoplakia: Updates and literature review "case report".

RATIONALE: Proliferative verrucous leukoplakia (PVL) is a multifocal, slowly evolving lesion that resists all types of treatment and has a high propensity for malignant transformation into oral squamous cell carcinoma. Lack of awareness and acquaintance with white lesions of the oral cavity makes it difficult to diagnose. Besides being rare, PVL significantly aggressive, so clinicians need to be aware of it carefully. Therefore, it is recommended to have the earliest possible diagnosis and total excision of this lesion. We report this case to present typical clinical and histologic features of PVL so a For the purpose of sensitizing clinician. PATIENT CONCERN: A 61-year-old female came to the clinic concerning of recurring painless, white patch on the tongue 2 months ago, associated with oropharyngeal dryness. DIAGNOSES: This case satisfies these major and minor criteria to diagnosed PVL. INTERVENTION: An excisional biopsy of the lesion was done to check for the presence of dysplasia, as lesions were persisting. Hemostasis was achieved with single interrupted sutures. OUTCOME: no recurrence has been observed since excisional 1 year follow-up. LESSON: The key feature is early detection, precisely in cases of PVL it is critical for better treatment outcomes, lifesaving, quality-of-life enhancement. To detect and treat any potential pathologies, clinicians should meticulously examine the oral cavity and patients have to be aware and informed of the importance of regular screenings. This lesion is resistant to the presently available treatment modalities; therefore, total excision with free surgical margins is critical combined with a lifelong follow-up.

Information needs and oral epithelial dysplasia: Development and psychometric evaluation of a novel instrument.

OBJECTIVES: Oral epithelial dysplasia (OED) can lead to significant information needs (IN) related to the risk of cancer development, the need for long-term monitoring and potential intervention. The present study aimed to develop and perform preliminary psychometric testing for a novel IN instrument specific to OED. SUBJECTS AND METHODS: Patients diagnosed with OED were invited to complete the Oral Epithelial Dysplasia Informational Needs Questionnaire (ODIN-Q), which was developed based on a known theoretical framework and with items generated via expert input and the literature. Face validity and content validity were initially assessed prior to finalisation of the tool. ODIN-Q was tested for internal consistency and test-retest reliability along with construct validity. RESULTS: ODIN-Q consists of 35 items, categorised under six domains, and rated by dual 4-point Likert scales (amount of information received and degree of importance). Internal consistency (Cronbach's alpha) was rated "excellent" for the scale (0.93) and both subscales (0.92/0.94). For test-retest reliability, moderate agreement was found (κ = 0.49-0.53). Regarding construct validity, a significant but limited relationship was found between ODIN-Q and the Krantz Health Opinion Survey. CONCLUSION: ODIN-Q showed adequate psychometric properties of reliability and validity. Further validation is, however, needed to assess its structural validity and responsiveness.

Psychosocial impacts of oral epithelial dysplasia.

BACKGROUND: The psychosocial impact of receiving the diagnosis of oral epithelial dysplasia, which presents up to 3.5% increased annual risk of mouth cancer, remains unknown. Using validated instruments, the present study aimed to investigate the prevalence and existing correlations between anxiety, depression and dental anxiety symptoms and burden on oral health-related quality of life. METHODS: A clinical cohort of 82 patients with oral dysplasia was asked to complete the Hospital Anxiety and Depression Scale, the Modified Dental Anxiety Scale and the shortened version of the Oral Health Impact Profile. Spearman's correlation coefficient and regression analyses were performed. RESULTS: The participants' scores were in keeping with the presence of anxiety, depression and emotional distress symptoms in 30%, 16% and 26%, respectively. However, 69% experienced anxiety related to procedures that may be required as part of long-term management of oral dysplasia (e.g. local anaesthetic injection). The oral health-related quality of life scores showed 41.5% reporting a recent daily problem due to their oral or dental health. Significant correlations [p >0.05] were found among and between all of the used instruments. Being a female with oral dysplasia also predicted increased odds of indicating higher anxiety and dental anxiety scores than males [p >0.05]. CONCLUSION: Oral dysplasia can adversely impact on the psychosocial well-being of affected persons. Establishing a causal relationship between the measured variables may, however, be challenging and would need further longitudinal studies.

Web-based information on oral dysplasia and precancer of the mouth - Quality and readability.

OBJECTIVES: The numbers of individuals with oral cancer are increasing. This cancer is preceded by oral epithelial dysplasia (OED). There remains no detailed study of the online information presently available for patients with OED or indeed what information such patients may require to be appropriately informed regarding their condition. Hence, the aim of the present study is to assess the patient-oriented web content with respect to OED. METHODS: The first 100 websites yielded from nine searches performed using different search terms and engines were considered. These were assessed for content, quality (DISCERN instrument, Journal of the American Medical Association benchmarks, and Health on Net seal) and readability (Flesch Reading Ease Score and Flesch-Kincaid Grade Level). RESULTS: There was a general scarcity of OED content across the identified websites. Information about authors, sources used to compile the publication, treatment, and shared decision were limited or absent. Only 6% and 27% of the websites achieved all the four JAMA benchmarks and HON seal, respectively. The average readability level was at 10th grade (US schools), which far exceeds the recommended levels of written health information. CONCLUSION: At present patients seeking information on OED are likely to have difficulty in finding reliable information from the Web about this disorder and its possible impact upon their life. Further work is thus required to develop a web-based resource regarding OED that addresses the shortfalls demonstrated by the current study.