Point-of-care, smartphone-based, dual-modality, dual-view, oral cancer screening device with neural network classification for low-resource communities.

Oral cancer is a growing health issue in a number of low- and middle-income countries (LMIC), particularly in South and Southeast Asia. The described dual-modality, dual-view, point-of-care oral cancer screening device, developed for high-risk populations in remote regions with limited infrastructure, implements autofluorescence imaging (AFI) and white light imaging (WLI) on a smartphone platform, enabling early detection of pre-cancerous and cancerous lesions in the oral cavity with the potential to reduce morbidity, mortality, and overall healthcare costs. Using a custom Android application, this device synchronizes external light-emitting diode (LED) illumination and image capture for AFI and WLI. Data is uploaded to a cloud server for diagnosis by a remote specialist through a web app, with the ability to transmit triage instructions back to the device and patient. Finally, with the on-site specialist's diagnosis as the gold-standard, the remote specialist and a convolutional neural network (CNN) were able to classify 170 image pairs into 'suspicious' and 'not suspicious' with sensitivities, specificities, positive predictive values, and negative predictive values ranging from 81.25% to 94.94%.

Automatic classification of dual-modalilty, smartphone-based oral dysplasia and malignancy images using deep learning.

With the goal to screen high-risk populations for oral cancer in low- and middle-income countries (LMICs), we have developed a low-cost, portable, easy to use smartphone-based intraoral dual-modality imaging platform. In this paper we present an image classification approach based on autofluorescence and white light images using deep learning methods. The information from the autofluorescence and white light image pair is extracted, calculated, and fused to feed the deep learning neural networks. We have investigated and compared the performance of different convolutional neural networks, transfer learning, and several regularization techniques for oral cancer classification. Our experimental results demonstrate the effectiveness of deep learning methods in classifying dual-modal images for oral cancer detection.

Effects of a Novel Formulation on Oral Biofilm, pH Buffering, and Gingival Health in Patients with Dry Mouth.

GOAL: To identify in patients with dry mouth the effects of a novel test agent (Oral Essentials Hydrating Formula Mouthwash, Beverly Hills, CA) versus a control agent (Biotène Dry Mouth Oral Rinse, GlaxoSmithKline Consumer Healthcare L.P., Moon Township, PA, USA) versus no treatment on dry mouth, plaque, salivary pH and buffering capacity, gingival health, and tooth sensitivity. MATERIALS AND METHODS: In this cross-over study, ten subjects with dry mouth used test and control dry mouth interventions, as well as no dry mouth intervention in randomized sequence. Plaque Index, Gingival Index, Sulcus Bleeding Index, Plaque staining, and photographs were recorded at baseline and end of each study arm. Salivary volume, pH, and buffering capacity were also recorded at these time points. Additionally, subjects completed a questionnaire for dry mouth and dentinal sensitivity at each visit. RESULTS: Reductions in plaque presence and clinical indices were similar after use of test or control products (p < 0.05). Saliva volume and pH buffering improved significantly after use of test and control products (p < 0.05). CONCLUSIONS: The effects of a novel dry mouth intervention are similar to those of an existing OTC remedy and are significantly better than no intervention.

Dental Plaque Removal and Re-Accumulation: A Clinical Randomized Pilot Study Evaluating a Gel Dentifrice Containing 2.6% Edathamil.

OBJECTIVES: The goal of this clinical study was to determine the effects of a dental gel containing 2.6% edathamil on overnight plaque re-accumulation and plaque removal. METHODS: In this double-blind, randomized crossover study, 10 subjects first brushed for one week with a washout toothpaste. On the evening of Day 7, prior to tooth brushing, Plaque Index (PI) was recorded, then plaque stained and photographed. Subsequently subjects were randomized to either brush with the test dental gel or the control. After overnight plaque accumulation, PI was recorded. Plaque was stained and photographed before and after subjects brushed with the same toothpaste as the previous night. Subsequently, the process was repeated with the second toothpaste. Image J software was used to quantify plaque presence. RESULTS: Mean increase in PI overnight after brushing (1.78 versus 0.94) and final PI after tooth brushing the next morning (2.20 versus 1.31) were significantly (p < 0.05) better after use of the test gel. Tooth surface covered by plaque overnight was significantly higher after using the control gel (22.3%) than the test gel (11.8%; p < 0.05). After morning brushing, the residual area of plaque on the teeth was significantly higher for the control gel (9.2%) than for the test gel (3.6%; (p < 0.05). CONCLUSIONS: A test dental gel more effectively reduced overnight plaque re-accumulation and achieved better plaque removal than a control dentifrice.

A Double-Blinded, Randomized Study Evaluating the In Vivo Effects of a Novel Dental Gel on Enamel Surface Microstructure and Microhardness.

OBJECTIVES: The objective of this study was to evaluate the in vivo effects of a 2.6% edathamil gel (Livionex® Dental Gel) on surface microhardness and microstructure in 180 pre-eroded enamel chips. METHODS: This was a double-blind, randomized study. Two enamel chips each were cut from 90 healthy sterilized extracted teeth. One chip from each pair underwent microhardness testing and scanning electron microscopy (SEM) to establish baselines. The remaining 90 samples were demineralized, and then mounted onto intra-oral retainers worn by nine subjects, with five chips mounted on each retainer for each of the two study arms. In one two-week study arm subjects brushed with the control toothpaste; in the other they used the test gel. Study arms were separated by a two-week washout. Sequence of toothpaste use was randomized. At the end of each study arm, samples underwent microhardness measurements (Knoop) and SEM visualization. RESULTS: After intraoral wear, enamel chips recovered fully from demineralization, with no significant difference in microhardness between the two treatments (p > 0.05). In SEM images, enamel surfaces at study's end also appeared comparable in the two groups. CONCLUSIONS: Pre-eroded enamel chips remineralized intra-orally to a similar level after using a control or a test toothpaste containing 2.6% edathamil.

Evaluating the Whitening and Microstructural Effects of a Novel Whitening Strip on Porcelain and Composite Dental Materials.

AIMS: The aim of this project was to evaluate the effects of 2 different whitening strips on color, microstructure and roughness of tea stained porcelain and composite surfaces. METHODS: 54 porcelain and 72 composite chips served as samples for timed application of over-the-counter (OTC) test or control dental whitening strips. Chips were divided randomly into three groups of 18 porcelain and 24 composite chips each. Of these groups, 1 porcelain and 1 composite set served as controls. The remaining 2 groups were randomized to treatment with either Oral Essentials® Whitening Strips or Crest® 3D White Whitestrips™. Sample surface structure was examined by light microscopy, profilometry and Scanning Electron Microscopy (SEM). Additionally, a reflectance spectrophotometer was used to assess color changes in the porcelain and composite samples over 24 hours of whitening. Data points were analyzed at each time point using ANOVA. RESULTS: In the light microscopy and SEM images, no discrete physical defects were observed in any of the samples at any time points. However, high-resolution SEM images showed an appearance of increased surface roughness in all composite samples. Using profilometry, significantly increased post-whitening roughness was documented in the composite samples exposed to the control bleaching strips. Composite samples underwent a significant and equivalent shift in color following exposure to Crest® 3D White Whitestrips™ and Oral Essentials® Whitening Strips. CONCLUSIONS: A novel commercial tooth whitening strip demonstrated a comparable beaching effect to a widely used OTC whitening strip. Neither whitening strip caused physical defects in the sample surfaces. However, the control strip caused roughening of the composite samples whereas the test strip did not.

Effects of a Novel Whitening Formulation on Dental Enamel.

OBJECTIVE: The goal of this study was to evaluate the enamel whitening effects of 2 new test formulations, one of which was a rinse, and the other a whitening strip. MATERIALS AND METHODS: Forty enamel chips were prepared from 20 healthy extracted teeth (2 from each tooth). After pre-staining and colorimetry to measure L* and b* values, 20 matched samples were immersed in either test or control rinses, and then colorimetry was performed again after 1 hr, 2 hr, 3 hr, 6 hr, 12 hr, 24 hr and 48 hrs (Each hour equates to one month of clinical use at the recommended dosage of 1 minute exposure 2 times a day). The remaining 20 matched samples were exposed to the test or control whitening strips and colorimetry was performed every 30 minutes for a total of 10 treatments. RESULTS: Overall, the whitening performance of test and control strips was similar. The test and control rinses had a similar lightening effect over the first 3 hours (equivalent to 3 months of clinical use). Subsequently, the control rinse continued to lighten samples, whereas the test rinse had little further effect. CONCLUSION: Test and control-whitening strips showed similar effects; over time whitening strips showed a greater lightening effect than whitening rinses.

Effects of A Novel Disc Formulation on Dry Mouth Symptoms and Enamel Remineralization in Patients With Hyposalivation: An In Vivo Study.

BACKGROUND: The goal of this study was to identify the in vivo effects in patients with hyposalivation of a novel slowly dissolving adhering test disc upon on enamel remineralization, oral biofilm, salivary production, pH and buffering, gingival health, and on self-evaluation of oral well-being. METHODS: Five subjects with xerostomia wore custom made retainers carrying 5 demineralized enamel chips for periods of 1 week each. In 1 study arm, subjects used the test agent plus oral hygiene self-care; in the other they used oral hygiene self-care only, with a 1 week washout in between arms. The treatment sequence was randomized. Before and after each study arm Plaque Index (PI), Gingival Index (GI) and Sulcus Bleeding Index (mSBI) were recorded. Clinical plaque staining was quantified using digital image analysis. Saliva production, pH and buffering capacity were recorded. Subjects completed a self-evaluation questionnaire for oral comfort. Enamel samples underwent standardized Knoop microhardness testing to quantify mineralization status. RESULTS: Plaque presence and clinical Plaque Indices decreased significantly with test agent use (p<0.05). Five-minute saliva production almost doubled 10 and 40 minutes after oral test disc insertion (significant, p<0.05). Salivary pH buffering improved in 4/5 subjects with disc use. All demineralized tooth samples re-hardened intraorally (p>0.05). The discs favorably impacted eating problems and dental sensitivity. Subjects were positive about disc flavor and mouth feel. CONCLUSION: Using established in vivo techniques, the effects of a novel product in xerostomic patients were evaluated and quantified. The adhering disc facilitated eating, reduced dental sensitivity, improved saliva production and buffering capacity, reduced plaque, and alleviated xerostomia symptoms. CLINICAL RELEVANCE: Xerostomia management is challenging. A novel dry mouth disc was effective in alleviating dry mouth symptoms.

Effects of a Novel Mouthwash on Dental Remineralization.

OBJECTIVE: The goal of this study was to evaluate the in vivo effects of a novel mouthwash on enamel remineralization. MATERIALS AND METHODS: Ten healthy volunteers wore removable intra-oral appliances for three study arms with duration of 5 days each. In 1 study arm, subjects used Oral Essentials Sensitivity FormulaR mouthwash; in another arm they used SensodyneR mouthwash, and in the third arm they used no mouthwash at all. Sequence of mouthwash use was randomized, and study participants and researchers were blinded throughout the study. Subjects used Crest Total CareR toothpaste throughout the study. During a one week washout period before study begin and between each study arm, subjects also used Crest Total CareR toothpaste. A total of 300 enamel samples were included in this study, 150 served as baseline controls, and 150 as test samples subjected to demineralization prior to intra-oral wear. At the end of each study arm, enamel chips were removed from the appliance and underwent standard Microhardness (Knoop) measurements, as did the control samples. Enamel microhardness in the test vs the 2 control groups was compared using the Kruskal-Wallis one-way analysis of variance with post-hoc Tukey's test to test for differences in remineralization between the 3 treatments. RESULTS: Both mouthwashes demonstrated similar levels of recovery from demineralization as the "no mouthwash" arm of the study, with no significant differences for all groupings and comparisons (p>0.05). CONCLUSION: A novel mouthwash for sensitive teeth supports enamel recovery from demineralization.

Effects of a Novel Dental Gel on Enamel Surface Recovery from Acid Challenge.

BACKGROUND: Objective was to evaluate the in vivo effects of a novel dental gel (Livionex gelR) vs. a comparison dental gel on the surfaces of pre-eroded enamel chips. METHODS: On days 1-5, after toothbrushing with dentifrice, nine subjects each wore 8 enamel chips mounted on a palatal appliance for 4 h. Enamel blocks were pre-demineralized daily. After 2 day washout, subjects repeated the protocol using fresh chips and the second toothpaste on days 8-12. Samples were evaluated using electron microscopy. RESULTS: Ten standardized enamel surface photomicrographs/sample (total 1440 images) were evaluated for signs of erosion visually and on a scale of 0-3 by 1 evaluator. No significant differences were found between the 2 groups (p>0.32, 95% C.I.). Minimal surface erosion on approx. 15% of sample area was visible in both groups. CONCLUSION: The enamel surface appeared similar after usage of a test or control dentifrice. Based on this study, the test formulation did not affect enamel surface recovery from an erosive challenge. PRACTICAL IMPLICATIONS: Dentifrices can contribute to maintaining a healthy enamel surface. An all-natural dental gel formulation with novel anti-plaque mechanism achieved similar recovery from acid challenge to enamel as a control gel.