Understanding patient safety in dentistry: evaluating the present and envisioning the future-a narrative review.

BACKGROUND: Patient safety is crucial in dentistry, yet it has received delayed recognition compared with other healthcare fields. This literature review assesses the current state of patient safety in dentistry, investigates the reasons for the delay, and offers recommendations for enhancing patient safety in dental practices, dental schools, and hospitals. METHODS: The review incorporates a thorough analysis of existing literature on patient safety in dentistry. Various sources, including research articles, guidelines and reports, were reviewed to gather insights into patient safety definitions, challenges and best practices specific to dentistry. RESULTS: The review underscores the importance of prioritising patient safety in dentistry at all levels of healthcare. It identifies key definitions and factors contributing to the delayed focus on patient safety in the field. Additionally, it emphasises the significance of establishing a patient safety culture and discusses approaches such as safety plans, incident management systems, blame-free cultures and ethical frameworks to enhance patient safety. CONCLUSION: Patient safety is vital in dentistry to ensure high-quality care and patient well-being. The review emphasises the importance of prioritising patient safety in dental practices, dental schools and hospitals. Through the implementation of recommended strategies and best practices, dental organisations can cultivate a patient safety culture, enhance communication, mitigate risks and continually improve patient safety outcomes. The dissemination of knowledge and the active involvement of all stakeholders are crucial for promoting patient safety and establishing a safe dental healthcare system.

Soluble Receptor Activator of Nuclear Factor Ligand and Osteoprotegerin Levels in Gingival Crevicular Fluid among Cigarette Smokers and Non-smokers with and without Periodontitis.

AIM: This study aimed to measure and compare the levels of soluble receptor activator of nuclear factor ligand (RANKL) and osteoprotegerin (OPG) in the gingival crevicular fluid (GCF), as well as their ratio, in smokers and nonsmokers with periodontitis. MATERIALS AND METHODS: Gingival crevicular fluid samples were collected using PerioPaper strips, from 150 individuals, who were categorized into three groups: current smokers with periodontitis stage III grades C and B (n = 50), nonsmokers with periodontitis stages I and II grade A (n = 50), and control healthy individuals (n = 50). The concentrations (pg/mL) of sRANKL and OPG in the GCF were measured by enzyme-linked immunesorbent assays (ELISA). RESULT: The smokers' group exhibited the highest sRANKL (pg/mL) concentration as a subsequent lead to a higher sRANKL/OPG ratio. The healthy control group exhibited higher OPG and lower sRANKL concentration, subsequently, the sRANKL/OPG ratio was reduced compared with the other study groups. However, there was no statistical significance of sRANKL and its relative ratio between periodontitis stage III grades C and B, periodontitis stages I and II grade A, and healthy control individuals. There was a statistically significant positive moderate correlation between smoking duration (years) and the sRANKL (pg/mL) concentration and a statistically significant negative moderate correlation between OPG (pg/mL) concentration and cigarettes smoked per day. CONCLUSION: As a result, compared to the other research groups, smokers with periodontitis stage III grades C and B had greater GCF concentrations of sRANKL, lower OPG, and a higher sRANKL/OPG ratio. The difference in OPG (pg/mL) level was statistically significant. However, there was no statistically significant difference in sRANKL (pg/mL) or its relative ratio, sRANKL/OPG, across the groups. CLINICAL SIGNIFICANCE: A characteristic that sets periodontitis apart is alveolar bone loss. Resorption is induced by RANKL and inhibited by OPG, resulting in a relative ratio. In light of this, the levels of RANKL and OPG may be helpful indicators for monitoring the activity of periodontal disease in both smokers and nonsmokers with and without periodontitis.

Association between Salivary Cortisol Levels, Dental Anxiety, and Dental Caries in Children: A Cross-Sectional Study.

AIM: This study aimed to investigate the relationship between dental caries, dental anxiety, and salivary cortisol levels in children visiting pediatric dental clinics and their implications on pediatric oral health. MATERIALS AND METHODS: A cross-sectional study was conducted at a dental university in the UAE. A total of 60 children, aged 4-12 years, were included. Salivary cortisol levels were measured using an Enzyme-Linked Immunosorbent Assay (ELISA) kit. Dental caries status was evaluated, and dental anxiety levels were assessed using the Modified Dental Anxiety Scale (MDAS). Statistical analyses, including Mann-Whitney U test and Pearson's correlation coefficient, were performed to determine significant differences and associations. RESULTS: The study group showed significantly higher salivary cortisol levels compared to the control group (p < 0.0001). A strong positive correlation was found between salivary cortisol levels and dental caries status (p < 0.001). However, no significant difference in dental anxiety levels was observed between the study and control groups (p = 0.85). A strong positive correlation was found between dental anxiety levels and dental caries status (p < 0.001). CONCLUSION: The findings indicate a significant association between salivary cortisol levels and dental caries, suggesting that higher cortisol levels are associated with active caries. Dental anxiety levels were positively correlated with dental caries. Understanding the relationship between these variables can contribute to better oral health strategies and interventions for children, emphasizing the importance of managing dental anxiety and stress in pediatric dental care. CLINICAL SIGNIFICANCE: This study highlights the potential of salivary cortisol as a biomarker for assessing stress and its impact on oral health in children. By addressing dental anxiety and stress, dental professionals can provide child-friendly dental care, enhance preventive measures, and improve oral health outcomes in pediatric patients.

Light-Based Non-Invasive Techniques as Diagnostic Tools in Cancer Detection: A Systematic Review.

Oral squamous cell carcinomas (OSCCs) fall between the sixth and eighth most common cancers. The prevention of cancer and the treatment of the disease depends on early diagnosis. To encourage dental professionals to use light-based detection techniques in clinical practice, this systematic review aims to evaluate the literature on the effectiveness of chemiluminescence and autofluorescent imaging equipment in the detection of OSCC and OPMDs. PUBMED [MEDLINE] and SCIENCE DIRECT were the electronic databases and retrieval systems used to look for pertinent articles. Search terms like"oral cancer,""early diagnosis,""potentially malignant disorders,"chemiluminescence," autofluorescence," and "VELscope" were used to search the database of indexed journals. 26 articles in total have been chosen for this review. The majority of the research was cross-sectional. Chemiluminescence and Autofluorescence can help a skilled doctor spot oral premalignant lesions with the autofluorescence technique being superior and the way for biopsies within the altered mucosa.

Rhino-orbital mucormycosis in COVID-19 (Corona Virus Disease): A case report.

Background: Mucormycosis, often referred to as black fungus is being recognized as post treatment complication in COVID-19. A complex interaction of immune compromised state may lead to secondary fungal infections. Rhino-orbital mucormycosis, a rare fungal disease, involves the orbit, nose, and sinuses. If not intervened early it might progress with a fatal outcome. The present case report is a Rhino-orbital mucormycosis presentating as a secondary infection in COVID-19 patient and its management. A 51-year-old male patient diagnosed with COVID-19, developed periorbital odema of the left eye along with tooth pain. Nasal endoscopy, computed tomography, and Magnetic Resonance Imaging suggested Rhino-orbital mucormycosis. Surgical debridement followed by intravenous Amphotericin B was prescribed. After a week of follow-up, complete resolution of symptoms was noticed. Conclusion: An early diagnosis and prompt management is the key to reduce morbidity and mortality in these patients. Prophylactic measures and judicious use of drugs may reduce the incidence of this opportunistic infection.

Efficacy of Spirulina 500 mg vs Triamcinolone Acetonide 0.1% for the Treatment of Oral Lichen Planus: A Randomized Clinical Trial.

AIM: The present study aimed at evaluating the efficacy of spirulina 500 mg in reducing the burning sensation and lesion size in oral lichen planus (OLP). MATERIALS AND METHODS: A total of 60 subjects who attended the oral medicine specialty clinic with histopathologically confirmed OLP and having symptoms of burning sensation were recruited for the study. They were randomly divided into two groups: group A (30) subjects were prescribed Spirulina 500 mg twice daily along with only a week application of topical triamcinolone acetonide 0.1% thrice daily; group B subjects were prescribed topical triamcinolone acetonide 0.1% alone thrice daily for 8 weeks. Both the groups were followed up posttreatment monthly for three consecutive months. RESULTS: Data were recorded, and statistical analysis by using ANOVA one-way test, and Chi-square test were performed, which showed statistically significant p-value (<0.005) for the parameters "burning sensation" and "size of the lesion". When compared between groups, group A showed a favorable outcome of the intervention. CONCLUSION: Spirulina 500 mg supplementation twice daily could be effective adjunct therapy with steroids to treat OLP. CLINICAL SIGNIFICANCE: This research allowed us to delve into spirulina as one of the treatment modalities for OLP. Further studies are needed as it is a rich source of proteins and vitamins and demonstrates potent anti-inflammatory, immunomodulatory, and antioxidant actions.

Is there any difference in the development of mandibular third molars according to the type of impaction: An orthopantomographic study in south Indian children and adolescents.

Development of third molars and their influence on the dental arch is a major concern in clinical dentistry especially, orthodontics and oral surgery. Lately, their position, eruption potential and development has become a subject of interest in forensic practice. The present study was aimed to determine whether if there is any difference in the development of the mandibular third molars according to the impaction type. Orthopantomographs (n = 1112) from 478 males and 634 females between 15 and 22 years old were analysed. In each radiograph, impaction status and the developmental stage of mandibular third molars were determined. Descriptive statistics were performed at developmental stages D to H. For stage G, there was a delay by 0.74 and 0.62 years for mesioangular impaction, 0.89 and 0.33 years for horizontal impaction, 1.43 and 0.9 years for distoangular impaction and 1.74 and 1.1 years for vertical impaction, in males and females. For stage H, delay by 0.17 and 0.74 years, 0.05 and 0.06 years, 0.48 and 1.48 years and 0.62 and 0.62 years, respectively for all impaction variants in both sexes. Mean chronological age of the distoangular and vertically impacted mandibular third molars were higher in certain developmental stages than mesioangular and horizontal impactions. Our findings concluded that distoangular and vertical impaction variants mineralize more slowly than mesioangular and horizontal variants, however these differences were smaller. Therefore, no distinction is required between impaction types for dental age estimation especially in the prediction of the age of majority (18 years).

Chemopreventive Agents in Oral Premalignancy: A Medical Management Review.

AIMS AND OBJECTIVE: The term chemoprevention denotes the use of specific natural or synthetic chemical agents to prevent carcinogenesis. Chemoprevention may help delay the process of carcinogen activation and prevent the conversion of preneoplastic cells. These agents play an active role in the secondary level of prevention and reduce malignancy-associated morbidity and mortality. A new term, "prophylactic antioxidant therapy," was coined and proposed. This review has assessed all major chemopreventive agents used for oral premalignancy and malignant conditions, which will reduce the economic burden on the patients. MATERIALS AND METHODS: A systematic literature search was performed using PubMed, Medline, Embase, Cochrane Library, and EBSCO search, with language restriction to English. The search incorporated published literature from 1990 to 2018 using the medical subject heading terms. Literature search was performed using the following keywords: Chemoprevention, Premalignancy, and Oral Malignancy. RESULTS: Of 99 publications related to the search strategy, 45 full articles relevant to the chemopreventive agents in premalignacy and oral malignancy were acquired for further inspection. Of the 45 articles, 30 met the inclusion criteria. Data were collected, and a brief summary of the studies regarding different chemopreventive agents that were most commonly used in oral premalignancy and malignancies was written. CONCLUSION: This review suggests administration of major chemopreventive agents for superior prognosis in individuals with an elevated risk of premalignancy and malignancy.

Serological and psychological assessment of patients with oral lichen planus using serum cortisol levels and hads questionnaire-a case control study.

BACKGROUND: Oral lichen planus (OLP) is a T cell-mediated chronic autoimmune disorder directed against antigens secreted by the basal cell layer, with an incidence of 0.02-0.22% in Indian population and showing female predilection. Stress is considered one of the etiological factors in the causation, progression, and recurrence of this disease. OBJECTIVES: To evaluate the levels of serum cortisol, anxiety, and depression in patients with symptomatic OLP and to correlate the levels of serum cortisol with anxiety and depression. METHODS: Sixty subjects were categorized into two groups. Group A: 30 adults with no history of OLP and no psychological history of anxiety and depression. Group B: 30 patients with clinically and histopathologically diagnosed symptomatic OLP. The subjects in both groups were evaluated for anxiety and depression levels using the Hospital Anxiety and Depression Scale (HADS) questionnaire and serum cortisol levels (8-9 am sample) using the chemiluminiscence method. RESULTS: Higher depression and anxiety levels were significantly associated with group B with significant P values (P < 0.0001 and <0.0002 respectively) when compared with group A; higher mean serum cortisol levels were seen in group B compared with group A, with P < 0.0001. In group A, a positive correlation was found between depression, anxiety, and serum cortisol levels with non-significant P-value. In group B, a positive correlation was found between depression, anxiety, and serum cortisol levels with a significant P value (P < 0.0001). CONCLUSION: Increased levels of depression and anxiety with increased serum cortisol levels were observed in subjects with OLP.

A Comparative Evaluation on the Effect of Oral Zinc 50 mg with or without 0.1% Triamcinolone Orabase on Oral Lichen Planus.

BACKGROUND: Lichen planus is a T-cell-mediated autoimmune disease, in which CD8+ T-cells releases the cytokines such as tumor necrosis factor-alpha and interleukin-12 disrupting basement membrane integrity. Treatment modalities were directed toward the relief in signs and symptoms and preventing recurrences. Zinc activates caspase-3 and DNA fragmentation, resulting in the apoptosis of keratinocytes. Prevention of matrix metalloproteinases1 (MMP1) activation, inhibits the Tcell accumulation in oral lichen planus (OLP) and by inhibiting MMP9, prevents the cleavage of collagen resulting in maintaining the integrity of the basement membrane. OBJECTIVES: The main objective of the study is to compare the efficacy of oral zinc 50 mg and 0.1% triamcinolone Orabase with 0.1% triamcinolone Orabase alone on the healing process of symptomatic OLP. MATERIALS AND METHODS: A total of forty participants were randomly categorized into two groups: Group A and Group B with 20 patients with OLP and having symptoms of burning sensation. Group A patients had received 0.1% triamcinolone Orabase twice daily application. Group B patients had provided with oral zinc 50 mg and 0.1% triamcinolone Orabase twice daily for 8 weeks. The follow-up period for both the groups was 6 months. Lesional size was measured by Thongprasom scale and burning sensation was assessed by visual analog scale at each visit till the cessation of treatment. RESULTS: There was decrease in the burning sensation and lesional size from the first visit to follow-up period which was statistically significant in both groups (P = 0.000). CONCLUSION: Oral zinc therapy was adjunctive in reducing the burning sensation and lesional size in the symptomatic OLP.

ANALGESIC EFFECT OF INTRAVENOUS ASCORBIC ACID VERSUS ACELCOFENAC POST-TRANSALVEOLAR EXTRACTION: A CASE-CONTROL STUDY.

One of the most important aspects of postsurgical care is finding an efficient way for the management of pain. Third molar extractions/surgical impaction is one of the most frequent surgical procedures in dental hospitals, and it is most often associated with postoperative complications like severe pain, oedema and reduced mouth opening. This study was aimed to evaluate the efficacy of 2 g intravenous (IV) vitamin C compared to 100 mg aceclofenac on postsurgical pain, swelling and trismus after the surgical removal of third molars. A total of 101 patients were recruited for the study, and theywere divided into two treatment groups; group A (n = 51) received 2 g IV vitamin C and group B (n = 50) received 100 mg aceclofenac. Pain intensity, facial swelling and mouth opening were assessed till day 3 post-surgically. Statistical analysis of pain intensity revealed that IV vitamin C performed slightly better but not significantly different (p>0.05) from aceclofenac group at the end of day 3. No significant difference for facial swelling and mouth opening between the two treatment protocols was seen (p>0.05). Our results concluded that both treatment groups were overall similar in analgesic efficacy, postoperative oedema and reduction in mouth opening. It was also determined that the method devised administering 2 g IV vitamin C intravenously was well suited to the treatment of postoperative pain, swelling and trismus following the surgical extraction of impacted third molars.

A Meta-Analysis on the Efficacy of Zinc in Oral Mucositis during Cancer Chemo and/or Radiotherapy-An Evidence-Based Approach.

Zinc in various therapeutic doses was used on patients suffering from oral mucositis during cancer treatment. A meta-analysis was conducted to probe the role of oral zinc as a possible treatment option for oral mucositis. A literature search was done using PubMed, EBSCO, Cochrane, MedLine, ScienceDirect, ResearchGate and Google Scholar with key words. The analysis was directed to recognize and identify the use of zinc supplementations at a confidence interval (CI) 95% with p value significance taken as <0.05. A total number of 21,428 articles was retrieved. After thorough screening and assessment of the eligibility criteria, 10 articles were included in qualitative and quantitative analysis in the study. The 10 articles constituted a total sample size of 299 in the case group and 294 in the control group. Oral zinc doses used were 25 mg, 30 mg, 50 mg and 220 mg capsules and mouthwash of 0.2% zinc, as well as 0.5 g of granules dissolved in 5% sodium alginate solution. Two studies showed no significance, with the overall effect 1.61. Eight studies favored zinc over a placebo with an overall effect size of -0.89 at 95% CI of -1.08 and -0.70 which was statistically significant (Z=9.27, p<0.00001). This analysis suggests that zinc usage has shown significant reduction in the severity of oral mucositis but not prevention. The onset of the reaction was delayed and hastened healing. Pharyngeal mucositis, pain and quality of life of the individuals received no effect from zinc therapy.

Zinc Therapy in Treatment of Symptomatic Oral Lichen Planus.

Lichen planus is a chronic inflammatory disease, which involves skin, mucous membrane, and nails. Prevalence of oral lichen planus varies between 0.5% and 2.6% of adult population worldwide with overall female preponderance. It is considered as a potentially malignant disorder with rate of transformation to oral cancer varying between 0.5% and 2%. Oral lichen planus may either be unilateral or bilateral, or may involve multiple sites. Although the exact etio-pathogenesis of this condition is unknown, it is believed that stress, use of medications, dental fillings, genetics, immunity, and hypersensitivity reactions may contribute to its pathogenesis. It is a T-cell-mediated autoimmune disorder in which CD8+ T cells are involved which release various cytokines such as tumor necrosis factor-α and interleuking-12 leading to disruption of basement membrane integrity. Zinc activates caspase-3 and DNA fragmentation, resulting in the apoptosis of keratinocytes. By prevention of matrix metalloproteinase (MMP)-1 activation, it inhibits T-cell accumulation in oral lichen planus, and by inhibiting MMP-9 it prevents cleavage of collagen IV resulting in maintaining the integrity of the basement membrane. The present case series describes the use of oral zinc acetate (50 mg) in patients having symptomatic oral lichen planus with favorable outcome in terms of size of lesion and global index score.

An Insight and Update on the Analgesic Properties of Vitamin C.

Pain is an unpleasant subjective feeling having implications on both physical and mental realm. Multiple dimensions of pain involving behavioral, spiritual, emotional, and cognitive changes have been studied and pathways elucidated. It is stressed that the nature in which pain is modulated and perceived at a higher center is a complex phenomenon. One of the main goals of pain modulation is to modify pain to a more tolerable level, rather than its complete eradication. Different pain management interventions were tried but have effects that are more adverse. Till date, the only reliable pain blockers are analgesics and anti-inflammatory drugs in the form of opioids and non-opioids. Despite this, most of the drugs are ineffective at various levels, furthermore, adding to complications. Thus, there is an urgent need for effective intervention with minimal side effects. Ascorbic acid, popularly known as vitamin C, has shown to exhibit promising analgesic properties. The literature is sparse with the usage of the drug in various forms of pain. This review focuses on the dynamics and kinetics of vitamin C and its usage in various forms of pain. With minimal adverse effects, the drug is shown to perform well in different types of pain disorders, thus paving way for alternative interventional agent for pain management.

Assessment of oral mucositis during concurrent chemoradiation of head and neck cancers using patient-reported measurement scale.

INTRODUCTION: Oral mucositis (OM) is a major challenge encountered in concurrent radiochemotherapy for the treatment of head and neck cancers. The patient reported OM symptoms scale (PROMS) was administered on these patients. The objective was to develop the similar scale in an Indian language and prescribe it population undergoing cancer treatment. MATERIALS AND METHODS: PROMS scale was converted to Telugu language. Fifty-one patients took part in the study. All of them answered the 10-point questions marked their responses on 100 mm visual analog scale after thorough oral examination using WHO grading by the same examiner. RESULTS: Internal consistency of Cronbach's alpha on PROMS scale was 0.81-0.97. The questionnaire study was administered on 35 males and 16 females with the mean age of 54.9 ± 11.8. The decrease in the total PROMS score was marked on day 35 in almost all patients, with a mean value of 34.04 ± 30.2 followed by a further significant decrease on day 60 (follow-up) with a mean of 3.71 ± 7.8. The PROMS scores correlated strongly with the clinician-rated OM scores during the first 35 weeks from the baseline at 0.84 with P < 0.01 and poor correlation was at day 60, i.e. 0.32 with P < 0.05 using Spearman's Rho correlation. CONCLUSION: The study showed a good correlation between patient-reported items and clinical score by standard grading scale. This questionnaire may not be a sole guide in assessing the severity of OM but could be definitely used as an adjunct to clinical oral examination at assessment levels.

A comparative evaluation of diclofenac sodium transdermal patch, oral diclofenac sodium with intramuscular injections of diclofenac sodium in patients suffering from oral pain: A randomized control trial.

BACKGROUND: Newer drug delivery systems such as transdermal patches using pain relieving or modifying agents emerged as a mainstream treatment protocol for management of pain on the outpatient basis. The administration of diclofenac 100 mg in the transdermal patch in the patients having dental pain due to periapical/periodontal infections was evaluated. MATERIALS AND METHODS: Ninety patients of either gender, between 18 and 80 years were divided into 3 groups (Group A - oral medication, Group B - transdermal patch, Group C - intramuscular group). Patients at the Dental Department with pain from periapical/periodontal pathologies were explained about the procedure of analgesia. With written consent, 100 mg diclofenac sodium transdermal patches were prescribed to patients who opted their use in pain control for 2 consecutive days. A visual analog scale was provided for all patients assessing the pain intensity during the study. RESULTS: Significant difference in the mean percentage reduction in visual analog scale (VAS) score among the three groups at day 1 and 2 (P < 0.001). Post hoc test showed that intramuscular (IM) and oral groups had significantly higher mean VAS score than patch group. CONCLUSION: Diclofenac administered through oral and IM routes showed significant improvement in pain relief when compared to the transdermal route. However, diclofenac transdermal patches have shown significant improvement in VAS score between the baseline and consecutive days and can be used in mild pain with lower adverse events.

Role of Vitamin E and Vitamin A in Oral Mucositis Induced by Cancer Chemo/Radiotherapy- A Meta-analysis.

INTRODUCTION: Oral mucositis is known to hamper the quality of life in patients treated for oral cancer. Many pharmacological agents have been tried and tested in its management, especially vitamin supplements including A, E and their combinations. AIM: A Meta-analysis was carried out to evaluate the efficacy of vitamins individually used for prevention or treatment of oral mucositis separately for chemotherapy, concurrent chemo radiotherapy, radiotherapy and Haematopoietic Stem Cell Transplantation (HSCT) individuals. MATERIALS AND METHODS: The literature study was done using PUBMED, MEDLINE, EBSCO, GOOGLE SCHOLAR and COCHRANE data bases with keywords vitamin A, vitamin E, vitamin B, vitamin C, Oral mucositis, Chemotherapy, Radiotherapy, Concurrent chemo radiotherapy and Haematopoietic stem cell transplantation individually, from the year 1980 to 2016. Only randomized controlled trials were included. The data was extracted, tabulated and was subjected to statistical analysis with CI of 95%. RESULTS: Among 201 subjects the analysis clearly demonstrated a male predominance to females in studies where male to female ratio was given. Out of 8 studies, 2 were studies in children and remaining 6 studies concentrated on adult population. WHO and NCI-CTC criteria were followed except for one study which used customised assessment. A meta-analysis was performed regarding usage of topical medication of Vitamin E group in all three cancer treatment modalities, which showed significant reduction in oral mucositis (p < 0.001). There was reduced oral mucositis in a small group of patients with Vitamin A when compared to controls. No information on the agent used for chemotherapy, the dose of radiotherapy and the type of tumours in 4 studies. CONCLUSION: Topical Vitamin E had performed better on oral mucositis than Vitamin E systemic administration. Though the efficacy of topical treatment with Vitamin A showed reduction in oral mucositis, it was evaluated in a very small sample which cannot be attributed to a larger sitting.

Assessment of Anxiety and Depression in Oral Mucositis Patients Undergoing Cancer Chemoradiotherapy: A Randomized Cross-sectional Study.

INTRODUCTION: Oral mucositis is an unavoidable complication occurring during the treatment of cancer by radiotherapy, concurrent chemoradiotherapy (CCRT), or chemotherapy. This is a painful sequelae, significantly affecting the nutritional intake and quality of life. MATERIALS AND METHODS: A multicentric cross-sectional study was done at four cancer centers in Hyderabad. About 455 subjects of both genders between 20 and 80 years undergoing cancer treatment such as chemotherapy (Group I), CCRT (Group II), radiotherapy within 14 days of initiation (Group III), and radiotherapy after 14 days of initiation of therapy (Group IV) who had oral mucositis were included in the study. A self-addressed Hospital Anxiety and Depression Scale questionnaire was used to assess the anxiety/depression in cancer therapy-induced oral mucositis patients. RESULTS: Group III had established anxiety (58.82%) followed by Group IV (47.5%) of patients showing severe oral mucositis. In Group I, 47.17% and in Group II, 40% patients with borderline anxiety had mild mucositis, which was statistically significant (P = 0.01). Group III had established depression in 56.36%, followed by Group IV with 39.62% patients showed severe oral mucositis. Group I and II had mild to moderate mucositis, which was associated with established depression at statistically significant result (P = 0.02). CONCLUSION: Group IV had maximum participants with anxiety and depression, closely followed by Group II, Group III, and least in Group I. Thus appropriate intervention in the form of nonpharmacological and pharmacological treatment is warranted.

Supplemental mandibular mesiodens: a diagnostic challenge.

Developmental anomalies affecting the number of teeth are occasionally encountered clinically. The incidence of supernumerary teeth is approximately 1-3%. Among these are the maxillary anterior teeth, the maxillary molars, and the maxillo-mandubular premolars, in terms of descending order of occurrence. Supernumeraries occur rarely in the mandibular anterior teeth region. They may be either supplemental or rudimentary. We are reporting case of a supplemental type of supernumerary tooth in the mandibular anterior region and steps which were followed to distinguish supernumerary tooth from the normal series.

Lycopene in the management of oral lichen planus: a placebo-controlled study.

CONTEXT: Oxidative stress has been implicated in the pathogenesis of lichen planus, and a lower level of lycopene has been reported in erosive and atrophic oral lichen planus (OLP) patients. However, its efficacy in the management of OLP has not been reported. AIM: This study was designed to assess the efficacy of systemic lycopene in the management of OLP. SETTINGS AND DESIGN: This prospective, randomized, double-blind, placebo-controlled study was done in the Oral Medicine Department of a postgraduate teaching dental hospital in India. MATERIALS AND METHODS: Thirty symptomatic OLP patients, randomly divided into two groups of 15 each, were administered lycopene 8 mg/day and an identical placebo, respectively, for 8 consecutive weeks. Burning sensation using visual analogue scale and overall treatment response using Tel Aviv-San Francisco scale were recorded at every visit. The data obtained were analyzed statistically using Wilcoxon Rank test, Mann-Whitney and Fischer's Exact test. RESULTS: A higher (84%) reduction in burning sensation was seen in lycopene than in the placebo group (67%). All 15 (100%) patients in the lycopene group showed 50% or more benefit and 11 (73.3%) patients showed 70-100% benefit, while this number was only 10 and 4 (26.7%), respectively, in the placebo group. CONCLUSION: Lycopene was very effective in the management of OLP, and oxidative stress may have a role in disease pathogenesis.