The Scope of Virtual Reality Simulators in Radiology Education: Systematic Literature Review.

Background: In recent years, virtual reality (VR) has gained significant importance in medical education. Radiology education also has seen the induction of VR technology. However, there is no comprehensive review in this specific area. This review aims to fill this knowledge gap. Objective: This systematic literature review aims to explore the scope of VR use in radiology education. Methods: A literature search was carried out using PubMed, Scopus, ScienceDirect, and Google Scholar for articles relating to the use of VR in radiology education, published from database inception to September 1, 2023. The identified articles were then subjected to a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-defined study selection process. Results: The database search identified 2503 nonduplicate articles. After PRISMA screening, 17 were included in the review for analysis, of which 3 (18%) were randomized controlled trials, 7 (41%) were randomized experimental trials, and 7 (41%) were cross-sectional studies. Of the 10 randomized trials, 3 (30%) had a low risk of bias, 5 (50%) showed some concerns, and 2 (20%) had a high risk of bias. Among the 7 cross-sectional studies, 2 (29%) scored "good" in the overall quality and the remaining 5 (71%) scored "fair." VR was found to be significantly more effective than traditional methods of teaching in improving the radiographic and radiologic skills of students. The use of VR systems was found to improve the students' skills in overall proficiency, patient positioning, equipment knowledge, equipment handling, and radiographic techniques. Student feedback was also reported in the included studies. The students generally provided positive feedback about the utility, ease of use, and satisfaction of VR systems, as well as their perceived positive impact on skill and knowledge acquisition. Conclusions: The evidence from this review shows that the use of VR had significant benefit for students in various aspects of radiology education. However, the variable nature of the studies included in the review reduces the scope for a comprehensive recommendation of VR use in radiology education.

Worldwide prevalence of carpal tunnel syndrome among dental health care personnel - A systematic review and meta-analysis.

Background: Carpal Tunnel Syndrome (CTS) is one such common disorder among dental health care personnel caused due to the entrapment neuropathy of the median nerve in the carpal tunnel. We aimed to evaluate the pooled estimates of the CTS among dental healthcare personnel. Methods: We systematically reviewed the existing literature from six databases till January 1 st, 2022. Studies reported in English along with the prevalence of CTS or where prevalence could be calculated were included. Independent screening of title and abstracts, and the full text was done by two examiners. Information collected was authors, year of publication, geographic location, type of dental healthcare personnel, sample size, distribution of age, sex, CTS, method of diagnosis, and risk of bias. The random effect model was used to estimate the pooled estimates. Results: Thirty-seven studies yielded 38 estimates. A total of 17,152 dental health care personnel were included of which 2717 had CTS. The overall pooled prevalence of CTS among the included studies was 15%, with a high heterogeneity. Meta-analysis showed no significant difference in the pooled estimates of CTS between male and female dental healthcare personnel (OR: 0.73; 95% CI: 0.52 -1.02; I 2= 69.71). The pooled estimates among the dentist and dental auxiliaries were 20% and 10%, respectively. The pooled prevalence of CTS with self-reported measures, clinical examination and NCS were 21%, 13% and 8% respectively. Meta-regression showed that the prevalence estimates were significantly associated with publication year (coefficient: 0.006; 95% CI= 0.002-0.01). Conclusion: One out of seven dental health care personnel may be affected by CTS. No significant difference was seen in the prevalence of CTS between male and female dental healthcare personnel.

Acceptability of fully guided virtual implant planning software among dental undergraduate students.

BACKGROUND: Fully guided implant surgery as a technique is gaining popularity. It has been observed that use of surgical guides improves precision and predictability for dental implant placement. However, like any other newer technology, the acceptance of fully guided dental implant technology among users is based upon its perceived usability. This study aimed at evaluating the perception about using Virtual Implant Planning Software (VIPS) among undergraduate dental students at the university of Sharjah. METHODS: Ninety-Six dental surgery students from the University of Sharjah were included in the study. One week after the Virtual Implant Planning Software (Planmeca Romexis version 6.2 procedure, students were asked to complete a Combined technology acceptance model and the theory of planned behaviour (C-TAM TPB) questionnaire. Sixty-six students responded to the questionnaire. RESULTS: Cronbach's alpha surpassed 0.7 for perceived usefulness, perceived ease of use, perceived behavioral control, and subjective norm. Attitude and behavioural intention reported Cronbach's alpha values less than 0.7. Spearman's correlation coefficient was significant for all the constructs. Perceived ease of use explained 49%, 33%, and 42% of the variance of perceived usefulness (R2 = 0.49), attitude (R2 = 0.33), and perceived behavioral control (R2 = 0.42) respectively. Perceived usefulness explained 25%, 18%, and 23% of the variance of attitude (R2 = 0.25), behavioral intention (R2 = 0.18), and perceived behavioral control (R2 = 0.23) respectively. Attitude accounted for 25%, 33%, and 29% of the variance of behavioral intention (R2 = 0.25), perceived behavioral control (R = 0.33), and subjective norm (R = 0.29) respectively. CONCLUSION: The fully guided VIPS was acceptable by dental students specifically because of its usability. This makes VIPS a very effective tool for teaching implantology for dental students. VIPS also allows students to perform multiple repetitions of the implant planning procedure which enhances understanding and content retention.

Necrotic oral lesions: a narrative review.

OBJECTIVES: Necrotic lesions affecting the head and neck region are of significance to dental professionals as they pose challenges in diagnosis and management. Necrotic oral lesions manifest with symptoms like pain, burning, altered sensation, oral malodor, fistula, exposed bone, and pathologic fracture of the bone in extensive cases. The manifestation of necrosis is a definitive clinical sign which helps to narrow down the exhaustive list of causative conditions. This article provides a comprehensive review of the pathogenesis, causative conditions, and management aspects of various necrotic lesions affecting the maxillofacial region. The prompt identification of the cause helps in streamlining the management aspects of necrotic lesions thus reducing the morbidity caused by these conditions. (Quintessence Int 2023;54:250-260; doi: 10.3290/j.qi.b3652393).

Prevalence of musculoskeletal disorders among dental healthcare providers: A systematic review and meta-analysis.

Background: Work-related musculoskeletal disorders (MSD) are common in dentistry due to the prolonged static work involved during patient care, making dental health care personnel vulnerable to musculoskeletal complaints. We aimed to pool the prevalence estimates of MSD among various dental healthcare providers, including dentists, dental students, dental hygienists, and auxiliaries. Methods: A systematic search of five databases was performed (Scopus, Embase, CINAHL, Web of Science, Dentistry & Oral Sciences Source). The studies that reported the prevalence of MSD among dental healthcare workers and those written in English were selected. Screening and data extraction were performed by two review authors independently. Discrepencies were resolved by another review author. Risk of bias assessment was done using a nine-item questionnaire developed by Hoy et al. Pooled estimates were calculated using meta-analysis of proportions (random effects model). Results: Among the 3090 publications screened, 234 publications were included for full-text screening. Meta-analysis was performed for 89 estimates from 88 publications. Females showed significantly higher prevalence [OR = 1.42 (95% CI = 1.09-1.84); I 2 = 66.02; N = 32]. The analysis yielded a pooled estimate of 78.4% (95% CI = 74.8-82). The meta-regression showed similar prevalence over the years (Coefficient: 0.001; P-value: 0.762). Conclusions: A high prevalence of MSD was noted among dental healthcare providers, with about seven out of ten having experienced MSD in the past. This emphasizes the need for awareness and adoption of appropriate ergonomic postures by dental healthcare providers from early in their careers to minimize work-related MSD.

Rhinocerebral mucormycosis: a systematic review of case reports and case series from a global perspective.

OBJECTIVE: Rhinocerebral mucormycosis (RCM) is the most common variant and the presenting features in the head and neck region are seldom pathognomonic. The aim of this systematic review was to obtain a thorough insight into the predisposing factors, clinical features, disease course, management protocol, outcome, and prognosis. STUDY DESIGN: An electronic search was carried out using MEDLINE by PubMed, Scopus, Google Scholar, Web of Science, and EMBASE databases. Articles in which the clinical findings on the extra- and intraoral features of RCM were included for systematic review. Descriptive statistics was applied to obtain the results. RESULTS: A total of 124 case studies (90 case reports, 34 case series) which yielded 219 patients. Diabetes mellitus (57.40%) was the most common comorbid condition. Neurologic manifestations were noted in 23.3% of the individuals. Maxillary/hard palate involvement was a common occurrence (59.2%). Intra-oral necrotic lesions with eschar were noted in 75/219 patients. Amphotericin B was the commonly used drug for the management, and surgical debridement was performed in majority of the cases. The mortality rate was 18.4%. CONCLUSIONS: The clinical manifestations often mimic odontogenic symptoms, hence a sound knowledge about the pathogenesis and course of the disease will aid in the prompt diagnosis and management.

Impact of the COVID-19 pandemic on graduating dental interns: the students' perspective.

Background: COVID 19 pandemic has caused an unprecedented change in the way of life of the individual as well as of the society globally. Medical and healthcare education has become virtual, complex, and challenging with minimal real-time experience. Dental education has faced major impacts affecting the skills and preparedness of the graduates. This study aimed to assess the overall impact of the COVID 19 pandemic on graduating dental interns. Methods: This cross-sectional survey was conducted among the graduating dental interns from various states across India. A specially designed questionnaire was used in our study which consisted of multiple-choice, Likert scale, dichotomous response, open-ended response questions. The 15 item questionnaire focused on 5 domains (i) demographic details (ii) perceptions regarding disrupted academic schedule and switch to E-education (iii) perceptions on its impact on the career (iv) items concerning the mental health and stress (v) potential solutions suggested by the interns. Results: 316 dental interns responded to this survey. Only 13.6% of them felt that the e-platforms were useful tools for learning. The dental interns felt that Conservative Dentistry and Oral Surgery postings had the maximum impact on clinical skills. Less than one-fourth (23.1%) of them agreed with the fact that they were under parental pressure; 43.4% agreed that the pandemic had affected the confidence and preparedness to start their clinical practice. Conclusion: It was observed that the interns faced major challenges due to the missed hours of clinical practice, which affected them in terms of preparedness and confidence in facing their future.

The effect of concha bullosa and nasal septal deviation on palatal dimensions: a cone beam computed tomography study.

INTRODUCTION: Nasal septal deviation (NSD) and concha bullosa (CB) are associated with airway obstruction in mouth breathers. Mouth breathing is associated with alterations in maxillary growth and palatal architecture. The aim of our study was to determine the effect of the presence of CB and NSD on the dimensions of the hard palate using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: A retrospective study was conducted using CBCT scans of 200 study subjects. The study subjects were divided into four groups based on the presence of CB and NSD. Septal deviation angle (SDA), palatal interalveolar length (PIL), palatal depth (PD) and maxillopalatal arch angle (MPAA) were measured in the study groups. RESULTS: The presence of NSD and CB was associated with significant (p < 0.001) differences in the palatal dimensions of the study subjects. The PIL and MPA (p < 0.001) were significantly reduced (p < 0.001), whereas the PD was significantly increased (p < 0.001) in study subjects with NSD and CB. There was no significant change in the palatal dimensions between the unilateral and bilateral types of CB. Among the palatal dimensions, the PIL had the most significant association (R2 = 0.53) with SDA and CB. There was a significant correlation between the palatal dimensions and SDA when CB was present along with NSD. CONCLUSION: Based on the results of this study, it can be concluded that the presence of NSD and CB have a significant effect on the palatal dimensions and, therefore, they may be associated with skeletal malocclusion.

Smart-phone based telemedicine: Instant messaging application as a platform for radiographic interpretations of jaw pathologies.

OBJECTIVE: To evaluate the reliability of WhatsApp in comparison to the images viewed on a workstation monitor (gold standard) for the identification and interpretation of radiographic images of jaw pathologies. METHODS: 150 panoramic radiographs were screened for the assessment of jaw pathologies in the workstation monitor. The radiographs were sent to two observers (Observer A and B) via WhatsApp® Messenger which were viewed independently on smartphones. A structured proforma was prepared to evaluate the radiographs for the presence or absence of various radiographic pathological characteristics. RESULTS: The reliability of WhatsApp for observers A and B concerning various characteristics like vital structures, pathological fractures, periodontal ligament widening, and root resorption indicated almost perfect agreement (0.8-0.97). The Kappa coefficients for WhatsApp for observers A and B for pre-categorized radiographic impressions were 0.95 and 0.97 which indicated almost perfect agreement. CONCLUSION: WhatsApp based expert teleradiology consultation can be a suitable and effective alternative for radiographic interpretations.

Changing trends in the outpatient dental visits during the COVID - 19 pandemic in a tertiary care hospital.

The coronavirus pandemic has caused a global public health crisis with an unprecedented shutdown of major establishments and non-emergency services. Disruptions across the country in dental hospitals led to challenges in addressing patient's dental complaints. The present study aimed to analyse the difference in the pattern of the Outpatient dental visits during the pandemic period in comparison to that of the pre-pandemic period in a tertiary care hospital. This retrospective study was carried out by retrieving the patient data from the diagnostic register of the Department of Oral Medicine and Radiology for a period of one year. The data that was retrieved from 24th September 2019 to 23rd March 2020 was categorized under the pre-pandemic period and the data from 24th March 2020 to 24th September 2020 was grouped under the pandemic period. Patient data regarding the age, gender and clinical diagnosis was recorded and categorized under three main categories: "Emergency", "urgent" and "elective". 7550 patients during pre-pandemic period and 4035 patients during the pandemic period visited the dental hospital during the study period. Under the "emergency dental care" category, during the pre-pandemic period, majority of the cases reported of acute dental pain (71.0%) followed by cellulitis and space infection (20.1%) and maxillofacial trauma (8.7%). During the pandemic period, acute dental pain consisted of all emergency visits (n = 307). The proportion of emergency dental visits during the pandemic were significantly higher than the pre-pandemic period. Elective dental visits were significantly higher during pre-pandemic period in comparison to the pandemic period. (P < 0.001). There was a notable change in the outpatient trend of the dental visits during the COVID-19 pandemic in comparison to the pre-pandemic period. Emergency dental services were utilized at a higher rate during the pandemic period in comparison to the pre-pandemic counterpart.

Email and instant messaging applications as platforms for remote oral radiology consultation in maxillofacial fractures.

OBJECTIVE: The present study aimed to test the reliability and diagnostic efficacy of the evaluation of radiographs transmitted by email and through instant messaging in the diagnosis of maxillofacial fractures. STUDY DESIGN: Screening of radiographs of 150 patients by a senior maxillofacial radiologist was performed as the gold standard method for the assessment of fractures by using a workstation monitor. The radiographs were sent to the Gmail accounts of 2 observers, who used their laptop computers to independently evaluate the radiographs for fractures. The same radiographs were sent to the smartphones of the observers via WhatsApp Messenger and were evaluated on the smartphone screens. Intra- and interobserver reliability, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. RESULTS: The reliability of the observers' diagnoses for both modalities ranged from 0.96 to 1.00 compared with the gold standard. Intra- and interobserver reliability ranged from 0.85 to 0.98. Measures of diagnostic efficacy ranged from 93.5% to 100% for images sent by Gmail and from 95.2% to 99.9% for radiographs transmitted through WhatsApp Messenger. CONCLUSIONS: The present study demonstrated that email and instant messaging applications can be reliable tools for the assessment of maxillofacial fractures by radiologists located at remote sites.

Status of thiocyanate levels in the serum and saliva of non-smokers, ex-smokers and smokers.

BACKGROUND: Use of tobacco is often implicated in the development of oral diseases. Questionable accuracy of the traditional questionnaires to assess cigarette exposure necessitates the use of biomarkers like thiocyanate which provide a definitive quantitative measure. OBJECTIVE: To assess the rise in the level of thiocyanate for measurement of smoking behaviour in adults. MATERIALS AND METHODS: Serum and salivary thiocyanate levels were estimated in 20 non-smokers, 20 ex-smokers and 40 smokers. Smokers were divided into two groups based on the presence or absence of oral mucosal lesions. RESULTS: The mean serum and salivary thiocyanate levels were increased significantly in smokers when compared to non-smokers and ex-smokers. The levels were not significantly different between ex-smokers and non-smokers and between smokers with tobacco related oral mucosal lesions and those without. Statistically significant correlation was seen between the serum and salivary levels of thiocyanate. CONCLUSION: This study highlights the high level of thiocyanate in the serum and saliva of smokers when compared to non-smokers and ex-smokers. Significant increase in thiocyanate level was also seen in saliva. Hence it can be stated that saliva can be used as a reliable, non-invasive tool to assess smoking behaviour in the population and its changes over time.

Status of Serum and Salivary Ascorbic Acid in Oral Potentially Malignant Disorders and Oral Cancer.

BACKGROUND AND AIMS: The aim of this study was to estimate the detoxification status of serum and saliva by assessing the serum and salivary Vitamin C in oral potentially malignant disorders and oral cancer. SUBJECTS AND METHODS: A total of 90 subjects, 30 subjects with oral potentially malignant disorders, 30 subjects with oral cancer, and 30 healthy subjects (controls) were included in the study. Serum and saliva were collected and levels of Vitamin C were assessed. Data obtained was analyzed using ANOVA test for the comparison between the groups. Post hoc Tukey's analysis was used for the comparison of the two study groups to the control group. Correlation between the groups was done using Pearson's correlation coefficient test. RESULTS: The mean serum and salivary Vitamin C levels were decreased significantly in potentially malignant disorders and oral cancer when compared to healthy subjects. CONCLUSIONS: As significant reduction of Vitamin C is seen in saliva, it can be stated that saliva can be used as a reliable, noninvasive biomarker in diagnosis and management of potentially malignant disorders and oral cancer.

Sialic acid as a biomarker of oral potentially malignant disorders and oral cancer.

BACKGROUND: Carcinogenesis is a multistep process where a healthy cell has initially a precancerous stage and finally an early cancerous stage. The process of carcinogenesis can be divided into three stages of initiation, promotion, and progression. In this process, there is increased turnover, secretion, and/or shedding from malignant cells. Glycoproteins like sialic acid are expressed on the cell surface. In oral potentially malignant disorders (OPMDs) and oral cancer (OC), the sialic acid level is seen to increase due to high cell turnover and shedding of malignant cells which, in turn, results in the release of glycoproteins like sialic acid into circulation. Glycoproteins also form an important constituent of salivary mucins and hence due to the same mechanism, an increase in sialic acid level is also seen in saliva. OBJECTIVE: The aim is to estimate serum and salivary sialic acid levels in healthy controls, patients with OPMDs and patients with OC. MATERIALS AND METHODS: In this observational cross-sectional study, serum and salivary sialic acid levels were estimated in thirty healthy controls, thirty patients with OPMDs and thirty patients with OC. RESULTS: Serum and salivary sialic acid levels obtained were subjected to statistical analysis. Post hoc Tukey test was used to compare the serum and salivary sialic acid levels of the two study groups to the control group. ANOVA test was used for the comparison of sialic acid levels between the groups. Pearson's correlation coefficient was used to assess correlation (P < 0.05 was considered statistically significant). The mean serum and salivary sialic acid levels were increased significantly in subjects with OPMDs and OC when compared to healthy controls. CONCLUSION: This study highlights the high expression of sialic acid on outer cell membranes, due to the significant increase in subjects with OPMDs and OC when compared to healthy controls. A significant increase in sialic acid level is also seen in saliva. Hence, it can be stated that saliva can be used as a reliable, noninvasive tool in diagnosis and management of OPMDs and OC.

Status of Serum and Salivary Levels of Superoxide Dismutase in Type 2 Diabetes Mellitus with Oral Manifestations: A Case Control Study.

BACKGROUND: Type 2 Diabetes Mellitus is a very well known metabolic disorder that has reached epidemic proportions worldwide. Evidence suggests that oxidative stress increases in Diabetes Mellitus because of the excessive production of reactive oxygen species and an impaired antioxidant defence mechanism. This study estimated, compared and correlated the serum and salivary Superoxide dismutase levels in healthy subjects and subjects with Type 2 Diabetes Mellitus having oral manifestations. MATERIALS AND METHODS: In this study, serum and salivary Superoxide dismutase levels were estimated in 45 healthy subjects and 45 patients with Type 2 Diabetes Mellitus with oral manifestations. RESULTS: The mean serum and salivary Superoxide dismutase levels were significantly decreased in subjects with Type 2 Diabetes Mellitus with oral manifestations compared to the healthy subjects. Positive correlation in both healthy and diabetics was observed between serum and salivary samples. CONCLUSION: This study highlights that the abnormally high levels of oxidative stress in diabetics coupled with simultaneous decline in antioxidant defence mechanism results in complications in Diabetes mellitus. Thus exploring saliva for antioxidant markers that accurately reflect the redox status of the body is worthwhile.