Is vitamin D deficiency a risk factor for recurrent aphthous stomatitis? A systematic review and meta-analysis.

OBJECTIVES: A few studies have associated vitamin D deficiency with the occurrence of recurrent aphthous stomatitis (RAS). Hence, the aim of the present systematic review and meta-analysis is to explore such a potential association. METHODS: A comprehensive search of PubMed, Scopus, and Web of Science databases was conducted in June 2019. The inclusion criteria were (a) observational studies that assessed the relationship between vitamin D and RAS, and (b) the outcome measures reported quantitative vitamin D levels. Studies without control groups, case series, case reports, experimental studies, letter to editors, reviews, were excluded. The random effects model was conducted for meta-analyses using RevMan 5.3 software. RESULTS: Five studies comprising 208 RAS patients and 241 healthy individuals were included. All studies except one reported significantly lower levels of vitamin D in RAS patients compared with the healthy individuals. The results of the pooled 5 studies revealed statistically significant lower levels of vitamin D in RAS patients (Mean Difference (MD) = -9.67 ng/ml, 95% CI = -15.68, -3.65; p Ë‚ .002). CONCLUSION: The present meta-analysis suggests a significant association between low vitamin D levels and RAS. Further well-designed studies with adequate sample sizes are required to elucidate the role of vitamin D in pathogenesis of RAS.

Tobacco Cessation Counseling: Attitudes and Practices among Yemeni Dental Professionals.

Tobacco use is a significant health problem in Yemen and worldwide. Dental practitioners can play a pivotal role in educating their patients on the risk of smoking and motivating them to quit. This study aimed to assess the attitudes towards and practices of tobacco cessation counseling (TCC) among Yemeni dental professionals and to evaluate whether such attitudes and practices are associated with gender, smoking status, and years since graduation. In this cross-sectional study, a self-administered questionnaire containing questions regarding the practice and attitudes towards TCC in dental clinic was used. SPSS version 20 was used for data analysis. For statistical analysis, Chi-square test was used with a significance level of P < 0.05. Of the 400 distributed questionnaires, 182 were completed and analyzed. 53.3% of the respondents were males and 46.7% were females. Around one fifth of the respondents were smokers. The majority reported that they routinely ask their patients about their tobacco habits (83.5%), and advise against tobacco use (85%). Around half of the respondents believed that tobacco cessation intervention may affect their clinical practice and their income negatively through decreasing number of attending patients and believed that provision of dental treatment is more important than TCC. The majority (92%) believe that health professionals should refrain from tobacco, and 83% agree that TCC should be included in dental school curricula. Recent graduates and non-smokers showed relatively better attitudes and practices. There is an urgent need for continuing educational programs in TCC. Also, inclusion of TCC to dental curriculum is highly required.

Myiasis Associated with Oral Squamous Cell Carcinoma--A Literature Review.

Advanced oral squamous cell carcinoma (SCC) is a possible risk factor for myiasis, a parasitic infestation of vital tissue of humans or other mammals by dipterous larvae (maggots). Oral myiasis is a rare entity, and is mostly associated with various medical and anatomical conditions, such as neglected mandibular fracture, lip incompetence, cerebral palsy, poor oral hygiene, suppurative lesions, and cancerous wounds. Larvae cause itching and irritation due to their crawling movements and can destroy vital tissues, inducing serious or even life-threating hemorrhage. The aim of the present article was to highlight the occurrence of oral myiasis in association with squamous cell carcinoma and also to highlight the treatment and preventive approaches for such cases. A literature search was performed using MEDLINE for articles published in English relating to the occurrence of oral myiasis in oral SCC. Our search revealed 6 reports on myiasis associated with oral SCC. The surgical debridement of infected tissue with the removal of maggots is the treatment of choice in most cases of oral myiasis.

Lip and oral lesions in children with Down syndrome. A controlled study.

BACKGROUND: Down syndrome (DS) is the most common chromosomal abnormality affecting numerous organs, including the orofacial region. The objective of the present study was to assess the prevalence of lip and oral soft tissue lesions, with particular emphasize on the incidence of fissured tongue, lip fissures and angular cheilitis, among individuals with DS in Yemen. MATERIAL AND METHODS: This controlled cross-sectional study included 50 children with DS (6-18 years), and 50 age-and gender-matched healthy controls. The prevalence of orofacial soft tissue lesions was evaluated in both groups. Data were analyzed by Chi-square and Fisher tests, and p < 0.05 was considered to be statistically significant. RESULTS: Ten orolabial lesions were identified among the subjects. The most frequently seen lesions were: Fissured tongue (78.0%), lip fissures (64.0%), angular cheilitis (38.0%) and Cheilitis (14.0%). The frequencies of these lesions were significantly higher in children with DS than healthy controls (P< 0.001). Most of lip fissures were in the lower lip, and 80% of the fissures were in the midline. CONCLUSIONS: The prevalence of lip and oral lesions among individuals with DS is remarkably high. Hence, oral physicians should be more aware of the orofacial findings seen more frequently in this genetic disorder. Key words:Down syndrome, lesions, lips, oral.

Oral mucosal lesions in elderly dental patients in Sana'a, Yemen.

OBJECTIVES: With aging, the oral mucosa becomes more susceptible to external stimuli. The aims of this study were to obtain baseline data on the prevalence of oral mucosal lesions (OMLs) in a population of elderly Yemeni patients and to investigate differences in the presentation of these findings in relation to age, gender, education level, and the wearing of dentures. PATIENTS AND METHODS: The prevalence of OMLs was assessed by clinical examination of a sample of 310 elderly Yemeni patients aged 60 years and older. A single examiner performed detailed oral examinations of the oral cavity according to international criteria and the World Health Organization codes. RESULTS: The overall prevalence of OMLs was 77.1%, with a significant difference (P < 0.05) between men (80.3%) and women (69.6%). The prevalence rate of OMLs indicated a significant decrease with advancing age. The most frequently observed lesions were fissured tongue (34.2%), benign tumors (17.1%), hairy tongue (16.5%), and qat-induced white lesions (12.6%). Hairy tongue, qat-induced white lesions, and shammah keratosis were associated with men (P < 0.01, P < 0.05, and P < 0.05, respectively), whereas geographic tongue was associated with women (P < 0.05). The presence of one or more lesions was significantly associated with low education level (P < 0.05). Certain OMLs showed a significant association with smoking and qat chewing (P < 0.05). No association was found between the occurrence of OMLs and denture wearing (P > 0.05). CONCLUSIONS: The present study has shown a high prevalence of oral lesions among Yemeni elders.

Dental caries and treatment needs of Yemeni children with down syndrome.

BACKGROUND: Oral health in Down syndrome (DS) children has some peculiar aspects that must be considered in the follow-up of these patients. The objective of the present study was to assess the prevalence of dental caries and treatment needs among children with DS in Yemen and also to investigate the association between these outcomes with various socio-demographic and clinical variables. MATERIALS AND METHODS: This cross-sectional study involved 96 children with DS aged between 6 and 15 years. Data were gathered through the use of a questionnaire and clinical observation. The dentition status and the treatment needs were recorded according to World Health Organization recommendations. ANOVA, Chi-square test, t-test and multiple regression analyses were applied using the statistical package for the social sciences (SPSS, Chicago, IL, USA) version 20.0 software, with P < 0.05 considered as significant. RESULTS: The results showed that 93.8% of the subjects had dental caries; overall, decayed missing filled surfaces (dmfs), decayed missing filled teeth (dmft), DMFS, DMFT were 10.35, 4.44, 4.32 and 2.45, respectively. Stepwise linear regression analysis has revealed that age was the most important predictor for DMFT and DMFS, while early age and less frequent teeth brushing were the most predictors for dmft and dmfs. Restorative care and extractions were the most needed specific treatments. CONCLUSION: The findings of this study demonstrate that children with DS in Yemen have a high prevalence of dental caries and extensive unmet needs of dental treatment. They would benefit from frequent oral health assessment.

Oral hygiene and gingival health status of children with Down syndrome in Yemen: A cross-sectional study.

PURPOSE: The objective of the present study was to assess the oral hygiene and gingival health status among Yemeni children with Down syndrome. MATERIALS AND METHODS: The study sample comprised 101 children with Down syndrome attending special needs schools in Sana'a, Yemen. The calculus index (CI), plaque index (PI), and the gingival index (GI) were used to assess oral hygiene and gingival health status. RESULTS: All subjects had gingivitis; the mean CI, PI, and GI scores were 0.58 ± 0.61, 1.45 ± 0.57, and 1.54 ± 0.64, respectively, with no significant difference found across gender. Stepwise linear regression analysis revealed that the best predictors in the descending order for CI were age and mother's education, and the best predictors for PI were IQ level, age, and father's education. Having severe mental retardation, older age, less educated parents were the most important predictors for poor gingival health status. CONCLUSIONS: These findings show that children with Down syndrome have poor oral hygiene and high levels of periodontal diseases. Hence, appropriate oral health education should be tailored to the needs of these children with the support of their teachers and parents.

Oral mucosal lesions and their association with tobacco use and qat chewing among Yemeni dental patients.

OBJECTIVES: This study aimed to assess the prevalence of oral mucosal lesions (OMLs) in patients attending outpatient dental clinics in Sana`a university, Yemen, and to evaluate the association of such lesions with age, gender, and oral habits. MATERIALS AND METHODS: This cross-sectional study included 409 subjects (272 males, 137 females, age: 15-86 years). Detailed clinical examination was performed in accordance with international criteria. Patient history included age, gender, education, denture wearing and risk habits (tobacco use and qat chewing). Data were analyzed using SPSS 19.00. RESULTS: The prevalence of OMLs was 58.4% with a significant difference between men (63.6%) and women (48.2%; P < 0.05). The most common lesions were fissured tongue (37.2%), hairy tongue (15.9%), tumors and tumor-like lesions (9.8%), qat-induced white lesions (9.3%) and racial pigmentation (5.9%). Overall OMLs prevalence was linked to risk habits and age; qat chewing was statistically significant risk factor for having fissured tongue (OR: 1.77), hairy tongue (OR: 2.74), and white lesions (OR: 2.39) (P < 0.05). Cigarette smoking was statistically significant risk factor for having hairy tongue (OR: 2.82), white lesions (OR: 3.60) and tumors and tumor-like lesions (OR: 2.91) (P < 0.01). The increase in age was statistically significant risk factor for having tumors and tumor-like lesions (OR: 1.04; P < 0.001). CONCLUSIONS: The current results indicate that the occurrence of OMLs among Yemeni adults is high and emphasize that risk habits and age have some relationship with the presence of OMLs. Key words:Oral mucosa, oral lesions, prevalence, smoking, qat chewing.

Oral lesions and dental status of autistic children in Yemen: A case-control study.

PURPOSE: This study aimed to assess the prevalence of oral lesions among children with autism in Sana'a City, Yemen, and to evaluate their dental status. PATIENTS AND METHODS: This case-control study included 42 children with autism, aged between 5 and 16 years, and 84 age- and gender-matched healthy children as controls. Oral lesions were assessed based on standardized criteria according to the World Health Organization (WHO) recommendations. Dental caries, gingival health, and oral hygiene status were assessed using dmft/DMFT index, Gingival Index (GI), and Plaque Index (PI), respectively. Chi-square test and Mann-Whitney's test were used to compare the groups. RESULTS: Compared to controls, children with autism revealed higher proportion of fistulae (9.5% vs. 2.4%), ulcerative lesions (7.1% vs. 1.2%), gingival hyperplasia (4.8% vs. 0.0%), and cheilitis (4.8% vs. 2.4%); however, the differences were not statistically significant. The mean dmft score was significantly higher in children with autism than in controls (5.23 vs. 4.06; P < 0.001). Moreover, children with autism revealed poorer oral hygiene than controls, and the majority had gingivitis. CONCLUSIONS: Children with autism in Yemen have high prevalence of oral soft tissue lesions, caries, and gingivitis. Therefore, proper oral health education programs should be initiated and directed toward this special section of the society.