Cultural factors and family influences on adolescent oral health: qualitative research in a socially disadvantaged population.

AIM: This qualitative study sought to assess the influence of cultural factors and family on oral health behaviour of 12- to 15-year-old adolescents from the socially disadvantaged population. DESIGN: A qualitative design was developed with focus group discussions (FGDs) among 12- to 15-year-old adolescents. Four focus groups (n = 32 participants) were created from a selected sample to capture oral health beliefs and practices, oral health-seeking behaviour along with other relevant information. Focus group discussions were audio-recorded, transcribed verbatim and translated. Data were analysed thematically and structural coding was applied. RESULTS: Three key themes that emerged from FGDs were importance of oral health; role of family in oral health behaviour; and beliefs influencing access, prevention and treatment of oral diseases. Cultural background, family values and beliefs were imperative in moulding the behaviour of adolescents towards oral health. The use of traditional oral hygiene aides was a norm in this population. CONCLUSIONS: Findings of the study provide greater insights into the authoritative role of family and cultural barriers in the uptake of dental services. The study also highlights the potential value of qualitative research and emphasizes the need to integrate oral health-associated cultural beliefs and attitudes of the adolescents towards a wider evidence base.

Clinical Assessment of Anatomic Origin Effect on the Clinical Outcomes in Primary Squamous Cell Carcinomas Affecting Nasoethmoidal Complex.

Background: Sinonasal squamous cell carcinomas (SCCs) present a great challenge in their diagnosis and management owing to their rapid growth, regional recurrence, local recurrence, and aggressive spread locally. Aims: The present clinical trial was conducted to evaluate anatomic subsites' impact on the outcomes concerning SCCs affecting ethmoid sinuses and nasal cavity. Materials and Methods: Medical records for tumor staging, tumor classification, grading (histologic) clinical features, symptoms, anatomic subsite, p16 results, treatment provided, and the Tumor-related outcomes were obtained for 28 subjects. Following staging and grading, p16 assays were evaluated along with disease-specific survival and disease-free survival. The collected data were subjected to the statistical evaluation and the results were formulated by keeping the level of significance at P < 0.05. Results: Origin was seen from nasal septum, nasal floor, lateral wall, ethmoid sinus, and edge of naris to mucocutaneous junction in 21.4% (n = 6), 7.14% (n = 2), 35.71% (n = 10), 7.14% (n = 2), and 28.57% (n = 8) subjects, respectively. For tumor staging, Stages I, II, III, and IV tumors were seen in, respectively, 39.28% (n = 11), 21.42% (n = 6), 10.71% (n = 3), and 28.57% (n = 8) study subjects. Node status was N0, N1, N2, and N3 in 78.57% (n = 22), 3.57% (n = 1), 7.14% (n = 2), and 10.71% (n = 3) subjects. Carcinoma arising from nasal septum had statistically significant worse disease-specific survival compared to carcinomas arising from other sites (P < 0.001). Conclusion: The present study concludes that anatomic subsites largely govern the outcomes and tumor behavior. Also, squamous cell carcinoma affecting the nasal septum is an aggressive tumor with more compromised outcomes and more lymph node involvement.

Serum Lactate Dehydrogenase Enzyme as a Tumor Marker in Potentially Malignant Disorders: A Systematic Review and Meta-Analysis.

BACKGROUND: Oral cancer is often preceded by Potentially Malignant Disorders (PMDs) and important role of biochemical markers for early diagnosis has been well documented; however, there is limited evidence of Serum lactate dehydrogenase (SLDH) as an effective biochemical marker in diagnosis of PMDs. The present meta-analysis was conducted to assess if serum LDH can be a used as standard biomarker for PMDs and consequently aid in diagnosis of oral cancer. METHODS: A comprehensive search was conducted in Medline, Scopus, Web of Science, EBSCO host, Cochrane databases and Google Scholar for studies evaluating estimation of SLDH in PMDs. Search strategy included all types of studies evaluating level of SLDH in patients with PMDs. PRISMA guidelines were followed for the meta-analysis. Fixed-effects model was used to assess the mean differences in SLDH levels between healthy controls and PMDs. RESULTS: A total number of nine studies were included in meta-analysis after screening for inclusion and exclusion criteria. Potentially malignant disorder was significantly associated with increased serum LDH level compared to healthy controls (pooled SMD: 1.83 (95% CI, 1.52, 2.15) (P < 0.00001; Subgroup analysis of OSMF (Oral Submucous Fibrosis) studies showed significant association with increased serum LDH level compared to healthy controls (pooled SMD: 2.57 (95% CI, 2.16, 2.98; P < 0.00001). Sensitivity analysis for the five studies reflected a significant reduction in I2 values to 24 % (P=0.26). Funnel plots were derived for any evidence of publication bias among the studies. CONCLUSION: Meta-analysis suggests that SLDH is increased in potentially malignant disorders compared to healthy controls. The results of this metanalysis should encourage use of SLDH as a biomarker in diagnosis of PMDs.

Analysis of Risk Factors Associated with Squamous Cell Carcinoma in the Indian Population.

BACKGROUND: Squamous cell carcinoma (SCC) describes the carcinomatous growth in the oral cavity. Recently, various authors have described increased SCC incidence in the young population. The distribution of SCC shows varied geographic spread, with the highest distribution in Asian countries. AIMS: The present trial was carried out to assess the associated factors that could lead to increased risk of developing oral cancer. MATERIALS AND METHODS: Oral examination was carried out for 21 participants by a dentist and any significant oral lesion or deleterious habit if present, was recorded. The data collected were analyzed. RESULTS: Areca nut was chewed by 47.61% participants (n = 10), smoking tobacco by 76.19% (n = 16), chewing tobacco by 38.09% (n = 8), and consuming alcohol in 9 participants (42.85%). No significant difference was seen concerning age for any factor except alcohol which showed higher intake in the older group where six participants depicted alcohol intake as compared to three participants in the younger group. In participants who chewed areca nuts, 6 participants also smoked tobacco and 1 consumed alcohol. For tobacco chewing, 5 consumed alcohol and 6 also took tobacco as smoke. CONCLUSION: The present study showed that areca nut and tobacco chewing along with alcohol consumption and tobacco smoking increase the risk of developing SCC in the Indian population.

A Comparative Study Evaluating Implant Success and Bone Loss in Diabetes and Nondiabetes.

BACKGROUND: Diabetes is seen to be associated with increased rate of failure of implants. The implant failure can be categorized as ailing, failing, and failed implants. The review of literature did not form any consensus on the effect of diabetes on the implant success rates. The reason we found was many confounding factors and nonconsideration of glycemic status of diabetic patients. Hence, in our study, we eliminated the confounding factors and took glycemic index in consideration. MATERIALS AND METHODS: Forty-six participants were included in this study, out of which 26 were nondiabetic and 20 diabetic. Diabetics were further divided into two groups based on the HBA1C values, as controlled and uncontrolled diabetics. RESULTS: We found that the uncontrolled diabetics had highest rate of implant failure as compared to other two groups. Furthermore, the controlled diabetics and nondiabetics had similar implant successes and failure rates. CONCLUSION: This suggests that controlled diabetics are comparable to nondiabetics in terms of implant success rates.

Reliability of C-reactive Protein as a Biomarker for Cardiovascular and Oral Diseases in Young and Old Subjects.

BACKGROUND: Increased C-reactive protein (CRP) levels are associated with various diseases such as cardiovascular diseases (CVDs), periodontal diseases, and other inflammatory diseases and can be an effective biomarker for predicting future risks of periodontal diseases. AIMS: The present trial was carried out to evaluate if CRP levels are lower in healthy and young individuals as compared to individuals with high body mass index (BMI), gingival index, and CVDs by assessing CRP levels in young and old individuals (more than 45 years). MATERIALS AND METHODS: A total of 174 participants were recruited for the study and were divided into three following groups: Less than 45 years healthy participants (n = 124), more than 45 years healthy participants, and more 45-year-old participants with CVDs (n = 25). The collected data were subjected to the statistical analysis. RESULTS: In Group I, females had a CRP level of 8476 ± 6.86 pg, females of Group II had a CRP value of 13,262 ± 3.76, and in females of Group III CRP value was 22,761 ± 6.24 pg. These values, respectively, for males were 8494 ± 7.68, 13,840 ± 4.82, and 13,839 ± 3.8. In smokers, the CRP values for Group I, II, and III were 29,012 ± 14.66, 12,568 ± 4.16, and 16,826 ± 3.42, respectively. CONCLUSION: CRP levels were higher in males as compared to females. Higher BMI was associated with higher values of CRP. The participants with higher BMI presented higher CRP values irrespective of age.

Skills, Knowledge, and Implementation of Techniques for Behavioral Guidance in Adults with a Fear of Dentistry.

BACKGROUND: Dental fear and anxiety (DFA) is considered the main reason of dental negligence which can lead to detrimental oral health as well as overall health including psychological well-being and quality of life in an individual. AIMS: The present trial was aimed to assess the skill and knowledge of dentists in managing DFA in adult subjects, to evaluate the available strategies used in treating such subjects, and to find the need for further education. MATERIALS AND METHODS: The present study was an original survey and questionnaire trial, which was distributed to the 82 dentists. The collected data were subjected to statistical evaluation and the results were formulated. RESULTS: Educating and motivating subjects was found to be effective by 62.19% (n = 51) of dentists followed by successive approximation, and muscle relaxation was considered highly ineffective by one responder (1.21%). Music and reduced waiting time in the clinic appeared to be the most effective strategy as responded by 56.09% (n = 46) of dentists. Attempting treatment in various visits than a single seems to be a highly ineffective technique by 4 dentists (4.87%). CONCLUSION: Within its limitation, the study showed that the application of various behavior modification techniques can be effective in alleviating DFA in adult patients.

Assessment of Oral Health and Prevalence of oral Conditions in Human Immunodeficiency Virus-infected Subjects Visiting Antiretroviral Therapy Centers.

BACKGROUND: Weakened immune system from acquired immunodeficiency syndrome (AIDS) makes the individual prone to various opportunistic infections which are life-threatening including various carcinomas and disorders affecting the neurological system. AIMS: The present trial was done to assess the prevalence of oral presentations and treatment needs in AIDS/human immunodeficiency virus (HIV)-infected subjects visiting antiretroviral therapy centers. MATERIALS AND METHODS: The study included 126 subjects. Oral cavity was assessed and dentition, periodontal condition, and lesions and conditions affecting the oral mucosa were identified along with their treatment needs. The collected data were subjected to statistical evaluation and the results were formulated. RESULTS: Candidiasis was seen in 25.39% (n = 32) of total subjects. Concerning the periodontal status of HIV-infected study population, it was seen that maximum attachment loss both in males and females was within the range of 0-3 mm. Regarding decayed, missing, and filled teeth scores, these were statistically significantly higher in males (P = 0.001). CONCLUSION: The present study concluded that the majority of subjects infected with HIV present one or more oral presentation and lesion, with candidiasis being the most common condition.

Evaluation of the Orofacial Features in the Victims of Abuse and Neglect of 5-16-Year-old Age Children.

BACKGROUND: Oral cavity may be considered a pivotal focal point in physical assault or abuse because of its implication in communication and nutrition. Dentists trained in a child abuse curriculum can provide valuable information and assistance to physicians about oral and dental aspects of child abuse and neglect. The present study was conducted to evaluate the orofacial features of children between the age group of 5-16 years suspected to be victims of child abuse/neglect. MATERIALS AND METHODS: This study was conducted on 250 children ranging between 5 and 16 years were enrolled in the study. All the participants were suspected to be victims of child abuse/neglect. The orofacial features were carefully examined by a well-trained dentist. RESULTS: Two hundred and fifty children were enrolled in the study. Seventy-two children (30%) presented with laceration of various sites including lip (n = 13), frenum (n = 8), buccal mucosa (n = 26), palate (n = 16), and floor of the mouth (n = 9). Twenty-nine participants exhibited the features of avulsion (11.6%). Eighteen children revealed dento-alveolar fractures, 104 presented with dental caries (41.6%), 19 presented with missing teeth (7.6%), all the candidates presented with deposits (100%). CONCLUSION: Careful intraoral and perioral examination of the participants victimized to abuse and/neglect is necessary as the oral cavity is a central focus for physical abuse, which may be allied to its importance in communication and nutrition. Physicians and dentists should work together to increase the prevention, detection, and treatment of these conditions.