Waking Up to Antibiotic Resistance.

Background: Antimicrobial resistance (AMR) has emerged as a global concern, particularly in developing countries where its causes seem to entrench the knowledge, attitude, and practice of healthcare professionals and patients toward the use of antimicrobials. Methods: This review aims to provide a compendious yet thorough overview of our understanding of antibiotic resistance pertaining to dentistry. Literature provides evidence of inadequate antibiotic prescribing practices by dental professionals. Considering the growing concern about antibiotic prescribing habits and patient's tendencies of improper use, we attempt to address the interventional efforts of dentists and patients in the context to focus on the root causes specifically to prevention of the antimicrobial resistance. Results: Following the guidelines and flowchart depicted in this article, the members of dental professions will get clear views on the use of antibiotics. This will cause a definite decrease in the growing concern about antibiotic resistance.

Effect of an educational intervention on manual toothbrush bristle wear: A light microscopic study.

Background and Objectives: The usage of a toothbrush with the most appropriate bristle type and a correct brushing technique are the most important factors in determining the thoroughness of plaque control. The dental undergraduate course conventionally does not impart tooth brushing techniques in the preclinical years. This study aimed to assess the effect of an educational intervention of correct tooth brushing technique on the wear of toothbrush bristles by light microscopic examination amongst the budding dental professionals. Materials and Methods: Toothbrush bristle wear was measured by light microscopy before and after an educational intervention amongst 30 first-year dental professional students. Wear index (WI), wear rate (WR), and acceptable percentage of bristle end morphology were calculated. Mann-Whitney U-statistics test and unpaired t-test were used to compare measurements of acceptable percentage and gender wise, respectively. The difference was said to be significant if P < 0.05. Results: The mean WI before intervention was 0.29 ± 0.122 and after the intervention was 0.23 ± 0.07, while the mean WR before intervention was 1.6 ± 0.167 and after the intervention was 1.17 ± 0.46% of bristle end morphology before intervention was 52.5 ± 10.064 and after intervention was 64.5 ± 5.625 with the difference being statistically significant with P < 0.05. Interpretations and Conclusion: The present study highlights the importance of imparting a correct tooth brushing technique in reducing the toothbrush bristle wear and improving the efficiency of the toothbrush in maintaining optimum oral hygiene. Early intervention of correct oral hygiene measures is especially prudent for the budding dental professional for future healthcare delivery to the general population.

Velscope guided oral cancer screening: A ray of hope in early oral cancer diagnosis.

Context: Early oral cancer diagnosis is an important factor in reducing cancer-associated mortality and morbidity. Traditional oral cancer screening by Conventional Oral Examination (COE) is limited. A new approach in this regard is the use of "optical biopsy systems" like VELscope. Aims: Hence, this study aimed to determine the diagnostic value of VELscope, an autofluorescence-based handheld device in detection of dysplasia and oral squamous cell carcinoma (OSCC) in general oral potentially malignant disorder. Settings and Design: A prospective, cross-sectional study was conducted at a tertiary hospital in western Maharashtra, India. Materials and Methods: Thirty patients with presence of clinically suspicious oral lesions were included, and for each lesion, both the COE and Autofluorescence Examination by VELscope were carried out at the same appointment by different experts. All lesions were biopsied and histopathological findings were documented and analyzed. Statistical Analysis Used: Sensitivity, specificity, positive predictive value and negative predictive value were estimated to determine the accuracy of VELscope examination analysis outcome. Results: The study included a total of 30 subjects including 19 (63.33%) males and 11 (26.66%) females. Autofluorescence examination by VELscope (AFV) revealed Autofluorescence Loss in 24 (80%) patients, while 6 (20%) patients showed Autofluorescence Retained. Comparison between the "high-risk lesions" (moderate/severe dysplasia and OSCC) and "low-risk lesions" (no/mild dysplasia) showed a 90.47% sensitivity but only 44.44% specificity. Conclusions: The findings of our study indicate that although AFV cannot be a substitute for COE, it can be used as a potential complementary diagnostic aid in surveillance of the high-risk patient population.

Correlation and Comparison of Cheiloscopy and Dactyloscopy with Blood Groups ­ An Institutional Study

Background: The most crucial evidence that is left behind at the crime scenarios that might narrow down the suspect pool are lip prints and fingerprints. These are undoubtedly the most reliable and valuable evidence till date in the court of law. One more biological record that remains unchanged throughout the lifespan of a person is the blood group. Aim and Objectives: To study, correlate and compare cheiloscopy and dactyloscopy with blood group among dental students in the Western Maharashtra population. Materials and Methods: A total of 200 dental students with age groups ranging between 18-25 years were included in the study. Lip print pattern, fingerprint pattern and ABO blood groups were collected and compared. SPSS version 20.0 was used to analyse the data. Results: There was a statistically significant correlation between lip prints and ABO - Rh (χ2 37.56, P < 0.05) as well as between fingerprints and ABO-Rh blood groups (χ2 30.6, P < 0.05). Conclusion: Hence, this study concluded that fingerprints-ABO blood group and lip prints-ABO blood groups are valuable evidence that can be relied upon in forensic investigations for the identification of the suspect in crime.

Effect of using tobacco on taste perception.

BACKGROUND: Impaired taste perception has impact on quality of life. Tobacco is a perilous factor that contributes to an impaired taste. OBJECTIVE: To evaluate and compare taste perception among tobacco chewers and nonchewers. MATERIALS AND METHODS: Sixty subjects (30 tobacco chewers + 30 nonchewers as controls) were enrolled in the study for evaluating taste perception. Taste identification time using four aqueous solutions of basic tastes - sweet, salty, sour, and bitter - was recorded (in seconds) and compared between tobacco chewers and controls. The data were analyzed using Student's t-test and analysis of variance using SPSS 20 version software. RESULTS: A statistically significant increase in taste identification time for salty taste in tobacco chewers (12.32 s) was noted compared with nonchewers (10.21 s) (P = 0.03). The average taste identification time was higher for tobacco chewers than nonchewers for sweet and salty taste. However, the average taste identification time was lower for tobacco chewers than nonchewers for sour and bitter taste. In nonchewers, the average taste identification time was 13.01, 10.21, 8.43, and 7.56 s for sweet, salty, bitter, and sour taste, respectively. In tobacco chewers, the average taste identification time was 15.16, 12.32, 7.75, and 7.04 s for sweet, salty, bitter, and sour taste, respectively. CONCLUSION: The results of the study demonstrated noticeable decrease in taste perception to salty taste among tobacco chewers when compared with tobacco nonchewers. There is a remarkable difference in taste perception to basic tastes among tobacco chewers and controls.

Prevalence and awareness of nutritional anemia among female medical students in Karad, Maharashtra, India: A cross-sectional study.

INTRODUCTION: Anemia is a global public health problem affecting both developing and developed countries. According to the World Health Organization, the highest number of individuals affected by anemia is observed in nonpregnant women aged 15-49.99 years. Though nutritional anemia can affect any age group, female medical students form a vulnerable population due to their hectic schedules, erratic mealtimes, and long working hours while staying in hostel for majority of times. Therefore, this study is aimed at determining the prevalence and awareness of anemia among the apparently healthy female students studying at a health institute. METHODS: A cross-sectional study is conducted among 300 female students studying at a health institute in western Maharashtra after their written informed consent. A structured questionnaire elicits their general information, the knowledge about signs and symptoms of anemia, and dietary habits. Basal metabolic index and hemoglobin using the spectroscopy method are estimated for each participant. RESULTS: Anemia prevalence in our population is 86 (28.6%). Based upon the severity of anemia, about 54 (18%) has mild anemia and 32 (10.6%) has moderate anemia. No case of severe anemia is noted in our study sample. CONCLUSION: The findings of the study highlight that anemia can affect even medical female students who are a vulnerable group unexpectedly suffering from nutritional deficiencies. Thus, this study highlights the need for interventional programs at primary health-care systems and colleges for improvement in the nutritional status of anemic students to reduce its complications.

Effect of socioeconomic status on dental caries during pregnancy.

BACKGROUND AND OBJECTIVE: It is generally agreed that people with low socioeconomic status have a significantly worse oral and general health compared to people with higher socioeconomic status. The aim of the study was to find out the role of socioeconomic status of pregnant women on their oral health by evaluating the dental caries risk factor, the salivary Streptococcus mutans count and DMFT index. MATERIALS AND METHODS: A total of 50 first time pregnant women were randomly sampled and were divided into different socioeconomic strata following the Kuppuswamy socioeconomic status scale. DMFT index and microbiological assessment of dental caries risk factor parameter, the salivary Streptococcus mutans colony forming units, were carried out during the three trimesters and postpartum period. The observations were compared with 50 non-pregnant women of same age group. RESULTS: Of the randomly sampled subjects, majority of the pregnant women (28/50) of the study group were of middle/lower middle class, 11 pregnant women were of upper middle class, and 11 were of the lower/upper lower class. When followed in their three trimesters and postpartum period, statistically significant increase in the salivary Streptococcus mutans colony forming units was noted in 2nd trimester, 3rd trimester and postpartum period (P value < 0.05) of all pregnant women. Comparison of the caries risk factor between the pregnant women of three socioeconomic strata, however, revealed that no particular class was at a higher risk for dental caries. CONCLUSION: This study gives an insight into the possible changing trends towards awareness for oral hygiene in various socioeconomic strata of pregnant women.

Salivary Human Chorionic Gonadotropin as a Novel Biomarker for Early Detection of Pregnancy: A Pilot Study.

CONTEXT: The role of saliva in detection of pregnancy has not received the due importance it deserves. AIMS: The present paper aims at determining the role of saliva in detection of pregnancy using home-based pregnancy detection kits to provide an alternative biofluid that is more user friendly, acceptable, noninvasive, rapid, and easy for home use. SETTINGS AND DESIGN: The study was conducted among 35 women visiting a gynecology clinic for confirmation of pregnancy, who gave a history of a missed menstrual cycle not more than 4 weeks. SUBJECTS AND METHODS: A home-based pregnancy detection kit meant for urinary human chorionic gonadotropin (hCG) detection with 20 mIU specification was used in the study for estimation of salivary hCG. Routine test that was prescribed to the patient such as laboratory-based urine hCG and/or ultrasound examination was used for confirmation of pregnancy status and correlation with the saliva-based result. RESULTS: A positive test was obtained in 74% participants, with a dark band in 43% participants and a light band in 31% participants. A negative result was noted in 26% participants. We observed that salivary hCG estimation showed a 77% accuracy and 23% false-negative results. CONCLUSIONS: An astounding 74% of participants showed a positive result with an existing pregnancy kit which indicates a strong plausibility of using salivary hCG as a biomarker for detection of pregnancy. With the findings obtained from our study, we could positively affirm that salivary hCG can be used as a potential, user friendly, and more acceptable biomarker for early detection of pregnancy.

An insight into diagnosis of a hidden entity: Impacted food material.

INTRODUCTION: Foreign bodies and tissue reactions to foreign materials are commonly encountered in the oral cavity. Exogenous materials causing foreign body reactions may be metallic (amalgam) or nonmetallic (suture materials, vegetable matter). Implantation of food particles in the oral tissues has been known to cause reactive lesions such as oral pulse granuloma. Implantation could be through extraction sockets, deep periodontal pockets, associated with tumor growth, interdental areas of teeth, unfilled root canals, and grossly decayed teeth. These get rapidly digested and altered by host responses. Cellulose persists as hyaline material and invokes chronic granulomatous response. This change may mimic other pathologies. MATERIALS AND METHODS: Representative specimens from commonly consumed food groups were selected, fixed in 10% neutral buffered formalin, processed, sectioned, stained with hematoxylin and eosin stain and observed under light microscope. RESULTS: Each specimen revealed unique, distinct histology of each food type. The plant materials had a characteristic appearance of rigid double cell wall while rigid regular partitions containing nutrient material were revealed in seeds and beans. Starch-contained lentils exhibited clear spaces. Following is a brief description of some of the significant histological findings of each of the specimens processed and stained. CONCLUSION: Thus, the study of histological structure of vegetables and legumes will enable their easy recognition in oral biopsy samples and help in distinguishing them from other pathologies and artifact.

Dietary habits amongst medical students: An institution-based study.

INTRODUCTION: In recent times, with the increasing burden caused by the lifestyle diseases on the health sector, there has been a renewed interest in the relationship between food and health. Research regarding nutritional status in college students in western Maharashtra, India, has been found lacking. Therefore, this study was undertaken to ascertain the dietary habits in the undergraduate students of a health institute. MATERIALS AND METHODS: This questionnaire-based study was conducted amongst 130 students from a health university regarding their dietary attitudes and lifestyle practices. The students had the option of choosing more than one answer based on the nature of the question. All the data were tabulated and relevant inferences were drawn. RESULTS: A total of 130 students comprising 74 girls and 56 boys from a health university participated in the study. Daily consumption of fruits and vegetables was only 1-2 portions for 98 (75%) of the participating students. Twenty-four (18%) participants were noted to be underweight and 11 (8%) students were either overweight or obese. CONCLUSION: Thus, the findings of the study indicate that the diet and nutritional aspects of our future medical health professionals should be researched in further details and timely interventions initiated for ensuring the knowledge and practice of the WHO principles regarding the same to be incorporated.

Evaluation of Radiation-induced Cytological Changes in Lesional Oral Cancer Cells and Adjacent Normal Mucosal Cells.

AIM: To assess various cytological changes for predicting radiosensitivity of oral squamous cell carcinoma by exfoliative cytology. MATERIALS AND METHODS: Histologically proven 30 cases of oral squamous cell carcinoma who underwent fractionated radiotherapy in a dose of 45-60 Gy in 5 fractions/week were enrolled in the study. The exfoliative cytology smear was evaluated on lesional and adjacent oral mucosa before radiotherapy, during radiotherapy (8 and 11th fraction) and post radiotherapy (4, 6 and 8 weeks). Various parameters like multinucleation, cellular enlargement, nuclear enlargement, cytoplasmic vacuolation, cytoplasmic granulation, leukocytic infiltration were evaluated. RESULTS: Statistical significant values were seen in the inter-group comparison of all the parameters when compared adjacent mucosa and normal mucosa for leukocytic infiltration in pretreatment smear. CONCLUSION: The study showed that radiation-induced cytological changes in oral squamous cell carcinoma have a significant dose-related increase. This dose-response relationship and the high intratumoral variations suggest that serial assay of these changes has potential use for radiosensitivity prediction. CLINICAL SIGNIFICANCE: Radiosensitivity prediction can be evaluated by means of cytological smears in one stop crisis centre (OSCC) individuals subjected to fractionated radiotherapy by evaluating the cytological parameters.

Estimation of DMFT, Salivary Streptococcus Mutans Count, Flow Rate, Ph, and Salivary Total Calcium Content in Pregnant and Non-Pregnant Women: A Prospective Study.

INTRODUCTION: Pregnancy, a period from conception till birth, causes changes in the functioning of the human body as a whole and specifically in the oral cavity that may favour the emergence of dental caries. Many studies have shown pregnant women at increased risk for dental caries, however, specific salivary caries risk factors and the particular period of pregnancy at heightened risk for dental caries are yet to be explored and give a scope of further research in this area. AIM: The aim of the present study was to assess the severity of dental caries in pregnant women compared to non-pregnant women by evaluating parameters like Decayed, Missing, Filled Teeth (DMFT) index, salivary Streptococcus mutans count, flow rate, pH and total calcium content. MATERIALS AND METHODS: A total of 50 first time pregnant women in the first trimester were followed during their second trimester, third trimester and postpartum period for the evaluation of DMFT by World Health Organization (WHO) scoring criteria, salivary flow rate by drooling method, salivary pH by pH meter, salivary total calcium content by bioassay test kit and salivary Streptococcus mutans count by semiautomatic counting of colonies grown on Mitis Salivarius (MS) agar supplemented by 0.2U/ml of bacitracin and 10% sucrose. The observations of pregnant women were then compared with same parameters evaluated in the 50 non-pregnant women. Paired t-test and Wilcoxon sign rank test were performed to assess the association between the study parameters. RESULTS: Evaluation of different caries risk factors between pregnant and non-pregnant women clearly showed that pregnant women were at a higher risk for dental caries. Comparison of caries risk parameters during the three trimesters and postpartum period showed that the salivary Streptococcus mutans count had significantly increased in the second trimester, third trimester and postpartum period while the mean pH and mean salivary total calcium content decreased in the third trimester and postpartum period. These changes reflected on the DMFT score which increased in the third trimester and postpartum period. CONCLUSION: The results of this study suggest that there is a definite correlation between pregnancy and dental caries. We conclude that the third trimester and postpartum period of pregnancy are the periods during which the pregnant women are at a higher risk for development of dental caries.

Trending Speculations of Tumor-Initiating Cells in Squamous Cell Cancers of Head and Neck.

Tumor-initiating cells are a diminutive subpopulation of stem cells that have ability of long term self-renewal and generation of varied traits of tumor cell population. Understanding the concept of tumor-initiating cells may have a great implicative intimation for our comprehension of cancer pathobiology and for the delineation of new therapies directed towards these stem cells. The present review is an endeavor to conceptualize the role of tumor-initiating cells in the Squamous Cell Cancers (SCC) of head and neck, their role in tumorigenesis and the possible supplementary approach in the latest treatment modalities.

Glucose Level Estimation in Diabetes Mellitus By Saliva: A Bloodless Revolution.

BACKGROUND: Diabetes mellitus is a massive, growing, silent epidemic that has the potential to cripple health services in all parts of the world. Currently, a diagnosis of diabetes is achieved by evaluating plasma glucose levels. Saliva offers some distinctive advantages. Whole saliva can be collected non-invasively and by individuals with limited training. The present study was aimed to estimate and correlate the plasma and salivary glucose levels in diabetic and non diabetic subjects, with special reference to age. METHOD: The study population consisted of three groups: Group I consisted of diabetics with BGL>200mg/dl and Group 2 consisted of diabetics with BGL 130-200mg/dl based on their random plasma glucose levels. Group 3 consisted of healthy population as controls with BGL <130 mg/dl. 2 ml of peripheral blood was collected for the estimation of random plasma glucose levels and unstimulated saliva was collected for the estimation of salivary glucose RESULTS: The salivary glucose levels were significantly higher in group 1 and group 2 diabetics when compared with controls. The salivary glucose levels show a significant correlation with plasma glucose levels between study populations, suggesting that salivary glucose levels can be used as a monitoring tool for predicting glucose level in diabetic patients. CONCLUSION: The present study found that estimation of salivary glucose levels can be used as a noninvasive, painless technique for the measurement of diabetic status of a patient in a dental set up.

Proposing national identification number on dental prostheses as universal personal identification code - A revolution in forensic odontology.

The proper identification of a decedent is not only important for humanitarian and emotional reasons, but also for legal and administrative purposes. During the reconstructive identification process, all necessary information is gathered from the unknown body of the victim and hence that an objective reconstructed profile can be established. Denture marking systems are being used in various situations, and a number of direct and indirect methods are reported. We propose that national identification numbers be incorporated in all removable and fixed prostheses, so as to adopt a single and definitive universal personal identification code with the aim of achieving a uniform, standardized, easy, and fast identification method worldwide for forensic identification.

Psychosocial characteristics of oromucosal diseases in psychiatric patients: observational study from Indian dental college.

BACKGROUND: Psychiatric diseases like anxiety, depression, schizophrenia and bipolar disorders can affect the mental and physical statuses of an individual. AIM: The study was to investigate the different oromucosal diseases (OMD) in psychiatric patients and to evaluate the correlation between these OMD to severity of anxiety and depression. MATERIALS AND METHODS: A cross-sectional study was carried out during a six-month period. Patients reporting to psychiatry department with anxiety, depression, schizophrenia and bipolar disorder as diagnosed by an experienced psychiatrist, were subjected to complete oral examination by a skilled oral diagnostician to check for OMD like oral lichen planus (OLP), aphthous stomatitis (AS) and burning mouth syndrome (BMS). During the above mentioned time interval, 1320 patients with any of the above mentioned psychiatric diseases were included in this study. Of these, 278 had anxiety, 398 had depression, 295 had schizophrenia and 349 had bipolar disorder. Equal number of individuals reported to the Oral Medicine and Radiology department for routine oral screening with no mucosal diseases were included as control group. RESULTS: In this study, statistically significant increase in the OMD of the psychiatric patients was recorded when compared with the control group. The OMD were significantly higher in patients with anxiety (20.86%) followed by patients with depression (9.04%), schizophrenia (7.7%), bipolar disorder (7.4%) and control group (5.17%), respectively. Most prevalent OMD in patients with anxiety was AS (12%) followed by OLP (5.7%), and BMS (2.87%) respectively. Patients with moderate to severe anxiety and depression showed significantly higher prevalence of these OMD compared to the ones with mild anxiety and depression. The AS and OLP were significantly more in the younger age group (18-49 year) and BMS was higher in 50-77 year age group in both the study and control groups. CONCLUSION: A positive association was established between psychological alterations and OMD. Emotional alterations may act as a precipitating factor that could influence the initiation and development of different OMD. Hence, better harmonization is essential between dentist and psychiatrists for comprehensive management of psychosomatic disorders of the oral mucosa.

Comparative analysis of cell proliferation ratio in plaque and erosive oral lichen planus: An immunohistochemical study.

BACKGROUND: Proliferating cell nuclear antigen (PCNA) is a nuclear protein synthesized in the late G1 and S-phase of the cell cycle. Detection of this protein represents a useful marker of the proliferation status of lesions. This study has been carried out to evaluate the cell proliferation rate in oral lichen planus (OLP) and comparison between plaque and erosive lichen planus, which indicates the potential for malignant transformation. MATERIALS AND METHODS: This study was comprised of 64 cases of histologically proven lichen planus, out of which 32 cases of plaque and erosive each was taken. Two sections were taken from each, one for H and E staining to verify histological diagnosis according to Eisenberg criteria, other sections were stained according to super sensitive polymer horse radish peroxidise method for identifying immunohistochemical expression of PCNA. Data were statistically analyzed by Tukey high-range statistical domain test. Statistically significant P value was considered <0.05. RESULTS: In two types of lichen planus, erosive type (66.86%) showed higher expression of PCNA followed by plaque (17.07%). Overall, P value was <0.001, which was statistically significant. It indicates that proliferation activity is more in erosive lichen planus followed by plaque type, which ultimately results in increased rate of malignant transformation. CONCLUSION: PCNA is a good nuclear protein marker to evaluate the proliferation status of OLP. Out of the two types of lichen planus, erosive type possesses more proliferative ratio and chances of malignant change is more in this type. It emphasizes the importance of long-term follow-up with erosive type when compared with plaque type.

Cheilitis granulomatosa: a case report with review of literature.

Cheilitis granulomatosa (CG) is a chronic swelling of the lip due to granulomatous inflammation. It is a rare inflammatory disorder first described by Miescher in 1945. It is a monosymptomatic form or an incomplete variant of Melkersson-Rosenthal syndrome; a triad of recurrent orofacial edema, recurrent facial nerve palsy and fissuring of the tongue. As the etiology remains unknown, treatment of CG is challenging. We present a case of CG in a 43-year-old female patient secondary to allergy to certain food items. The present case highlights the importance of thorough investigations in the diagnosis of this lesion as the findings mimic many other granulomatous conditions.