Evaluation of the Oral Health Education Programme for Nurses using an Oral Lesion Simulator.

PURPOSE: This study aimed to investigate the usefulness of a newly developed oral simulator for nursing students' oral assessment education on oral diseases and symptoms. MATERIALS AND METHODS: The participants were first-year students (n=105) at a nursing school in Japan. Ten identical oral simulators with angular cheilitis, missing teeth, dental caries, calculus, periodontitis, hypoglossal induration, food debris, and crust formation were created by a team of dentists. After a 45-minute lecture programme for oral assessment performance with the Oral Health Assessment Tool (OHAT), the ability test with the simulators and the OHAT as well as test feedback were conducted in a 30-minute practical programme. To evaluate the effectiveness of the programmes, questionnaires and ability tests with slides of oral images were conducted at baseline and after the programme. RESULTS: Ninety-nine students (94.3%) participated in this study. The results of the ability test with the simulators and the OHAT in the practical programme showed that the correct answer rates of assessing tongue, gingiva, present teeth, and oral pain were less than 40%. Their levels of confidence, perception, and oral assessment performance were statistically significantly higher after the programmes than they were at baseline. Their level of confidence in assessing the need for dental referral had the largest increase in scores compared to the lowest scores at baseline in the nine post-programme assessment categories. CONCLUSIONS: This study identified several problems with nursing students' oral assessment skills and improvements of their oral assessment confidence, perceptions and performance.

The association between referral by specialists in oral diagnosis on survival rates of patients with oral cancer: A retrospective cohort study.

BACKGROUND: To assess the influence of diagnosis and referral provided by specialists in oral diagnosis on disease-free survival and overall survival of patients with oral cancer. METHODS: A cohort of 282 patients with oral cancer treated at a regional cancer hospital from 1998 to 2016 was analyzed retrospectively. The referral register of the patients was analyzed and assigned to two groups: (1) those referred by oral diagnosis specialists (n = 129), or (2) those referred by nonspecialized professionals (n = 153). The cancer treatment evolution was assessed from the patients' records, and the outcome was registered concerning cancer recurrence and death. Sociodemographic and clinicopathological variables were explored as predictors of disease-free survival and overall survival. RESULTS: Group 1 exhibited lower T stages and a reduced incidence of regional and distant metastases. Surgery was performed in 75.2% of cases in Group 1, while in Group 2, the rate was 60.8%. Advanced T stages and regional metastases reduced the feasibility of surgery. Higher TNM stages and tumor recurrence were associated with decreased disease-free survival, while surgical intervention was a protective factor. Higher TNM stage had a negative impact on the overall survival. CONCLUSION: Specialized oral diagnosis did not directly impact disease-free survival and overall survival and did not influence the indication of surgery in oral cancer; however, it was associated with the diagnosis of early tumors and better prognosis.

A deep learning method for multi-task intelligent detection of oral cancer based on optical fiber Raman spectroscopy.

In the fight against oral cancer, innovative methods like Raman spectroscopy and deep learning have become powerful tools, particularly in integral tasks encompassing tumor staging, lymph node staging, and histological grading. These aspects are essential for the development of effective treatment strategies and prognostic assessment. However, it is important to note that most research so far has focused on solutions to one of these problems and has not taken full advantage of the potential wealth of information in the data. To compensate for this shortfall, we conceived a method that combines Raman spectroscopy with deep learning for simultaneous processing of multiple classification tasks, including tumor staging, lymph node staging, and histological grading. To achieve this innovative approach, we collected 1750 Raman spectra from 70 tissue samples, including normal and cancerous tissue samples from 35 patients with oral cancer. In addition, we used a deep neural network architecture to design four distinct multi-task network (MTN) models for intelligent oral cancer diagnosis, named MTN-Alexnet, MTN-Googlenet, MTN-Resnet50, and MTN-Transformer. To determine their effectiveness, we compared these multitask models to each other and to single-task models and traditional machine learning methods. The preliminary experimental results show that our multi-task network model has good performance, among which MTN-Transformer performs best. Specifically, MTN-Transformer has an accuracy of 81.5%, a precision of 82.1%, a sensitivity of 80.2%, and an F1_score of 81.1% in terms of tumor staging. In the field of lymph node staging, the accuracy, precision, sensitivity, and F1_score of MTN-Transformer are 81.3%, 83.0%, 80.1%, and 81.5% respectively. Similarly, for the histological grading classification tasks, the accuracy was 83.0%, the precision 84.3%, the sensitivity 76.7%, and the F1_score 80.2%. This code is available at https://github.com/ISCLab-Bistu/MultiTask-OralRamanSystem.

Structural brain feature is associated with changes of masticatory performance in healthy elderly people: Evidence from longitudinal neuroimaging research over two years.

BACKGROUND: Human neuroimaging studies have revealed the association between brain structure and masticatory function. However, the majority of the studies adopted a cross-sectional design, which hardly reveals the change in masticatory function and brain structure between different timepoints, and the dynamical association between changes in masticatory function and changes in brain structure has not been elucidated. OBJECTIVE: With a longitudinal design, we assessed the association between changes in masticatory performance (MP) and regional brain volume. METHODS: Twenty-two elderly participants received assessments of the number of missing teeth and MP (via colour-changeable chewing gum) when they entered the study (i.e. the initial stage, T0 ), approximately 6 months later (T0.5 ), and approximately 1-2 years later (T1 ). Difficulty of food intake was assessed using a questionnaire. The participants received magnetic resonance imaging (MRI) at T0 and T1 . The brain volume of the motor-related area was estimated using FreeSurfer for MRI data. The associations between different stages were analysed using Spearman's rho correlation coefficients. RESULTS: (1) Individually, a smaller volume of right primary motor cortex at T0 was associated with increased MP from T0 to T1 , suggesting the brain's role in changing oral functions; (2) higher MP at T0 was associated with an increased volume of the left superior frontal cortex from T0 to T1 p, suggesting a potential effect on brain plasticity, and (3) increased difficulty to eat was associated with decrease MP but not brain volume of motor-related area. CONCLUSIONS: The preliminary findings revealed a complicated pattern of structural brain features and masticatory function in elderly people, and either the hypothesis that the brain predisposes masticatory function or the hypothesis that mastication reshapes the brain is oversimplified.

Prevalence of Oral Lesions Diagnosed at a Pathology Institute: A Four-year Analysis

Abstract Objective: To identify the most prevalent oral lesions based on reports from a pathology institute's reports and associations between malignant and oral potentially malignant disorders with patient's demographic variables and the anatomical location. Material and Methods: All 1,298 histopathological reports of oral lesions recorded in the database were reviewed. Demographic variables, anatomical location of the lesion, histopathological diagnosis of the lesions, and their biological behavior were analyzed. Results: Regarding the biological behavior of the identified lesions, benign lesions were predominant (70%), followed by lesions of undetermined behavior (14.3%), malignant lesions (14.2%), absence of histological alteration (1.2%), and finally, oral potentially malignant disorders (0.5%). The anatomical locations of the most prevalent oral lesions potentially malignant disorders and malignant were in the following structures of the oral cavity: gums, buccal mucosa, floor of the mouth and hard palate (p=49.2%), and tongue (p=48.7%). Conclusion: The probability of malignant and premalignant lesions was higher among males (PR= 4.21; 95% CI 2.08-6.22), the increase in age (PR = 1.06; 95% CI 1.05-1.08), and in the tongue region (PR = 5.48; 95% CI 1.67; 17.92). Identification of malignant and potentially malignant oral conditions is higher in older men and in tongue specimens.

Assessment of studies on oral manifestations and COVID-19: a meta-research study

This study aimed to evaluate how different study designs influences the presence and characteristics of diagnosis of oral manifestations in patients with COVID-19. Methods: This study is a meta-search conducted with studies evaluating the relationship between patients with oral manifestations and COVID-19. A search was conducted in three databases (PubMed, Web of Science, and Scopus), using terms specific to COVID-19 and oral lesions, including only primary studies. Study selection was undertaken by two reviewers independently. A descriptive analysis was performed. Results: The results included 55 studies in the data synthesis analysis. Most of the studies were case reports and case series. Some of the studies did not relate a biological test to confirm COVID-19. The ulcer lesion and that clinical examination by specialists were the most reported lesion in case reports and case series studies, while taste alterations and patient self-report were more reported in observational studies. Conclusions: This review concluded that the oral lesions in patients with COVID-19 differ according to the study design. The lack of high-quality scientific evidence in the dental literature on COVID-19 makes the findings inconsistent by the lack of sample selection criteria, diagnostic criteria and classification of oral lesions

Misconceptions about Oral Diagnosis and Radiology among Dental Students: A Questionnaire Study.

BACKGROUND: Misconceptions are learning deficits that may cause clinical judgments in a dental practice to be made incorrectly. AIM: This study aimed to identify and look into students' misconceptions regarding Oral Diagnosis and Radiology. MATERIALS AND METHODS: The fourth and fifth-grade students at the Altinbas University Faculty of Dentistry were given a self-administered questionnaire that included multiple-choice questions about Oral Diagnosis/Medicine and Radiology. 106 students participated in the questionnaire and 50.9% of the participants were fourth-grade students, 49.1% of them were fifth-grade students. The questions were classified into two parts: five scenario-based questions and ten knowledge-based questions. Students' replies were evaluated for accuracy and confidence, and when a student was certain of giving an inaccurate response, misconceptions were noted. Two groups were compared using the Mann-Whitney-U test (P = 0.05). RESULTS: A total of 1590 responses were collected. Regarding the question type, scenario-based questions had more misconceptions (19.6%) than knowledge-based questions (18.4%). Depending on the question, the majority of misconceptions were seen in the questions about denture stomatitis (46.2%) and radiographic contrast (38.7%). CONCLUSIONS: To prevent misdiagnosis, it is essential to recognize and overcome misconceptions in Oral Diagnosis/Medicine and Radiology. Therefore this study assists students and lecturers in defining misconceptions and organizing precautions to avoid and fix them.

John Greenwood's sidenotes on a 1778 John Hunter text at The New York Academy of Medicine.

John Greenwood (1760-1819) was George Washington's preferred dentist. He practiced in New York and made at least one of eight sets of dentures Washington wore (currently in the collection of the New York Academy of Medicine (NYAM). We know very little about John Greenwood's (JG) formal education, except that he came from a famous family of dentists. He inherited from his father, Isaac Greenwood, one important book of the time, John Hunter's 1778 treatise, A Natural History of the Human Teeth. That copy was donated to the New York Academy of Medicine by descendants of John Greenwood. Recently, we became aware of extensive marginalia that John Greenwood wrote in this book. The present article describes John Greenwood's opinion on a variety of dental subjects such as the causes and mechanisms of tooth destruction and gum disease and the presence of microscopic annamalcula that were thought to be connected to poor oral hygiene. Although John Greenwood was self-educated, his observations are surprisingly insightful and at least 37 years ahead of what was described in the contemporary literature.

The development of an online serious game for oral diagnosis and treatment planning: evaluation of knowledge acquisition and retention.

BACKGROUND: While serious games seem to be supportive in healthcare education, none of them had been designed to develop competence in diagnosis and treatment planning of oral lesions. Therefore, this research aimed to develop an online simulation-based serious game for training diagnosis and treatment planning of oral lesions (SimOL) and to evaluate its educational impact in terms of knowledge improvement and retention. METHODS: As a mandatory task in an oral lesion course, all 28 students were required to participate in SimOL activities. Participants were instructed to complete a pre-knowledge assessment following a one-week washout period prior to the game activity. Subsequent to the game completion, they were tasked to complete a post-knowledge assessment I (Full score = 15) and satisfaction questionnaire. A post-knowledge assessment II was administered a week later to evaluate knowledge retention. RESULTS: The findings demonstrated a significant increase in the assessment scores after interacting with the game (P < 0.001), where the pre- and immediate post-knowledge assessment scores were 8.00 (SD = 2.11) and 11.71 (SD = 2.39), respectively. The game also exhibited a positive impact on knowledge retention, as there was no significant difference between the scores of post-knowledge assessment I and II (P > 0.05). Additionally, students perceived the game as positively in all aspects, although the entertainment aspect achieved a slightly lower score of 3.70 (SD = 0.21), in comparison to the usefulness and ease of use with a score of 4.02 (SD = 0.11) and 4.02 (SD = 0.16), respectively. CONCLUSION: SimOL demonstrated its potential as an effective learning tool for improving and retaining knowledge for diagnosis and treatment planning of oral lesions. The game was perceived positively by dental students in all aspects, however further improvements should prioritize the enhancement of entertaining components.

A internação da gestante pode afetar a condição bucal do filho no terceiro ano de vida? / Can a pregnant woman's hospitalization affect the child's oral condition in the third year of life?

Objetivo: Avaliar se a hospitalização na gestação pode influenciar na condição bucal do filho no terceiro ano de vida. Métodos: Estudo longitudinal com bebês de gestantes internadas e acompanhadas no setor da Obstetrícia de um Hospital Escola em Pelotas, RS, Brasil. Os dados referentes a hospitalização e ao parto foram coletados do prontuário hospitalar e no terceiro de vida do filho (a) de um questionário aplicado a mãe e do exame bucal da criança. Cada agravo bucal foi avaliado com critérios específicos, por uma examinadora calibrada e analisado no programa IBM SPSS Statistics com 5% de nível de significância. Resultados: Participaram 20 díades mãe-filho (a). Alterações da oclusão acometeram 95% das crianças, sendo a mordida aberta anterior (MAA) a principal. Ainda, 25% das crianças apresentaram opacidades demarcas e/ou hipoplasia do esmalte, sendo significativamente maior em filhos de mães mais jovens e 20% tinham cárie da primeira infância (CPI), estando relacionada à ausência de creme dental fluoretado e à qualidade da higiene bucal. Conclusão: O reflexo mais evidente da hospitalização na gestação na saúde bucal no terceiro ano de vida do filho (a) foi a oclusão alterada, especialmente a MAA.(AU)

Objective: To assess whether hospitalization during pregnancy can influence the child's oral condition in the third year of life. Methods: Longitudinal study with babies of pregnant women hospitalized and followed up in the Obstetrics sector of a Teaching Hospital in Pelotas, RS, Brazil. Data referring to hospitalization and childbirth were collected from the hospital records and in the child's third of life through a questionnaire applied to the mother and the child's oral examination. Each oral condition was evaluated with specific criteria, by a calibrated examiner and analyzed in the IBM SPSS Statistics program with a 5% minimum significance level. Results: 20 mother-child participated. Occlusion alterations affected 95% of the children, with anterior open bite (AOB) being the main. Still, 25% of the children had opacities and/or enamel hypoplasia, which was significantly higher in children of younger mothers, and 20% had early childhood caries, which is related to the absence of fluoride toothpaste and the quality of oral hygiene. Conclusion: The clearest reflection of hospitalization during pregnancy on oral health in the third year of the child's life was altered occlusion, especially the AOB.(AU)

Prevalence of white spot lesions in children up to 71 months of age in Gujarat state.

Introduction: The earliest sign of a new carious lesion is the appearance of chalky white spots on the surface of the tooth, indicating an area of demineralization of enamel. At this stage, the demineralization process can be reversed or arrested. This study aimed to determine the prevalence of white spot lesions (WSLs) among children up to 71 months in Gujarat state and to increase awareness among parents about its various preventive measures. Materials and Methods: Oral examination was done using the mouth mirror and tongue depressor. The prevalence of WSL was recorded using the International Caries Detection and Assessment System II coding and WSL index by Gorelick. Results: The overall prevalence of WSL was 31.8% (n = 2025) in Gujarat state. The parents of the participating children explained the various preventive measures to prevent decay followed by diet counseling and toothbrushing techniques. Conclusion: Knowledge of the actual prevalence of WSL will help in the implementation of appropriate and timely preventive measures required to decrease the incidence of early childhood caries in that region.

Multi-modal deep learning for automated assembly of periapical radiographs.

OBJECTIVES: Periapical radiographs are oftentimes taken in series to display all teeth present in the oral cavity. Our aim was to automatically assemble such a series of periapical radiographs into an anatomically correct status using a multi-modal deep learning model. METHODS: 4,707 periapical images from 387 patients (on average, 12 images per patient) were used. Radiographs were labeled according to their field of view and the dataset split into a training, validation, and test set, stratified by patient. In addition to the radiograph the timestamp of image generation was extracted and abstracted as follows: A matrix, containing the normalized timestamps of all images of a patient was constructed, representing the order in which images were taken, providing temporal context information to the deep learning model. Using the image data together with the time sequence data a multi-modal deep learning model consisting of two residual convolutional neural networks (ResNet-152 for image data, ResNet-50 for time data) was trained. Additionally, two uni-modal models were trained on image data and time data, respectively. A custom scoring technique was used to measure model performance. RESULTS: Multi-modal deep learning outperformed both uni-modal image-based learning (p<0.001) and time-based learning (p<0.05). The multi-modal deep learning model predicted tooth labels with an F1-score, sensitivity and precision of 0.79, respectively, and an accuracy of 0.99. 37 out of 77 patient datasets were fully correctly assembled by multi-modal learning; in the remaining ones, usually only one image was incorrectly labeled. CONCLUSIONS: Multi-modal modeling allowed automated assembly of periapical radiographs and outperformed both uni-modal models. Dental machine learning models can benefit from additional data modalities. CLINICAL SIGNIFICANCE: Like humans, deep learning models may profit from multiple data sources for decision-making. We demonstrate how multi-modal learning can assist assembling periapical radiographs into an anatomically correct status. Multi-modal learning should be considered for more complex tasks, as clinically a wealth of data is usually available and could be leveraged.

Burning mouth disorder and Parkinson's disease: A scoping review of the literature.

BACKGROUND: Burning mouth disorder (BMD) is a complex medical condition characterized by a burning sensation in the mouth of fluctuating intensity. BMD is considered a diagnosis of exclusion, as oral burning can occur secondary to local or systemic conditions. Parkinson's disease (PD) is one such condition. OBJECTIVE: To provide a scoping review of the literature by assessing all articles written in English that investigated the relationship between BMD and PD. MATERIALS AND METHODS: Various databases (PubMed, Ovid, Web of Science, Science Direct and Scopus) and a search platform (EBSCOhost) were searched following similar investigative approaches. Duplicates were removed and reference lists of original studies were scrutinized for additional articles. Any decision about the inclusion/exclusion in the review was by consensus among the co-authors. RESULTS: Twenty-five original articles and one supplemental article were included in the final review, of which 13 met the inclusion criteria. These were further divided into five categories based on the study design/article, which included Prevalence studies (n = 6), Letter to the editor (n = 1), Incidence study (n = 1), Case reports (n = 2) and Experimental studies (n = 3). Strongest data was provided by epidemiological studies, which suggest BMD and PD are poorly associated. CONCLUSIONS: A scoping review of the existing literature does not suggest that PD patients are any more at risk of developing BMD compared to the general population. While there may be a link through the dopaminergic system as determined by imaging studies, it is unlikely that the pathogenesis of PD disease shares significant commonality with BMD.

Teledentistry: A Future Solution in the Diagnosis of Oral Lesions: Diagnostic Meta-Analysis and Systematic Review.

Introduction: Teledentistry (TD) can offer a wide range of possibilities in the field of oral medicine. Oral potentially malignant disorders (OPMDs) are hard to detect, and even harder to diagnose correctly. With the help of TD, OPMDs can be detected and diagnosed by a remote specialist. Our aim was to investigate whether TD could provide a reliable diagnostic method compared with clinical oral examination (COE) in the diagnosis of OPMDs. Methods: A systematic search was conducted in three databases (Medline, EMBASE, CENTRAL) until November 2021. We included studies that compared telediagnosis and COE, both made by experts. Pooled specificity and sensitivity were calculated and visualized on a two-dimensional plot. Risk of bias was assessed using the QUADAS-2 tool, and the level of evidence is shown with the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) tool. Results: Of the 7,608 studies, 13 were included in the qualitative and 9 in the quantitative synthesis. Using TD tools in the detection of oral lesions (OLs) showed high specificity (0.92 confidence interval [95% CI] = 0.59-0.99) and sensitivity (0.93 95% CI = 0.17-1.00). In the differential diagnosis of lesions, we found high sensitivity and specificity (0.942 95% CI = 0.826-0.982 and 0.982 95% CI = 0.913-0.997), respectively. We summarized the available data on time-effectiveness, screening person, referral decision, and technical settings. Conclusion: Detecting OLs with TD tools might lead to earlier diagnosis, treatment, and stricter follow-up of OPMD. TD may offer a great substitution for COE in the diagnosis of OLs, and thus, fewer referrals could be made to special care, resulting in a greater number of treated OPMDs.

Oral examination of fourth-year medical students on surgery rotations allows faculty to assess Core Entrustable Professional Activities for entering Residency (CEPAR): Proof-of-concept and analysis of student submissions.

BACKGROUND: As a community-based medical school which recruited faculty preceptors new to teaching, we sought to create objective assessments for fourth-year surgery experiences via administration of an oral exam. Students provided three authentic cases, which faculty used as a springboard to ascertain student proficiency in five entrustable professional activities: 1-oral presentation, 2-recognition of urgency/instability, 3-calling consults, 4-transitions of care, 5-informed consent. We present proof-of-concept and analysis of student case submissions. METHODS: Twenty-seven student submissions (79 cases in total) were evaluated for case complexity, level-appropriateness, and an estimation of the ability to conduct a quality exam based on the information provided (subjective measures). Objective metrics included word count, instruction adherence, inclusion of figures/captions. A resident-in-training rated cases via the same metrics. In-examination data was separately culled. RESULTS: The average word count was 281.70 (SD 140.23; range 40-743). Figures were included in 26.1% of cases. Faculty raters scored 29.0% as low-complexity, 37.7% medium-complexity, and 33.3% high-complexity. Raters felt 62.3% of cases provided enough information to conduct a quality exam. The majority of cases submitted (65.2%) were level-appropriate or higher. The resident rater scored cases more favorably than surgeons (Cohen's kappa of -0.5), suggesting low inter-rater agreement between those of differing experience levels. CONCLUSION: Student's case submissions lessened faculty burden and provided assessors with adequate information to deliver a quality exam to assess proficiency in clinical skills essential for residency. Cases demonstrated sufficient complexity and level-appropriateness. The request to correlate case rating with exam performance is under review by our institution's assessment office. Near-peer tutoring by resident alumni is a program under development.