Comparative efficacy of flapped versus flapless dental implant procedures: A meta-analysis.

Objectives: Dental implant procedures are crucial for replacing missing teeth, with various surgical techniques impacting the outcome. This systematic review and meta-analysis aimed to evaluate the effects of flapped and flapless surgical techniques on implant survival and marginal bone loss (MBL). Methods: We included clinical studies with at least ten subjects, excluding review articles, editorials, and conference abstracts. Studies were sourced from PubMed, Medline, ERIC, and Wiley, published between 2000 and 2022. Data were analyzed using random-effects models to compare implant survival and MBL between flapped and flapless techniques. Results: The review identified 21 studies meeting the inclusion criteria. Flapless techniques showed a higher implant survival rate with an approximate survival rate of 98.6% in prospective cohort studies and 95.9% in retrospective studies. MBL was consistently lower in the flapless group, averaging 0.6-2.1 mm, compared to 1.5-3 mm in the flapped group. Low-risk studies demonstrated more consistent and reliable results, supporting the efficacy of flapless procedures. Conclusion: Flapless implant surgery offers a viable alternative to traditional flapped surgery, showing higher rates of implant survival and less MBL. However, successful outcomes depend on advanced imaging, precise surgical techniques, and adequate training. Further high-quality studies are needed to confirm these findings and refine clinical recommendations.

Prevalence of undernutrition among migrant, refugee, internally displaced children and children of migrated parents in lower-middle-income countries: A meta-analysis of published studies from last twelve years.

BACKGROUND AND AIMS: This review aims to estimate the prevalence of undernutrition among migrants, refugees, internally displaced children, and children of migrated parents living in lower-middle-income countries. METHODS: PubMed, Scopus, Science-Direct, CINAHL-Plus, & Google Scholar were searched for peer-reviewed evidence published between January 2010 to March 2023. Two researchers independently examined the studies and retrieved the data. The internal and external validity of the studies was assessed using the NIH quality assessment tool, and a checklist adapted from Downs & Black, Bracht & Glass, and Del Siegle's guidelines. A random effect model was chosen to pool the estimates. Subgroup analysis, Meta-regression, and sensitivity analysis were done to explore the source of heterogeneity and the robustness of estimates. RESULTS: Among the 1978 records initially searched, 21 studies were selected for analysis. The pooled prevalence estimates for stunting, wasting, and underweight were estimated to be 29.39% (Confidence Interval [CI] 21.69-37.73; I2 99%; p < 0.01), 12.76% (CI 7.84-18.68; I2 99%; P < 0.01), and 24.05% (CI 16.17-32.94; I2 100%; p < 0.001) respectively. Among different WHO regions, all three undernutrition estimates were higher in LMICs belonging to the Southeast Asian region (Stunting 37.62%; wasting 14.28% and underweight 31.24%). Undernutrition among migrant Indian children was 43.55%, 18.71%, and 37.45% respectively. High heterogeneity was noted across all estimates with I2-value >90%. Sensitivity analysis across indicators showed the stability of our estimates. CONCLUSIONS: The extent of undernutrition, particularly wasting was high among migrant/refugee children living in lower-middle-income countries. Measures should be taken to strengthen the government-subsidized public food distribution system, increase healthcare outreach, and ensure public health insurance coverage among the migrant population.

Biosimilar in Breast Cancer: A Narrative Review.

Breast cancer (BC) has been identified as a major public health cancer as it topped the list of most prevalent cancers among women in the last three years. Rigorous research has been conducted to improve the prognosis of cancer therapies since the time of inception. Recent advancements in cancer therapy have introduced monoclonal biosimilars as a promising treatment alternative. Monoclonal antibodies (mAbs), produced through cloning, have demonstrated effectiveness in targeting diverse antigens. Biosimilar, considered complex entities compared to small-molecule drugs, pose challenges in replication due to their biological nature. The manufacturing process involves rigorous comparability testing to ensure similarity in quality, safety, and efficacy with the reference product. Trastuzumab biosimilars, such as CT-P6, Ontruzant®, ABP 980, and PF-05280014, have shown efficacy in treating HER2-positive metastatic BCs, presenting a viable alternative to the reference product. The implications of monoclonal biosimilars extend beyond trastuzumab, with bevacizumab emerging as another significant biosimilar for BC treatment. The shift toward biosimilar aims to enhance accessibility to biologics by reducing costs. Health economic analyses indicate potential cost savings, contributing to the overall cost-effectiveness of biosimilar adoption. While concerns about switching between reference products and biosimilars exist, evidence suggests a lower risk of immunogenicity-related side effects with mAbs like trastuzumab. Monoclonal biosimilars present a promising avenue in BC therapy, demonstrating efficacy, safety, and potential cost savings. The integration of biosimilars into cancer treatment strategies offers a means to improve accessibility to effective care while addressing economic considerations in healthcare.

Towards a Resilient Post-Pandemic Health System: Lessons through the Spectacles of Indian Health Policy Scenario.

A resilient health system necessitates strong governance, political commitment, effective administrative entities and inter-organisational collaboration. This paper examines India's current health policy landscape and explores the analytical and operational capacities required to establish a robust post-pandemic health system using the policy capacity framework described by Wu et al. (2015). We emphasised the need for a coordinated policy response to strengthen health information systems, health service management, human resource management and healthcare financing. The role that the planned implementation of Indian public health management cadres would play in the coming era, the importance of a comprehensive health information management system and the need for operational coordination between government and non-governmental organisations has also been emphasised.

Assessing knowledge, attitude, and readiness to use e-health among doctors in a tertiary health care unit in Bhubaneswar city, Odisha - A cross-sectional survey.

BACKGROUND: The term ""e-health"" refers to all technological applications in the delivery of a more affordable, high-speed, and widely accessible mode of health care. It is a definite solution to managing the public's health and well-being during the coronavirus disease (COVID-19) pandemic, and doctors from all fields of expertise are required to be at par with it in terms of knowledge, attitude, and readiness to use it to their advantage under the current circumstances. MATERIALS AND METHOD: A cross-sectional survey was conducted among the faculty, postgraduates, and interns of the medical and dental schools of a university, which used an expert-validated self-administered questionnaire assessing knowledge, attitude, and readiness to use e-health. RESULTS: Among the 400 participants, it was observed that the categories of age (P < 0.0001), gender (P = 0.018), designation (P = 0.031), and years of service (P < 0.0001) have significant differences across the groups. It was seen that the mean e-health knowledge (3.55 ± 0.52) and mean attitude (2.42 ± 0.59) to use e-health were more in dentists while participants from the medical field showed higher mean readiness (1.97 ± 0.58) to use e-health in daily practice. It was observed that male professionals had more mean knowledge (3.54 ± 0.60) than female professionals (3.43 ± 0.52) while female participants had more mean e-health readiness (1.96 ± 0.57). CONCLUSION: In a broad sense, the majority of participants responded positively to using e-health in their everyday practice. While medical doctors have a stronger outlook and preparedness, dentists showed more literacy and a supportive attitude to adopting e-health and telemedicine. Thus, it is necessary to step up comprehensive e-health workshops and training sessions for health care experts.

Recognition of Oral Pathology as a Subject among Dental Undergraduates: Addressing their Concerns.

Oral and Maxillofacial Pathology is a speciality department of dentistry which deals with identification of diseases affecting oral and maxillofacial regions and investigates the cause, processes and effect of these diseases. Books, internet, lectures have made great progress but there is still a gap between students' understanding and interest in the subject. The aim of this study was to evaluate and analyse the challenges faced by undergraduate students in understanding oral pathology theory & practical and modify the teaching process accordingly. A descriptive cross-sectional study of 300 BDS third year students was conducted in our college. The results stated that 83% of the participants attended classes, 90% found the topics covered to be useful, 97% reported that the classes were taken to provide an in depth view of the subject, 71% faced difficulties in understanding the topics in theory classes. 46% attended seminars, 68% viewed more than 4 slides on an average in one practical class, and 80% faced difficulties in identifying the slide. Our data concluded, that if certain measures will be taken so as to engage the students' interests, then this subject would prove to be a much better scope of learning for the budding dentists.

Tobacco usage in India: A meta-analysis of evidence drawn from regional studies between 2010 and 2022.

OBJECTIVES: To generate a national and zonal pooled estimate of current tobacco usage (CTU) in any form, as well as stratified gender and tobacco type (smokeless and smoke) specific estimates among the Indian population, utilising evidence from 2010 to 2022. METHOD: PubMed, Scopus, ScienceDirect, CINAHL and Google Scholar databases were searched for articles on tobacco use among Indian adults published between January 2010 and October 2022. The NIH Quality Assessment Tool was used to assess study quality, and a random-effects inverse-variance method was used to attain a pooled estimate of usage. Heterogeneity was estimated through I2 statistics and prediction intervals, and further subgroup analysis and meta-regression were conducted. A leave-one-out analysis was done to establish the sensitivity of the pooled estimate. RESULTS: CTU prevalence of any form among the adult Indian population was 35.2% [confidence interval (CI) 25.27-45.92, I2 = 99.7, p < 0.001] between 2010 and 2022 with a wide Prediction interval between 3.19 to 78.74. The regionally drawn estimate for the years 2016-2022 was 44.3% (CI 30.57-58.64, I2 = 99.8, p < 0.01). Highest prevalence was found in the East zone (55.4%) followed by the northeast with 51.8% tobacco consumption. Although residual heterogeneity persisted after subgroup analysis, the variability in estimates showed statistical significance when considering disaggregated estimates across administrative zones and gender-wise consumption. The estimated CTU among males was 54.1%, whereas in females it was 15%. Leave-one-out analysis indicated the findings are reliable and are not dependent on any one study. CONCLUSION: This review highlights differences in tobacco usage estimates from national-level surveys and regional studies. More regionally representative surveys of tobacco usage to tailormade prevention efforts alongside increased regional efforts improved community-level advocacy and more coordinated and stringent tobacco prevention policy implementation at national and state levels are warranted.

Lactate Dehydrogenase as a Biomarker in Oral Submucous Fibrosis: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis was planned with the objective of evaluating the level of Lactate Dehydrogenase (LDH) in oral submucous fibrosis patients and in controls and comparing them. For this meta-analysis, we searched Google Scholar, PubMed, Scopus, and Directory of Open Access Journals (DOAJ) databases using a search methodology that included combinations of MeSH terms and keywords and included cross-sectional studies to evaluate the levels of LDH in patients with Oral Submucous Fibrosis (OSMF), Oral Squamous Cell Carcinoma (OSCC) and compared it with the controls. The total number of records identified through database searching was 4161 (n). Analysis of the quality of the studies was done using the National Heart, Lungs and Blood Institute (NHLBI) tool for case-control studies. Twelve case-control studies which matched the inclusion criteria were included after the literature search. The meta-analysis was carried out using R Studio (version 4.1.3, 2022; The R Foundation for Statistical Computing, Vienna, Austria). The pooled estimate that has been calculated from the salivary LDH course for OSMF was 15.35% and from the serum LDH course for OSMF was 6.82%. There was a visual observation of the funnel's plot asymmetry suggesting publication bias. After adjusting the publication bias, the t2 values for salivary and serum LDH were 41% and 14.71%, respectively, which was less than 50%, indicating that the meta-analysis was statistically significant. The evaluation of salivary and serum LDH can be a useful method for early diagnosis of OSMF as well as OSCC. To infer that individuals may have OPMD or OSCC, specific values for salivary and serum LDH must be found in further investigations.

Utilization of dental care services among adult Indian population: A meta-analysis of evidence from 2011-2022.

Background: This study aimed to generate a pooled national estimate on dental health care services utilization by the adult population in India from any public or private facility in an effort to highlight the demand and usage for oral health care. Methods: In this meta-analysis, PubMed, ScienceDirect, DOAJ, and Google Scholar were searched using a search strategy that combined MeSH headings and keywords (e.g., "Oral Health", "Dental Health Services", utilization, India, etc.) for articles on dental utilization among Indian adults, published between January 2011 and June 2022. Study quality was assessed using the NIH Quality assessment tool, and a random-effects inverse-variance method was used for pulling utilization proportions. Meta-regression and sub-group analyses were conducted to identify the sources of heterogeneity. Heterogeneity is reported as I2. To examine publication bias, the funnel plot, egger's test, and trim-and-fill analysis were performed. Results: From 4012 identified articles, 21 were eligible for inclusion. The pooled dental care utilization amongst Indian adults were found to be 23.96% (confidence interval [CI]: 16.81%- 31.11%, P<0.001, I2=98.93%), and the highest estimate was in South Zone (30.02%, CI: 19.14-40.90, P<0.01, I2=98.63%). Visual inspection of the funnel plot revealed the presence of publication bias (egger's P value 0.02). A mild decrease in utilization estimate was noted through trim and fill analysis (adjusted estimate 17.65%, CI: 8.97-26.33, P=0.03). No significant subgroup effect was found for the variables study zone and conduction years (P value: 0.09 & 0.34 respectively). Conclusion: Future studies should be undertaken to focus on the demand and supply of oral health care services since an evidential gap has been identified due to the uneven distribution of studies available from various regions of India. The heterogeneity can be attributed to the diverse socioeconomic, literacy, and inherent health system performance status.

Nicotine replacement therapy: A friend or foe.

According to the World Health Organization (WHO) Framework Convention for Tobacco Control (FCTC), tobacco cessation is a primary health-care service that should be provided not only to the people having adverse habits of consuming tobacco but also to the nonconsumer, as they can also be harmed due to its deleterious effects. Tobacco has been regarded as a potential risk factor for oral diseases such as oral potentially malignant disorders and oral cancers. Various aids of achieving cessation have been studied, including education of the ill effects of tobacco to the patient, behavioral counseling, and pharmacotherapy. Various pharmacological interventions are available nowadays but nicotine replacement therapy (NRT) is most widely used. The various types of NRT products results in general and breakthrough craving relief with immediate release of nicotine. All of these products have different levels of efficacy and variable rates of nicotine absorption. Knowledge of these will be beneficial for the patients, the budding dentist and the nation in the upcoming days ahead.

Modern endodontic practices among dentists in India: A comparative cross-sectional nation-based survey.

INTRODUCTION: More than 41,000 root canal treatments (RCTs) are performed every day and about 25 RCTs are performed every week by an endodontist. The success rate of endodontic treatment ranges between 86% and 98%; however, the failure rates cannot be ignored which can range up to 20% of the treated cases due to a varied number of reasons including incorrect adoption of working techniques and usage of inappropriate materials. The present study aimed at comparing the practices of various levels of dentists toward RCT in their daily practice. METHODOLOGY: A cross-sectional, descriptive, questionnaire-based study was conducted among the dental practitioners who have completed the Masters of Dental Surgery (MDS) curriculum in India and postgraduate students in various dental colleges in India. The sample size was achieved to be 1601 at the completion of the study. The response rate for the study was 80.05%. All the dentists practicing RCT either in the clinic or in the college and willing to participate in the study were included in the study. A self-structured questionnaire was used as study tool. SPSS was used to analyze the data. RESULTS: A total of 26.7% of the PG students (endodontists) used rubber dam. Majority of the dentists preferred hand instruments (62.36%) over rotary. Almost half (53.09%) of the postgraduates belonging to other branches reported to prescribe drugs. CONCLUSION: The present study showed a varied profile of the dentists with most of them following the basic protocols and techniques of international standards.

Oral hygiene habits amongst chromium mine workers-A cross sectional study.

BACKGROUND: Oral health means much more than just having healthy teeth. Various oral diseases have significant side effects on general health; also systemic diseases can show a reciprocal effect on oral health. So oral health needs to be regarded by multi-professional approaches and should be combined into comprehensive health-promotion strategies and actions. The present study aimed to determine oral hygiene habits amongst chromium mine workers. MATERIALS AND METHODS: The present observational, cross-sectional study was conducted for a period of 4 months from April to October 2017. The present study evaluated the oral hygiene habits amongst the chromium mine workers of Odisha. A total of 1140 males were enrolled in the study. The study was conducted after the institutional ethical board clearance and informed written consent for participation in the study and written consent was obtained from all in their vernacular language. Data were entered using MS-EXCEL 2016 and the statistical analysis was done using SPSS software. RESULTS: There were 91.9% of subjects who brushed once a day, 6.9% brushed twice a day and 1.1% brushed after every meal. The results of the study showed that 75.9% and 8.1% of subjects used tooth paste and tooth powder respectively for brushing there teeth regularly.the results of this study also showed that 11.9% of study participants used indigenous means (other means) as an aid to tooth brushing. CONCLUSION: There is a lack of awareness and education about oral hygiene practices amongst mine workers due to which they do not resort to good oral hygiene practices.

Software Intervention in Smoking Cessation among Engineering Students in Bhubaneswar City: A Randomized Controlled Trial.

OBJECTIVES: The study objective was to test the effectiveness of a photoaging software (APRILAGE©) intervention based on personalized, vivid illustrations of "smoker's face" among smokers aged 18-24 years of age in Bhubaneswar city through a self-structured questionnaire. MATERIALS AND METHODS: A total of 204 engineering college students were randomized into two groups: intervention and control. A self-structured questionnaire in the form of Google Form was distributed among the participants. The study group participants were photographed using Aprilage® Software. Follow-up data were collected using the same questionnaire at 1-month and 3-month intervals. Statistical Analysis was done using STATA 15 software. Descriptive statistics and the relation between the dependent and independent variables were done using the nonparametric tests of significance. The probability value was kept at 0.05. RESULTS: Significant reduction in nicotine dependency, was seen in 64.36% of the study population (P < 0.0001). There was a shift from severely dependent group to moderately or low dependence group in 33% of the study occupants. CONCLUSION: Aging software intervention is contemporary, congenial, and admissible and can be espoused to educate youngsters along with the conventional motivational methods. This method successfully delivers smoking cessation advice to young adults. This novel approach can be implemented in motivating young smokers to quit smoking.

Factors associated with dental visit and barriers to the utilization of dental services among tribal pregnant women in Khurda district, Bhubaneswar: A cross-sectional study.

BACKGROUND: There is a lack of knowledge related to the utilization of dental services by tribal pregnant women who constitute over 35% of the Indian population. The aim of the present study was to identify barriers to the utilization of the dental services and also the factors that concern the tribal mothers' visit to the dental office. MATERIALS AND METHODS: A total of 300 tribal mothers visiting a tertiary care unit participated in this cross-sectional, observational study. A pilot study with twenty participants was conducted before the commencement of the study. Data were collected using a modified questionnaire consisting of demographic data and questions relating to oral health knowledge, attitude, and practices, as well as barriers to the utilization of dental services and factors that concern dental visits during pregnancy. Data analysis was done using SPSS software package 21.0. Nonparametric statistical tests were done to analyze oral health knowledge and attitude of the participants. Various factors were identified using univariate and multivariate models using simple logistic regression analysis and multiple logistic regression analysis. RESULTS: Among the two different tribes considered in the present study, the Saora tribe seemed to be more conscious toward oral health, and 29.7% of participants visited the dentist during pregnancy. The age and experience of the participants along with the educational level, employment status, and knowledge about oral health-related pregnancy outcomes influenced their dental visits. The most reported barrier included the lack of awareness and knowledge of the availability of the dental services. Accessibility and distance to the dental clinic were not found to be negative confounding factors among the participants for the utilization of the services. CONCLUSION: This study concludes that previous experience and consciousness of the mother to utilize the dental services played a vital role in the utilization of dental services among tribal pregnant women. However, the findings of the present study clearly indicate the need for further research to understand barriers to the utilization of dental services among underprivileged tribal groups of population.

Assessment of Knowledge, Attitude, and Practice of Dental and Medical Interns toward Toothbrush Maintenance and Replacement in Bhubaneswar City, Odisha, India.

BACKGROUND: Toothbrushes are an important medium for maintaining good oral hygiene, and hence there arises a need to maintain and replace toothbrushes at a regular interval. Assessing the knowledge, attitude, and practice (KAP) of the medical and dental interns would help the society in promoting oral hygiene in a broader aspect. MATERIALS AND METHODS: A cross-sectional questionnaire study was conducted among 759 medical and dental interns residing in Bhubaneswar, Odisha, India. The data on oral health KAP were collected using a self-structured questionnaire. Descriptive statistics was evaluated using SPSS software package, version 19. RESULTS: Of 759 participants, 445 were dental interns and 314 were medical interns. Knowledge about toothbrush maintenance was seen to be more in the dental interns. The attitude toward maintenance was seen to be better among the dental interns compared with the medical interns. The practice of toothbrush maintenance was seen in both the groups but more dominantly in the dental interns. CONCLUSION: Education regarding the effective use and maintenance of the toothbrush would help improve the KAP toward toothbrush maintenance and replacement. The lack of knowledge holds back the attitude of properly maintaining the toothbrush in a regular basis.

Association Between Depression and Acute Pain in Adults Attending a Tertiary Care Hospital in Bhubaneswar.

BACKGROUND: Recent burden on health care organization due to acute pain and simultaneous rise in the depression cases have been ringing alarms among the medical professionals. AIMS: This study was taken up with a hypothesis that acute pain and depression are inter-linked and any acute painful condition leads to some behavioural and psycho-somatic effects which needs to be detected at the earliest possible. SETTINGS AND DESIGNS: This relationship was established by designing a cross-sectional study where four most common causes of acute pain (i.e. post-labour, post-caesarean, postoperative, dental conditions) were studied in 70 subjects each and compared with 70 subjects of control group who presented to a tertiary care hospital in Bhubaneswar, without any painful condition or underlying depression. MATERIALS AND METHODS: Various pain scales (Visual Analogue Scale- VAS, Verbal Rating Scale - VRS, Box Scale) were used to assess the degree of pain while Montgomery-Åsberg Depression Rating Scale (MADRS) was used to assess the level of depression in these subjects. STATISTICAL ANALYSIS: Using SPSS version 16 software, the correlation coefficient was determined between the depression levels and acute pain. RESULTS: It was seen that the geriatric populations were more depressed, while the older adults perceived more pain. The females differed from males in their pain perception; they were more depressed and proved to be more tolerant to painful conditions such as post-partum acute painful conditions. Dental pain was found to be the second most reported painful condition after postoperative acute pain. A statistically significant strong correlation was established between depression and acute pain. CONCLUSION: Thus the psychosomatic component of pain needs to be evaluated on a priority basis by health providers.