Accuracy of sex estimation by morphometric evaluation of foramen magnum using computed tomography - a systematic review and meta-analysis.

The objective of this study is to determine whether the morphometric evaluation of the foramen magnum using computed tomography can be used as an accurate tool in estimating the sex of an individual. An extensive search of the databases, PubMed, ProQuest, Google Scholar, and Scopus, was carried out to procure articles that fulfilled the inclusion criteria. The AQUA tool was used to assess the quality of the included studies. A random effects model was used for the meta-analysis of the eligible studies using the STATA software, version 16, 2019 at 95% CI and p ≤ 0.05. Eleven eligible articles that measured the transverse and sagittal diameters of the foramen magnum using computed tomography were included in this study. The sagittal diameter of the foramen magnum was greater than the transverse diameter, and both the diameters were greater in males than in females. Meta-analysis revealed that both transverse and sagittal diameters were more reliable for male sex estimation. Since there is a dimensional variation between the male and female foramen magnum, it can be used for initial sex identification and also as an auxiliary to other advanced methods of sex estimation.

Utility of salivary biomarkers for diagnosis and monitoring the prognosis of nicotine addiction - A systematic review.

Objectives: Tobacco and smoke associated with tobacco comprises of a mixture of more than 9500 chemical compounds, most of which have been identified as harmful. Two of the most potent carcinogens found in cigarette smoke are N'-nitrosonornicotine (NNN) and polycyclic aromatic hydrocarbons (PAHs). The most commonly used method to detect and monitor nicotine addiction is via serum cotinine levels. Though considered the gold standard, there is a decline in preventive screening and diagnostic testing due to the fear of pain from invasive testing. Data sources and study selection: A structured literature search was performed using the search engines PubMed and Google scholar following the PRISMA guidelines for systematic reviews. The titles and abstracts were retrieved and analysed, followed by full-text relevant data extraction in addition to a risk-of-bias analysis. Data extraction and synthesis: A total of 37 studies were included in the systematic review. Salivary cotinine levels were compared between smokers and non-smokers, cigarette smokers and water pipe smokers, water pipe smokers and non-smokers. Lactate dehydrogenase salivary levels were compared between smokers and non-smokers, and salivary thiocyanate were compared between smokers and non-smokers. Conclusions: Identifying biomarkers with high performance in terms of sensitivity and specificity will contribute to accelerating future research in this domain.

Efficacy of bioadhesives in the management of oral mucositis in patients undergoing radio-chemotherapy for treatment of head and neck cancer-a systematic review and meta-analysis.

BACKGROUND: Management of head and neck cancers requires a multidisciplinary approach where surgery followed by radio and chemotherapy is the mainstay of treatment. The above-mentioned treatment can cause mucositis, a severely debilitating side effect. This can have a significant impact on quality of life. A recent advancing mode of drug delivery is the bioadhesive system. This interacts with mucosa by adhering to it and thereby improving the efficacy of the therapeutic agent delivered. AIM AND OBJECTIVE: The purpose of this systematic review is to evaluate the effectiveness of bioadhesives in reducing oral mucositis and relieving pain associated with mucositis in head and neck cancer patients receiving radio-chemotherapy. MATERIALS AND METHOD: Studies assessing the effectiveness of bioadhesives for the treatment of radiation-induced oral mucositis were retrieved from specialized databases (PubMed/MEDLINE, Scopus, ProQuest, Google Scholar, LILACS, OpenGrey) as well as institutional repositories. Data on incidence, pain reduction, resolution, and improvement of oral mucositis using bioadhesive were compiled. A Cochrane tool was used for randomized controlled trials and a JBI tool for non-randomized controlled trials and observational studies to assess the quality of included studies. Based on the eligible study data, a meta-analysis was conducted with STATA version 16, 2019 software, and 95% confidence intervals and p values greater than 0.05. RESULTS: A total of 15 studies were included which assessed the effectiveness of bioadhesives in managing mucositis and its associated pain. Studies included in the review described either reduction, resolution, or incidence of oral mucositis respectively. A total of three meta-analyses were conducted to assess the incidence of oral mucositis and the pain associated with it, as well as the reduction in incidence. Bioadhesives showed statistically significant differences in the incidence of severe mucositis (p = 0.04). A meta-analysis comparing bioadhesives efficacy in reducing mucositis and pain associated with it found no statistically significant differences (p = 0.36). CONCLUSION: Bioadhesives are emerging as a novel drug delivery method for treating radio-chemotherapy-induced oral mucositis because of their rapid absorption and easy application. Regardless of its benefits, clinical trials comparing it with conventional treatment methods are necessary to assess its efficacy in treating oral mucositis.

Salivary Lactate Dehydrogenase as a Potential Biomarker in Oral Potentially Malignant Disorders and Head & Neck Cancer- A Systematic Review and Meta-analysis.

BACKGROUND: The prognosis of head &neck cancer (HNC) depends on its early detection, diagnosis, and treatment, which has advocated a search for a simple, reliable, noninvasive, cost-effective tool to aid in the same. Salivary lactate dehydrogenase has gained interest in recent years, meeting the above requisite. OBJECTIVES: To evaluate the levels of salivary lactate dehydrogenase in patients with oral potentially malignant disorders (OPMD), HNC, and in the healthy control group (CG); to find the correlation, grade-wise and genderwise difference between them; and to assess whether it can be used as a potent biomarker in OPMD and HNC. MATERIALS AND METHODS: A comprehensive search of the specialized 14 databases and 4 institutional repositories was performed for including the studies evaluating salivary lactate dehydrogenase in OPMD and HNC patients either comparing or not comparing to the healthy control group in the systematic review process. The meta-analysis was performed with the eligible study data with the STATA version 16, 2019 software with 95% CI and p ≤ 0.05 in the random-effects model. RESULTS: Twenty-eight studies of case-control, interventional, or uncontrolled non-randomized design evaluating salivary lactate dehydrogenase were included. A total of 2074 subjects were included, involving HNC, OPMD, and CG. The salivary lactate dehydrogenase levels were significantly higher in HNC than in CG & oral leukoplakia (OL) (p=0.00); in OL & oral submucous fibrosis (OSMF) than CG (p=0.00); and higher in HNC than OSMF, however not significant (p=0.49). Also, the salivary lactate dehydrogenase levels had no significant difference between males and females in CG, HNC, OL, and OSMF groups(p> 0.05). DISCUSSION: It is evident that the epithelial transformations in the various OPMD and HNC, and the proceeding necrosis in the case of HNC, raises the LDH levels. It's also worth noting that when degenerative alterations continue, the SaLDH levels rise correspondingly, which are higher in HNC than in OPMD. Hence, it is essential to determine the cut-off values for SaLDH for establishing that the patient may have HNC or OPMD. It would be easy to follow-up frequently and perform investigations such as biopsy for the cases with high SaLDH levels, thereby aiding in the early detection and improving the prognosis of HNC. Moreover, the increased SaLDH levels were indicative of a lower degree of differentiation and an advanced disease leading to a poor prognosis. Salivary sample collection is less invasive, simple, and more acceptable to the patient; however, saliva collection is a time-consuming procedure as it is mostly collected by the passive spit method. Also, it is more feasible to repeat the SaLDH analysis during the follow-up, but the method has recently gained interest for over a decade. CONCLUSION: Salivary lactate dehydrogenase can be a potential biomarker for the screening, early detection, and follow-up of OPMD or HNC being simple, noninvasive, cost-effective, and readily acceptable modality. However, more studies with new standardized protocols are recommended to determine the precise cut-off levels for HNC and OPMD. Keywords (MeSH): L-Lactate dehydrogenase; Saliva; Mouth Neoplasms; Squamous Cell Carcinoma of Head and Neck; Oral; Precancerous conditions.

Reliability of gender determination from paranasal sinuses and its application in forensic identification-a systematic review and meta-analysis.

This systematic review aims to determine whether linear or morphometric analysis of paranasal sinuses can be used for accurate determination of gender and to appraise which sinus can be evaluated for accurate gender determination.A comprehensive search of the specialized databases (PubMed/MEDLINE, Science Direct, Clinical Key, ProQuest, Google Scholar, Epistomonikos, LILACS, OpenGrey) and other institutional repositories was performed for including the studies which assessed paranasal sinuses for gender determination. Quality assessment was carried out with the AQUA tool. The meta-analysis was performed with the eligible study data at 95% CI and p ≤ 0.05 in the random-effects model.Forty-six studies evaluating frontal sinus (13), maxillary sinus (26), frontal and maxillary sinus (5), or three paranasal sinuses (2) were included. All the included studies assessed height, length, width, and volume, respectively, and other additional parameters (area, perimeter) if wherever applicable. Frontal sinus had significantly higher values for males compared to females except for left height (LH) and left volume (LV). Maxillary sinus measurements were significantly higher in males contrasted to females except for LH. Sub-group analyses revealed that analyses involving the population had statistically significant results for all the measured parameters for both the sinuses (p < 0.05 and p = 0.00, respectively).Measurements obtained from assessing sinuses reveal that there are variations in size, among populations in different geographic regions. Hence, more studies with improved sample sizes and standardized measurement protocols should be carried out on different populations to see the diversity and their reliability.

A hospital-based observational study on clinical and radiographic findings in COVID-19 associated rhinomaxillary mucormycosis: revealing the pandora box

Mucormycosis is a rare, rapidly spreading, fulminant, opportunistic infection that is caused by a group of filamentous molds. During the second wave of COVID-19 India reported most of the cases of mucormycosis which is termed as COVID-19-associated mucormycosis (CAM). Aim: The purpose of this study is to describe and understand the clinical and radiographic findings related to COVID-19 associated rhinomaxillary mucormycosis. Methods: In this observational study 76 individuals with proven rhinomaxillary mucormycosis were included. The demographic profile, predisposing factors, anatomic structures involved, oral manifestations, radiographic findings management, and 90-day mortality were recorded and analyzed. Results: Among 76 individuals with COVID-19-associated rhinomaxillary mucormycosis diabetes mellitus was present in 93.42% of cases. Almost all patients received corticosteroids during COVID-19 treatment. The maxilla was most commonly involved in around 98.6% of cases. Interestingly 1 case involving the mandible was noted and the maxillary sinus was the most commonly involved. Mortality occurred in 1.31% (n=1) of cases. Conclusion: Diabetes was the most common predisposing factor. Administration of corticosteroids was evident. A considerable number of patients developed diabetes during the treatment of COVID-19. Early signs and oral manifestations of rhinomaxillary mucormycosis play a pivotal role in the early diagnosis and prompt treatment to reduce mortality and morbidity in COVID-19 associatedrhinomaxillary mucormycosis patients

Inclusion of gerodontology in dental curriculum: An urgent case for India.

The proportion of older adults is on the rise. Management of dental problems in this group is different from the general population, and hence requires special training. Gerodontology is yet to find its place in the Indian dental curriculum. A lack of training would result in inadequate care delivery. In this article, we share our views on the need for inclusion of the subject, potential challenges, and a guide for incorporation of gerodontology in undergraduate and postgraduate curriculum in the Indian dental institutes. We propose a framework based on the salient features of Kern's 6-step approach for curriculum development and Kotter's 8-step change management model. Some features are common to both the models. A combination of these models includes the following salient features: Problem identification and general needs assessment, beginning with a sense of urgency and targeted needs assessment, communication of the vision for change, working in guided coalitions and defining clear goals and objectives, adopting the relevant educational strategies, implementation strategies to enable change and generating short-term wins, evaluating the effectiveness of the curricular reform and sustaining and anchoring the change. The proposed framework may also be useful for countries where gerodontology is yet to be implemented.

Comparative efficacy of low-level laser therapy (LLLT) to TENS and therapeutic ultrasound in management of TMDs: a systematic review & meta-analysis.

OBJECTIVE: To assess the reduction in pain, muscle tenderness, joint clicking, and improvement in mouth opening (MO) after low-level laser therapy (LLLT) compared to transcutaneous electrical nerve stimulation (TENS) and therapeutic ultrasound (US) among temporomandibular joint disorder (TMD) patients. METHODS: A systematic search of online sources of electronic databases was undertaken. The quality of the study was assessed using the Cochrane risk of bias assessment tool for randomized controlled trials (RCTs). RESULTS: Twelve RCTs were included in the systematic review, and 9 were included in the meta-analysis. For reduction in pain between LLLT and TENS, LLLT was found to be better than TENS, at 95% CI. LLLT was also proven to be better in reducing pain than therapeutic US, at 81% CI. CONCLUSION: This systematic review and meta-analysis compared the effectiveness of LLLT, TENS, and therapeutic US in TMD. LLLT provided relatively more effective pain relief and improvement in MO.

Current status of gerodontology curriculum in India and other parts of the world: A narrative review.

BACKGROUND: The current rise in the world's geriatric population has placed additional demands on dental professionals, as the management of geriatric patients requires distinct competencies. AIM: To review and perform a content analysis of the gerodontology undergraduate curriculum worldwide. DATA SOURCES: A search was carried out in PubMed, Web of Science, ERIC and EMBASE databases for the period-July 2008 till May 2019, using MeSH terms. A search for websites of Indian universities was also done, and undergraduate curricula were screened. STUDY ELIGIBILITY CRITERIA: The study included articles related to the undergraduate curriculum, which contained training in geriatric dentistry. Articles in foreign languages and those related to dental hygienists were excluded. RESULTS: A total of 218 articles were obtained, of which 19 met the inclusion criteria. A total of 301 colleges taught gerodontology. Amongst them, 50 colleges had a gerodontology department. Clinical training and outreach experience were provided in 175 and 73 colleges, respectively. There are no reports on the status of gerodontology in Asian countries (excluding Japan). In India, gerodontology is not taught as a separate subject. However, few gerodontology-related topics are covered in clinical subjects. CONCLUSIONS: There seems to be a wide variation in the content of gerodontology curriculum taught worldwide. Other than the European and American regions, gerodontology is yet to develop in other parts of the world. In India, a robust training programme is required to address the lack of dental care providers for the geriatric population using guidelines established by ECG and ADEA.

Are Multiple Choice Questions for Post Graduate Dental Entrance Examinations Spot On?-Item Analysis of MCQs in Prosthodontics in India.

BACKGROUND: Construction of appropriate test items is a challenge in preparing quality multiple choice questions. Item analysis provides valuable feedback data on validity of multiple choice questions. The present study was conducted to evaluate the difficulty index, discrimination index and distracter efficiency of the items present in the multiple choice questions of post graduate dental entrance examinations. METHODS: A list consisting of 20 MCQs was taken from the entrance exam books of MCQs on an introductory topic and administered to 104 undergraduate students. RESULTS: In the present study 15% of the MCQs related to impression making procedure were difficult with difficulty index (p) less than 30%, 15% were poor discriminators and 55% had at least one non-functional distracter. CONCLUSION: Item analysis of MCQs in post graduate entrance examinations demonstrated low difficulty index, discrimination index and distracter efficiency. Hence, we propose a strong need for faculty training in test constructors and their post validation.

Lycopene in the management of oral lichen planus: a placebo-controlled study.

CONTEXT: Oxidative stress has been implicated in the pathogenesis of lichen planus, and a lower level of lycopene has been reported in erosive and atrophic oral lichen planus (OLP) patients. However, its efficacy in the management of OLP has not been reported. AIM: This study was designed to assess the efficacy of systemic lycopene in the management of OLP. SETTINGS AND DESIGN: This prospective, randomized, double-blind, placebo-controlled study was done in the Oral Medicine Department of a postgraduate teaching dental hospital in India. MATERIALS AND METHODS: Thirty symptomatic OLP patients, randomly divided into two groups of 15 each, were administered lycopene 8 mg/day and an identical placebo, respectively, for 8 consecutive weeks. Burning sensation using visual analogue scale and overall treatment response using Tel Aviv-San Francisco scale were recorded at every visit. The data obtained were analyzed statistically using Wilcoxon Rank test, Mann-Whitney and Fischer's Exact test. RESULTS: A higher (84%) reduction in burning sensation was seen in lycopene than in the placebo group (67%). All 15 (100%) patients in the lycopene group showed 50% or more benefit and 11 (73.3%) patients showed 70-100% benefit, while this number was only 10 and 4 (26.7%), respectively, in the placebo group. CONCLUSION: Lycopene was very effective in the management of OLP, and oxidative stress may have a role in disease pathogenesis.