Study of Hypoxia-inducible factor-2α expression in the malignant transformation of Oral submucous fibrosis.

CONTEXT: Hypoxia-inducible factor (HIF)-2α is overexpressed in primary and metastatic human cancers, whose expression is correlated with tumor angiogenesis and patient mortality. HIF plays a role in the progression of fibrosis in oral submucous fibrosis (OSF). AIM AND OBJECTIVE: The aim is to study and compare the expression of HIF-2α in OSF (a), oral squamous cell carcinoma (OSCC) with areca nut usage (b), OSCC without areca nut usage (c) and normal mucosa (d) by immunohistochemistry. SUBJECTS AND METHODS: Immunohistochemical detection of HIF-2α was done on 51 samples, which included 11 cases (a), 15 cases (b), 15 cases (c) and the expression was compared with that of (d). STATISTICAL ANALYSIS: Data were analyzed using the SPSS™ software (ver. 21.0). Chi-square test and kappa analysis were performed to compare the intensity of staining between the groups and for inter-observer agreement, respectively. Value of P ≤ 0.05 was considered statistically significant. The mean labeling index between the groups was studied by the Kruskal-Wallis test. RESULTS: All the cases of (d), (a), (b) and (c) showed HIF-2α expression (P = 0.329). About 13% cases of (c) showed intense expression (P = 0.406) and 27% of (a) cases showed expression only in the connective tissue (P = 0.023). The number of positively stained nuclei in both (b and c) cases reduced as the tumor progression was from well to poorly differentiated. CONCLUSION: Areca nut initiates fibrosis and subsequent hypoxia in OSF which triggers HIF-2α expression in the epithelium. HIF-2α could be a surrogate marker for cancer initiation and progression.

"Burden of the Triumph:" Burden of peri-implantitis in Indian population - A mathematical model.

CONTEXT: India suffers from a heavy burden of oral diseases. Dental implants (DIs) are prescribed widely by the dental practitioners to replace lost natural teeth. There is no estimate, however, to determine the number of DIs or the number of people with peri-implantitis or the failure of implants after placement. In this modeling study, we attempted to estimate the prevalence of adult Indians who would choose DI in the near future and to calculate the peri-implantitis and failure of DI. MATERIALS AND METHODS: Using the Global Burden of Disease database (2016), the number of dental caries in permanent dentition, periodontal diseases, and edentulism was obtained. Empirical assumptions of patients with anodontia in urban and rural areas who opted for DI, percentage of implants placed, the affordability factors, and mathematical models for DI were formed and executed. Peri-implantitis and survival data from literary evidence were collated. RESULTS: Based on assumptions, 909,643 Indians, (830,231-858,703) would choose DI. Estimated number of peri-implantitis would be 145,543-254,700 and estimated number of failures should be 50,940-79,412 in the near future. CONCLUSIONS: In spite of the high economic challenge and the risks or complications of peri-implantitis, DIs are gaining prominence. It is the dentists' burden to face the renewed challenges due to emerge and provide remedial measures.

Tobacco use, oral cancer screening, and oral disease burden in Indian women.

INTRODUCTION: India lacks data on national level adaptation of oral cancer screening measures and burden of oral diseases. We intend to address the issue through a secondary data analysis of existing data and reports. MATERIALS AND METHODS: Data were acquired from the National Family Health Survey-4 (2015-2016). Of the 699,686 responses, representing 99% of India's women population living in all of India, the following data from the age group of 15-49 years were mined - any tobacco use, desire to quit tobacco use, and oral cavity screening for cancers. Data from Central Health Intelligence Bureau 2016 was used to identify population served by dentists in each state. The state-level data of the District Level Household and Facility Survey-4 (2012-2013) were mined for household population having symptoms of chronic illness including mouth/dental illness persisting for more than 1 month and had sought treatment. STATISTICAL ANALYSIS USED: SPSS version 20; Descriptive statistics for values in proportions; Pearson's correlation test assessed between the various factors. RESULTS: Tobacco use in any form was highly prevalent among the North Eastern states, and there was also a lack of willingness to quit the habit. There was unequal distribution of dentists in different states. No significant statistical correlation was found between the proportions. CONCLUSION: There is disparity existing in treating seeking behavior of the general population as well as the need for dental treatment. The skewedness in dentists' distribution among the nation as compared with oral burden of diseases needs to be correlated before oral health policies are planned.