The impact of unmet treatment need on oral health related quality of life: a questionnaire survey.

BACKGROUND: Based on the present global burden of oral diseases, unmet dental needs affect a more significant population worldwide. It is characterised by the need for dental care but receiving delayed or no care. The contributing factors include lack of knowledge about oral health, its consequences, and the availability of dental services. We need to find out the scale of the problem of unmet dental needs for the south Indian population. Therefore, the objective was to determine the relationship between the presence of oral disease and the quality of life-related to oral health using the OHIP-14 tool. METHODS: The unmet dental requirements of the south Indian population were determined using a cross-sectional questionnaire survey. Close-ended questions were used to obtain data from two investigators trained to record the answers from the patients. The data was collected using the OHIP-14 questionnaire, which consists of 14 items divided into seven domains with two questions each. Physical pain, psychological impairment, physical disability, psychological disability, social disability, and disability were all considered. An additional analysis of artificial neural network (ANN) was done. RESULTS: The response rate was 100 per cent. N = 1029 people replied to the questionnaire about their unmet dental needs. N = 497 (48.3%) were men, whereas N = 532 (51.7%) were women. The average age was 31.7811.72. As their current occupation, most of the included subjects (60.1%) were students. The respondents had no known personal habits and a mixed diet (94.93%). The average BMI was 24.022.59 (14-30.9). OHIP was present in 62.3% of the population. The average OHIP-14 severity score was 10.97. (8.54). The severity and degree of unmet dental need were substantial (p0.01) due to pain in the mouth/teeth/gums, malocclusion, and gum bleeding. The most common OHIP-14 domains affected by unmet oral needs were psychological discomfort, psychological limitation, social limitation, and feeling handicapped. The analysis of ANN revealed that high OHIP scores were primarily attributed to dental caries, poor oral health, and dental aesthetics. CONCLUSION: The severity and degree of unmet dental needs were significant among the south Indian population. The most common oral health status that impacted OHIP-14 domains were pain, malocclusion, and bleeding gums. These patients were significantly impacted by psychological discomfort and social limitations and felt handicapped.

Impact of Treatment Response on Risk of Serious Infections in Patients With Crohn's Disease: Secondary Analysis of the PYRAMID Registry.

BACKGROUND & AIMS: Traditional risk factors for serious infections with advanced therapies in patients with Crohn's disease (CD) have been assessed at baseline before starting therapy. We evaluated the impact of treatment response on the risk of serious infections in adalimumab-treated patients with CD through secondary analysis of the PYRAMID registry (NCT00524537). METHODS: We included patients with CD who initiated adalimumab and classified them as treatment responders (achieved steroid-free clinical remission based on patient-reported outcomes) vs nonresponders (not in steroid-free clinical remission) at 6 months after treatment initiation (landmark). We compared the risk of serious infections between responders vs nonresponders between 6 and 36 months after treatment initiation through stabilized inverse probability of treatment weighting Cox proportional hazards model. RESULTS: Of 1515 adalimumab-treated patients, 763 (50.4%) were classified as responders at 6 months (37 ± 13 y; 56% female; disease duration, 9.5 ± 8.5 y). Compared with nonresponders, responders were less likely to have moderate to severe symptoms (55.6% vs 33%), or require steroids (45.5% vs 17.3%) or opiates (6.6% vs 1.3%) at baseline, without any differences in disease location, perianal disease, and prior CD complications. During follow-up evaluation, using stabilized inverse probability of treatment weighting, responders were 34% less likely to experience serious infections compared with nonresponders (hazard ratio, 0.66; 95% CI, 0.46-0.96). Risk of gastrointestinal and extraintestinal infections was lower in responders vs nonresponders. CONCLUSIONS: Patients with CD who respond to adalimumab have a lower risk of developing serious infections compared with nonresponders. These findings underscore that initiation of advanced therapy for CD may lower the risk of serious infections through effective disease control and avoidance of corticosteroids.

Comparative Speed of Early Symptomatic Remission With Advanced Therapies for Moderate-to-Severe Ulcerative Colitis: A Systematic Review and Network Meta-Analysis.

INTRODUCTION: Rapidity of symptom resolution informs treatment choice in patients with moderate-severe ulcerative colitis (UC). We conducted a systematic review and network meta-analysis comparing early symptomatic remission with approved therapies. METHODS: Through a systematic literature review to December 31, 2022, we identified randomized trials in adult outpatients with moderate-severe UC treated with approved therapies (tumor necrosis factor α antagonists, vedolizumab, ustekinumab, janus kinase inhibitors, or ozanimod), compared with each other or placebo, reporting rates of symptomatic remission (based on partial Mayo score, with resolution of rectal bleeding and near-normalization of stool frequency) at weeks 2, 4, and/or 6. We performed random-effects network meta-analysis using a frequentist approach and estimated relative risk (RR) and 95% confidence interval values. RESULTS: On network meta-analysis, upadacitinib was more effective than all agents in achieving symptomatic remission at weeks 2 (range of RR, 2.85-6.27), 4 (range of RR, 1.78-2.37), and 6 (range of RR, 1.84-2.79). Tumor necrosis factor α antagonists and filgotinib, but not ustekinumab and vedolizumab, were more effective than ozanimod in achieving symptomatic remission at week 2, but not at weeks 4 and 6. With approximately 10% placebo-treated patients achieving symptomatic remission at 2 weeks, we estimated 68%, 22%, 23.7%, 23.9%, 22.2%, 18.4%, 15.7%, and 10.9% of upadacitinib-, filgotinib-, infliximab-, adalimumab-, golimumab-, ustekinumab-, vedolizumab-, and ozanimod-treated patients would achieve early symptomatic remission, ustekinumab and vedolizumab achieving rapid remission only in biologic-naïve patients. DISCUSSION: In a systematic review and network meta-analysis, upadacitinib was most effective in achieving early symptomatic remission, whereas ozanimod was relatively slower acting.

Translucency characteristics of permanent maxillary central incisor in Indian population: An analytical cross-sectional study.

Background: Understanding the optical characteristics, especially the translucency patterns (TPs) in teeth can assist clinicians in creating biomimetic restorations. Aim: This study assessed the differences in enamel TPs and the area of translucency (AOT) in the most dominant teeth of an individual's smile according to their age and gender. Materials and Methods: This cross-sectional study was conducted on 140 consented individuals. Based on the age, there were four groups with 35 subjects in each. The digital imaging method is used to classify and differentiate different TPs. The AOT was measured with the assistance of ImageJ 1.51j8 software. Statistical Analysis Used: One-way ANOVA with a post hoc test was used to test the statistical significance difference among the various age groups, and an independent t-test was used to test the variations between genders. Results: The outcome of this study showed that the AOT was the highest for the 50 and above age group as compared to other age groups (P = 0.003). Although there were variations in the TPs between the two genders, the AOT showed no significant difference. Conclusion: The area of incisal third translucency in the upper central incisors varied between different age groups. However, gender had no influence in the area of incisal translucency. Wide variations in the TPs were seen based on age and gender.

The "3D Versascrew": An Innovative Approach for Management of Bilateral Cleft Lip and Palate Case.

The purpose behind the innovation of modified nasoalveolar moulding appliance was to achieve simultaneous anteroposterior and transverse correction in bilateral cleft cases with minimal vomeroid bending. This paper presents a 3D Versascrew appliance that has been used for presurgical nasoalveolar moulding in a 15-day-old neonate with bilateral cleft. Treatment was initiated at 30 days and continued for 90 days following which mild expansion of posterior maxilla with establishment of arch continuity and concomitant improvement in nasal morphology was achieved towards the end.

Comparative efficacy trials in inflammatory bowel disease: current and future implications for practice.

PURPOSE OF REVIEW: Over the last decade, there has been rapid expansion of the therapeutic armamentarium, and evolution of treatment strategies, for the management of inflammatory bowel diseases (IBDs). Consequently, there is an increasing need for head-to-head or comparative efficacy trials to inform optimal positioning of therapies, and pragmatic trials comparing treatment strategies to inform treatment approach. In this review, we will discuss the current status and future of comparative efficacy clinical trials in IBD. RECENT FINDINGS: Pivotal phase IIIB superiority clinical trials have demonstrated superiority of vedolizumab over adalimumab for achieving clinical remission in patients with moderate-to-severe ulcerative colitis (VARSITY) and failed to demonstrate superiority of ustekinumab over adalimumab in patients with moderate-to-severe Crohn's disease (SEAVUE). Noninferiority clinical trials of biosimilars have confirmed absence of meaningful differences in safety and efficacy of biosimilar infliximab over originator infliximab, as initial therapy or switching stable patients during maintenance. Network meta-analyses, indirect treatment comparison using patient-level data from placebo-controlled trials and real-world observational studies have inform comparative effectiveness and safety of different therapies for management of IBD. SUMMARY: Head-to-head clinical trials are critically important to advance the field of IBD. Comparative efficacy trials are slow and expensive to conduct, may not be broadly generalizable, and are not powered for safety events or other relevant outcomes. Alternative approaches to comparative effectiveness such as network meta-analysis and well designed real-world observational studies are able to bridge gaps in clinical practice.