A scoping review exploring oral health inequalities in India: a call for action to reform policy, practice and research.

INTRODUCTION: Reduction in health inequalities and providing universal access to health care have been identified as two important global milestones by the World Health Organization for countries to achieve by 2030. Therefore, recognizing the magnitude of oral health inequalities in India has become a pressing priority to improve access to dental care within the country. This scoping review was conducted with the aim of reviewing, collating and analysing the current knowledge base on oral health inequalities in India. METHODOLOGY: The scoping review followed Arksey and O'Malley's approach, and reporting was performed in accordance with the PRISMA-ScR guidelines. A systematic search was conducted on Scopus, PubMed, Web of Science, and EMBASE to identify literature addressing one or more dimensions of oral health inequalities in India, published in English between January 2002 and April 2022. The data were charted, and qualitative analysis was performed to derive themes, highlighting the key concepts emerging from this review. RESULTS: In accordance with the eligibility criteria, a total of 71 articles retrieved through database search and backward citation search were included in this scoping review. The major themes ranged from individual to diverse sociodemographic factors acting as barriers to and facilitators of access to dental care. Deficiencies in human resources for oral health, along with a wide diversity in dental service provision and dental education were other major themes contributing to inequality. Subsequently, this has resulted in recommendations on restructuring the dental workforce and their development and modifications in oral health care policies and practices. The qualitative synthesis demonstrates the intertwined nature of the multiple factors that influence the goal of achieving an affordable, accessible, extensive and inclusive oral healthcare system in India. CONCLUSIONS: This comprehensive review provides a broad perspective on oral health inequalities in India, providing valuable insights for both researchers and policymakers in this area and guiding their efforts towards achieving universal oral health coverage in the Indian context.

Effect of whitening toothpastes on the surface roughness and microhardness of human teeth-an in vitro study.

OBJECTIVE: To determine the effect of whitening toothpastes on the surface roughness and microhardness of human teeth. METHODOLOGY: Surface roughness was estimated using the Talysurf instrument, and microhardness was estimated using the Vickers hardness tester before and after the application of whitening toothpastes on mounted extracted human teeth. RESULTS: In the activated charcoal group, there was a reduction in the surface roughness from 1.21 at baseline to 1.09 at 1 month and a further reduction to 1.02 at 3 months, which was found to be statistically significant. However, no statistically significant difference in surface roughness was found in the other toothpaste groups. With respect to microhardness, all 4 whitening toothpastes showed a statistically significant reduction in microhardness after 3 months of brushing. However, the reduction was significantly higher in group 2 and in group 4 compared to the others. CONCLUSION: This study showed that whitening toothpaste containing activated charcoal significantly reduced the surface roughness, whereas toothpastes with blue covarine and toothpastes containing activated charcoal significantly reduced the microhardness of the tooth. CLINICAL RELEVANCE: This study emphasizes the need for healthcare professionals to be aware of the potential disadvantages of whitening toothpastes and make evidence-based decisions when recommending the product to patients.

Biopsychosocial impact on caregivers of head and neck cancer patients undergoing radiotherapy at a tertiary care hospital.

Introduction: Patients diagnosed with head and neck cancer are often subjected to an array of unprecedented challenges, which have seldom been scrutinized in other cancers, such as prolonged restrictions in their capaci-ty to breathe, speak, and swallow, considerable deformity, and an alleviated risk of death. These predicaments have consequential repercussions on the psychological well-being of patients, and they debilitate the mental, social, and financial facet of not only the patient's but also of the caregiver's lives, placing them in a state of constant uncertainty while also deteriorating their physical and mental health. Aim of the study was to assess the burden on the caregiver and their quality of life (QOL) using the Caregiver Quality of Life Index-Cancer (CQOLC) scale by comparing the sali-vary cortisol levels of caregivers at different intervals of the radiotherapy session. Materials and methods: The current study was a prospective cohort study conducted on 28 caregivers of patients undergoing radiotherapy, aged 15 years and more. The entire collection of saliva samples of each of the caregivers was collected on day 1, day 14, and day 21 of the radiotherapy session while simultaneously handing out the CQOLC for them to fill out. The samples were later analysed using an ELISA kit to measure the cortisol levels. Results: On day 1 the QOL score was 1.97 ±0.28, on day 14 the QOL score was 2.53 ±0.31, and on day 21 the QOL score was 3.15 ±0.26, with a p-value of 0.0001 over the entire session. There was no statistically significant change in the salivary cortisol level. P < 0.05 is considered statistically significant. Conclusions: The assessed quality of life portrayed a progressive decline over the calculated period, concluding that the radiotherapy sessions of the patients subjected the caregivers to distress. It was also found that the males had a noteworthy diminution in QOL compared to the females; however, there was no signifi-cant change in the cortisol level over the calculated period.

Effect of Paneer and Cheese Consumption on Salivary Acidogenicity and Calcium Concentration: A Comparative Study.

PURPOSE: To assess and compare the salivary pH reversal phenomenon and calcium concentration in subjects consuming paneer and cheese after an acidogenic challenge and also to compare the salivary pH measurements using pH strips and a portable pen-type pH meter. MATERIAL AND METHODS: Sixty caries free undergraduate students were randomly selected and divided into two group: 1. paneer; 2. cheese. After determining the resting salivary pH using pH strips and a pen-type pH meter, participants were subjected to an acidogenic challenge (10% sucrose). Following consumption of test foods (10-gram cubes), salivary pH was measured at intervals of 5, 10, 15, 30 and 60 min to record the time taken for the salivary pH to return to baseline. Colorimetric salivary calcium concentration was estimated (Biochemical Analyzer) at baseline and after 60 min of test food consumption. The statistical tests used were Shapiro-Wilk's test for normality, repeated measures ANOVA, and the independent t-test. RESULTS: Test meals reversed the fall in pH after acidogenic challenge starting at 5 min and returning to baseline values after 30 min in both groups (p = 1.000). Colorimetric estimates showed higher salivary calcium concentrations with paneer (p < 0.001). The pen-type pH meter showed superior efficiency in terms of time (p < 0.001) compared to pH strips. CONCLUSION: The salivary pH reversal phenomenon was evident after consumption of both paneer and cheese following the acidogenic challenge. Consumption of paneer significantly increased salivary calcium concentration. The pen-type pH meter proved to be more efficient.

Changes in the Oral Environment after Placement of Fixed Orthodontic Appliance for the Treatment of Malocclusion - a Descriptive Longitudinal Study.

PURPOSE: The aim of this study was to determine the changes of salivary flow rate, pH, buffering capacity, total antioxidant capacity and changes in streptococci and lactobacilli counts at baseline, 1 month and 6 months of fixed orthodontic treatment. MATERIALS AND METHODS: An unstimulated salivary sample was collected from 30 out of 43 patients who were in need of fixed orthodontic treatment (mean age 17.8 ± 5.01 years). Salivary samples were collected from the patients before the placement of fixed orthodontic appliance (Gemini MBT 0223M) at 1 month and 6 months following start of the treatment. Samples were tested for significant changes in flow rate, pH, buffering capacity, total antioxidant capacity and streptococci and lactobacilli counts. Results were compared using ANOVA. RESULTS: The study results showed that orthodontic appliances significantly changed the unstimulated salivary flow rate (p < 0.05) (baseline: 0.40 ± 0.11, 1 month: 0.45 ± 0.09, 6 months: 0.44 ± 0.07) and buffering capacity (p < 0.05) (baseline: 5.01 ± 0.50,1 month: 3 .98 ± 0.78, 6 months: 4.02 ± 0.78) at the end of 1 month and 6 months whereas lactobacilli count showed significant changes at the end of 6 months (p < 0.05) (baseline: 6.20 ± 2.07, 1 month: 7.09 ± 3.78, 6 months: 7.85 ± 1.88). The pH, total antioxidant capacity and streptococci counts did not show any significant changes during the study period. CONCLUSION: It appears that 6 months of treatment with fixed orthodontic appliance resulted in a significant increase in unstimulated salivary flow rate and lactobacilli counts, whereas buffering capacity decreased significantly during the study period.

Effectiveness of Motivational Interviewing and cross platform messaging application in improving oral health knowledge, attitude and behaviours among pregnant women- A Randomized Controlled Trial.

Background: Body goes through significant hormonal and physiological changes during pregnancy, which could be linked to changes in oral health. Many women are unaware of the negative consequences of poor dental health during and after pregnancy, both for themselves and their children. Therefore, this study aimed to assess the effectiveness of Motivational Interviewing (MI) and cross platform messaging application (WhatsApp messenger) for oral health education on the oral health knowledge, attitude and behaviours among pregnant women attending ante natal care. Methods: A randomized controlled trial was conducted among 84 pregnant women. Simple random sampling was employed to select participants after oral examination. Participants were randomly allocated to two groups (Group 1: Cross-platform messaging application [WhatsApp]; Group 2: MI) using a lottery method. Pregnant women aged 18 years and older, gestational age between 8 and 30 weeks were included. A face-to-face interview and oral examination were conducted to assess baseline knowledge and oral hygiene status. A follow-up examination was conducted after one month of intervention. Inferential statistics, including the chi-square test and independent t-test, were used to compare variables between the two groups. Results: The mean knowledge score at baseline was comparable between Group 1 (WhatsApp) and Group 2 (MI). However, post-intervention, Group 2 showed a significantly higher mean knowledge score compared to Group 1. Post-intervention, Group 2 exhibited a significantly better oral hygiene status compared to Group 1. Significant improvements in oral health behaviours were observed in Group 2 compared to Group 1 (p < 0.001). Conclusions: The findings suggested that while both interventions were effective, MI showed superior results in improving knowledge, oral hygiene status, and oral health behaviours. The personalized and client-centred approach of MI enables participants to explore and resolve ambivalence, promoting a deeper understanding of the importance of oral health during pregnancy. Registration: CTRI ( CTRI/2021/09/036407, 10/09/2021).

Osseointegrative and antimicrobial properties of graphene oxide nano coated dental implants: A systematic review.

Introduction: Osseointegration stands as a pivotal concept within the realm of dental implants, signifying the intricate process through which a dental implant integrates with the adjoining bone tissue. Graphene oxide (GO) has been shown to promote osseointegration, the process by which the implant fuses with the surrounding bone. The objective of this study was to assess the osseointegrative and antimicrobial properties of GO nano coated dental implants. Methods: A systematic search was conducted using electronic databases (e.g., PubMed, Scopus, Web of Science) to identify relevant studies published. Inclusion criteria encompassed studies that evaluated the effects of GO nano coating on osseointegrative and antimicrobial characteristics of dental implants. Studies not written in English and published before 2012 were excluded. Results: The initial search yielded a total of 127 potential studies, of which six met the inclusion criteria and five were included in the review. These studies provided data on GO nano coated dental implants and their osseointegrative and antimicrobial properties. All the included studies showed moderate risk of bias. None of the studies provided information related to sample size calculation or sampling technique. Discussion: The findings from the included studies demonstrated that GO nano coating had a positive impact on osseointegrative properties of dental implants. Enhanced bone-implant contact and increased bone density were observed in animals and humans receiving GO nano coated implants. Furthermore, the antimicrobial properties of GO nano coating were found to inhibit bacterial colonization and biofilm formation on the implant surface, reducing the risk of implant-associated infections. Conclusion: The findings indicate that GO nano coating holds promise in enhancing the success rate and longevity of dental implants. However, more studies with larger sample sizes, are needed to further strengthen the evidence and determine the long-term effects of GO nano coated dental implants.

Tobacco Control Policy in India: Progress and Challenges Quantified Using the Tobacco Control Scale.

INTRODUCTION: One of the most vexing challenges to public health today is the menace of tobacco. Despite the large body of evidence indicating the vast scale of health hazards, tobacco use continues to be a major cause of preventable death. This study was conducted with the objective of quantifying the progress and challenges of the tobacco control policy of India. METHODS: The Tobacco Control Scale (TCS) was used, which has a maximum score of 100 and assesses nine components including, price of cigarettes, smoke-free public and work places, spending on public information campaigns, comprehensive bans on advertising and promotion, large pictorial health warning labels, treatment to help smokers stop, illicit tobacco trade, tobacco industry interference and ratification of the WHO FCTC. The components of the TCS for India were scored based on data obtained from the WHO, Report on The Global Tobacco Epidemic, 2021 and the Cigarettes and Other Tobacco Products Act 2003 and their amendments and the Tobacco India 2023 country profile. RESULTS: The total score for the tobacco control scale placed India at 65 points, scoring highest with respect to 'large pictorial health warning labels', and lower with respect to 'spending on public information campaigns', 'illicit tobacco trade' and 'price of cigarettes'. CONCLUSIONS: Strong tobacco control legislation and its equally robust implementation is an affirmative step in achieving the vision of the WHO-FCTC and empowering the world towards being tobacco free.

Understanding rapid oral health deterioration and its associated factors among older adults: A scoping review.

Background: Understanding the pivotal interplay between systemic and oral health is paramount to ensuring holistic care, particularly among the aging demographic. Therefore, this review article aims to explore the emerging concept of Rapid Oral Health Deterioration (ROHD) by reviewing the current knowledge base among older adults and identifying knowledge gaps in this area of research. Methods: This scoping review was conducted in line with Arksey and O'Malley's framework between December 2023 and March 2024 and reported while adhering to the PRISMA-ScR guidelines. A systematic database search was performed across three databases i.e. PubMed, Scopus, and EMBASE to collate the existing literature published in English between January 2013 and February 2024 addressing ROHD among older adults. After data charting, a critical appraisal of the selected studies was followed by qualitative thematic analysis. Results: Among the 12 papers in this scoping review, 10 were cross-sectional studies, with one each of retrospective cohort and case-control studies. The qualitative thematic analysis of the selected articles resulted in the emergence of four main themes: risk factors for ROHD, attributes related to ROHD, challenges encountered in the management of ROHD, and management approaches for ROHD among older adults. Conclusions: This scoping review provides an overview of the rapid deterioration of oral health among older adults. Age-related dental disease harms the quality of life and overall health. To avoid dental disorders and to maintain and improve oral health in older adults, an integrated and multidisciplinary approach is essential. If ROHD is not treated, it may lead to poor health, a lower quality of life, and in severe cases, systemic infections that increase hospitalizations and possibly cause death.

A qualitative exploration of patients' perception regarding the comprehensive dental services availed at a primary health center.

Introduction: Comprehensive oral care is a service centered around the patient, and individuals who need it the most often face limited access. Patient perception acts as a guide for enhancing quality, ensuring patients' future intent to utilize the services and facilitating recommendations to others. The present study aimed to assess the patients' perception of comprehensive dental services availed at a Primary Health Center (PHC). Methods: This qualitative study was based on a phenomenological interpretive approach, and judgment sampling method was employed. A validated interview guide, developed from relevant literature was employed in the local language to conduct interviews among adults visiting the PHC, gathering their views regarding the services provided. The interviews were audio recorded on a digital voice recorder, and files were password protected. Content saturation guided the determination of the final number of participants interviewed. After translating and transcribing the interviews, thematic analysis and coding were performed using ATLAS. ti 23 for Windows. Results: A total of 12 participants were included in the study, following data saturation. Among them, there were 8(66.7%) female and 4(33.3%) male participants. Ten overarching main themes were discerned through the assigned codes, including positive views, neutral views, negative views, previous dental clinics visited, previous experience with dental treatment, treatments sought at the center, referrals, source of information about the dental center, subsequent visits and suggestions for improvement. Conclusions: The findings of this study revealed a positive patient perception of the comprehensive dental services offered at the PHC. Through insightful interviews, various strengths, and areas for improvement regarding the center and care provision were identified. These insights provide valuable suggestions that can be applied to elevate the utilization of dental services, ensuring continuous improvement in patient care.

Correction: Effectiveness of Silver Diamine Fluoride for Early Childhood Caries Among Children Aged 24 to 72 Months: Protocol for a Randomized Controlled Trial.

[This corrects the article DOI: 10.2196/46144.].

Effectiveness of Silver Diamine Fluoride for Early Childhood Caries Among Children Aged 24 to 72 Months: Protocol for a Randomized Controlled Trial.

BACKGROUND: Dental caries is a serious public health issue globally. It is one of the most prevalent chronic disease in children worldwide. An important public health concern is the existence of one or more decayed, missing, or filled tooth surfaces in any primary teeth of preschool children. Early childhood caries (ECC) can be halted with the use of silver diamine fluoride (SDF) solution. Previous research has indicated that it may have a preventive impact in the treatment of ECC. It is well known that 38% silver diamine fluoride (SDF) is helpful at preventing dental caries. On the other hand, there is not enough evidence on SDF's ability to prevent caries in primary teeth. To date, no well-planned clinical study has been carried out to investigate SDF's impact on caries protection. OBJECTIVE: The study's objective is to evaluate and compare the efficacy of 12%, 30%, and 38% silver diamine fluoride in preventing ECC in children aged 24 to 72 months in Mangaluru Taluk. METHODS: This is a single-center, randomized, active-controlled, parallel-group pragmatic trial. Children attending preschool in Mangalore Taluk aged 24 to 72 months will be included in the study. There will be three study groups: group 1 will receive 12% SDF semiannually; group 2 will receive 30% SDF semiannually; and group 3 will receive 38% SDF semiannually. After 6 and 12 months, the principal examiner will conduct a clinical examination of the teeth with a visual and tactile assessment. The effectiveness of the various concentrations of SDF will be determined after 12 months. RESULTS: The research was funded in September 2020, and data collection started in September 2022. As of February 2023, 150 participants have enrolled in the study. The project is still underway, and it is expected to be completed in December 2023. CONCLUSIONS: Uncertainty surrounds the efficacy of 38% SDF in preventing ECC. Consensus-Based Clinical Case Reporting (CARE) guidelines recommending the use of SDF for ECC prevention will be modified if the findings are as expected. Additionally, since the findings will be broadly disseminated, more nations will implement the use of SDF, easing the burden of ECC on the entire world. Future research on the treatment and prevention of ECC will benefit from the study results. If SDF is successful in preventing caries in a classroom or community context, it will mark an important turning point for preventive dentistry. TRIAL REGISTRATION: Clinical Trial Registry of India CTRI/2020/02/023420; https://tinyurl.com/3ju2apab. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/46144.

Microplastic content of over-the-counter toothpastes - a systematic review.

Background: Microplastic particles are used as ingredients in personal care products such as face washes, shower gels and toothpastes and form one of the main sources of microplastic pollution, especially in the marine environment. In addition to being a potential pollutant to the environment, the transfer of microplastics to humans can become a severe threat to public health. This systematic review was conceptualized to identify evidence for the presence of and characteristics of microplastics in toothpaste formulations. Methods: The PICOS Criteria was used for including studies for the review. Electronic databases of Scopus, Embase, Springer Link, PubMed, Web of Science and Google Scholar were searched, as well as hand and reference searching of the articles was carried out. The articles were screened using the software application, Covidence® and data was extracted. Results: This systematic review showed that toothpastes from China, Vietnam, Myanmar and the UAE, reported no evidence of microplastics and those from Malaysia, Turkey and India reported the presence of microplastics. The shape of the microplastics present in these toothpastes were found to be granular, irregular with opaque appearance and also in the form of fragments and fibers and the percentage weight in grams ranged from 0.2 to 7.24%. Malaysia releases 0.199 trillion microbeads annually from personal care products into the environment and toothpastes in Turkey release an average of 871 million grams of microplastics annually. Similarly, in India, it has been reported that 1.4 billion grams of microplastic particles are emitted annually from toothpaste. Conclusions: The findings of this systematic review provide evidence that toothpastes, at least in some parts of the world, do contain microplastics and that there is a great risk of increase in the addition of microplastics to the environment by the use of toothpaste.

Validation of ageism scale for dental students in India: (Ageism Scale for Dental Students- India) - a cross sectional study.

Background: Ageism persists in many different societies as it is innate and subconscious in nature. Negative effects such as loneliness, mistreatment, and occupational discrimination are frequently present due to ageism. The dental students in our study were wary of the possible benefits of expensive dental care because ageism is rife in their field. There is no validated and reliable ageism scale to assess how dental students perceive ageism in India. The current study was carried out to validate the ageism scale for dental students in the Indian context. METHODS: This was a cross sectional analytical study carried out among both males and females in Manipal College of Dental Sciences, Mangalore in which the instrument was 27-item Ageism scale for dental students. Content validity was done by six subject experts. The final version was administered to 213 students/Residents of dental school. The factorability of data was confirmed with KMO = 0.61 and Bartlett's Test of Sphericity resulting in p < 0.001. RESULTS: Final PCA model resulted in 15 items and six components that together accounted for 70.37% of overall variance. The six components had reliability ranging from marginal 0.51 (Component 6) to a high of 0.81 (Component 3). As per the gender differences by component females showed less ageism than men in "non-compliance" (-0.9(-1.66-0.14), p<0.05) and "practitioner perspective" (1.43 (0.84, 2.03), p<0.01). Statistical significance was seen in Barriers/concerns in dental treatment of elderly where residents showed reversed (1.4 (0.41, 2.38), p<0.01). Urban group showed more ageism for component 'time restraint' (-0.79 (-1.57, -0.02), p<0.05. CONCLUSION: Preliminary validation resulted in 15 item scale with six components with acceptable validity of the ageism scale and could be further tested in large samples. This scale will help recognize ageism in Indian context and provide necessary information to make changes in the curriculum as required.

Role of nutritional supplements on oral health in adults - A systematic review.

Purpose: The word 'diet' usually encompasses the consumption of food that includes all the necessary nutrients required for the optimal functioning of the body. Nutritional supplements hold a supreme position due to the demanding lifestyles or medical conditions in this current era. Although medical literature has sufficient evidence exploring the effect of nutrients on general health, this systematic review aimed at specifically evaluating the role of nutritional supplements on oral health in adults. Methods: PRISMA guidelines were followed in conducting this systematic review where four electronic databases including Scopus, PubMed, EMBASE, and Web of Science were reviewed. Based on the inclusion criteria, four studies exploring the effect of oral nutritional supplements on oral health among the adult population were included in this systematic review. Results: This review generated evidence suggesting a positive effect of nutritional supplements on oral health. These findings were depicted in the form of a reduction in plaque scores, probing depths, gingival inflammation, and greater improvement in periodontal healing among individuals with higher intakes of nutritional supplements within recommended doses. Conclusions: The systematic review outlines the positive impact of consuming nutritional supplements in the recommended dosage on oral health. Additionally, this review stresses the necessity for interventional studies to further investigate the effects of nutritional supplements on oral health, particularly in regard to periodontal healing. PROSPERO registration: CRD42021287797 (27/11/2021).

Comparative Evaluation of Salivary Sialic Acid Levels Among Beedi Rollers and Tobacco Users in Mangalore, South India.

INTRODUCTION: According to World Health Organization, the global cancer burden is estimated to have risen to 18.1 million new cases and 9.6 million deaths in 2018. Tobacco use is a leading cause of cancer and of death from cancer. Beedis are the most popular smoking form of tobacco in India. Thirty-four percent of the tobacco produced in India is used for making beedis. The beedi sector is agroforestry-based and the second largest industry in India with approximately 4.4 million full-time beedi workers in India. Toxic constituents present in tobacco are released into the ambient air during the processing of beedis. METHODS: A descriptive cross-sectional study was conducted to assess and compare salivary sialic acid levels among beedi rollers, tobacco smokers, smokeless tobacco users and individuals with no tobacco exposure. The study sample comprised of 140 individuals who were 30 to 60 years old, who attended dental screening and treatment camps in rural and urban areas in Mangalore, conducted by the Department of Public Health Dentistry, Yenepoya Dental College and patients who visited the Department of Oral Medicine and Radiology of Yenepoya Dental College. Saliva was collected by passive drool method into a sterile container. Biochemical analysis of salivary sialic acid was done using the acidic ninhydrin method. Continuous variables are expressed in terms of mean and standard deviation. Categorical variables are expressed in terms of frequencies and percentages. To compare salivary sialic acid levels between the groups ANOVA was used. The Chi-square test was used to compare categorical variables between the groups. RESULTS: A total of 140 participants, 35 beedi rollers, 35 smokers, 35 smokeless tobacco users and 35 individuals with no tobacco exposure participated in the study. Among the 140 participants, 90 participants were males and 50 participants were females. There was a statistically significant difference in the mean salivary sialic acid level between the different groups (p<0.001) with smokeless tobacco users having the highest (10.60 mg/dL) mean salivary sialic acid level. It was found that the mean salivary sialic acid level reduced as the age progressed, even though there was no statistically significant difference. There was a statistically significant difference in the mean salivary sialic acid level between the different groups (p=0.010) with participants with 11 to 20 years of exposure to tobacco having the highest (8.67 mg/dL) mean salivary sialic acid level and participants with no tobacco exposure having least (3.06 mg/dL) mean salivary sialic acid level. CONCLUSION: The salivary sialic acid level was more in beedi rollers than individuals with no tobacco exposure, even though the difference was not statistically significant. The results showed elevated levels of salivary sialic acid in smokeless tobacco users followed by tobacco smokers. This may be an indication that smokeless tobacco use has harmful effects similar to or more than tobacco smoking since salivary sialic acid levels in smokeless tobacco users were higher than those in smokers.

Tobacco use patterns and predictors among college students in Mangalore, South India: Findings from the Global Adult Tobacco Survey.

INTRODUCTION: Tobacco use is a leading cause of death and disability worldwide, particularly in South-East Asia. The tobacco problem in India is probably more complex than in any other country, with a huge consequential burden of tobacco related diseases and deaths. The present study aimed at analyzing the pattern and predictors of tobacco use among college students aged 18-24 years, using the Global Tobacco Surveillance System (GTSS). METHODS: A cross-sectional study was conducted among 2063 students, from 30 colleges of Mangalore, South India, who were selected by multistage sampling with probability proportional to size. The tobacco questions used for this study were a validated, recommended subset of key questions from the Global Adult Tobacco Survey (GATS). Data analysis was performed using GATS manuals and SPSS version 24.0. RESULTS: A total of 2063 students participated in the study (738 males, 1325 females). Prevalence of tobacco smoking was 4.8%, which included 9.9% males and 2.1% females. Manufactured cigarettes were the most commonly preferred tobacco product among daily smokers. The overall percentage of smokeless tobacco use was 4.8%, which included 7.4% males and 3.3% females. Logistic regression analysis showed that 71.4% of the participants who noticed anticigarette information on television made an attempt to quit smoking. The odds ratio (OR) of quitting was 4.4 times higher compared to those who did not notice any information on television (p=0.002). In addition, noticing health warnings on cigarette packs strongly influenced an individual to quit smoking (OR=30.09). CONCLUSIONS: The study results showed low prevalence of the use of both smoked and smokeless forms of tobacco, current smoking, and chewing tobacco, among the study population. Generating data in this part of the country on tobacco use and developing tobacco control measures at regular intervals are essential to better understand and develop effective intervention programs.

COVID-19 in Smokeless Tobacco Habitués: Increased Susceptibility and Transmission.

As the coronavirus disease (COVID-19) pandemic continues to sweep across the globe, the world is responding by implementing public awareness campaigns, social distancing measures, and other preventive strategies to arrest the spread of this lethal disease. Infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exacts a heavy toll on patients with existing comorbidities. Smokeless tobacco (SLT) consumption is of particular concern in countries in South Asia with high population densities, as it facilitates exposure to SARS-CoV-2 within or between communities by the act of public spitting. Salivary droplets generated in this act are a potential threat because they can transmit this airborne infection. Moreover, large gatherings at tobacco retail outlets, frequent hand-to-mouth contact, and sharing of apparatus by SLT habitués could also aid in increasing the spread of SARS-CoV-2. SLT-induced higher expression of angiotensin-converting enzyme 2 receptors along with the presence of furin in the oral mucosa and dysfunctional immune responses among SLT habitués increase viral dissemination and an individual's susceptibility to COVID-19. Issuing rigorous regulations to restrict the use of various forms of SLT products and the obnoxious act of spitting in public can assist in arresting the spread of COVID-19. Widespread education campaigns enlightening the community regarding the adverse effects of SLT consumption and its relationship with COVID-19, along with providing effective assistance to quit for those who are addicted, would decrease the spread of COVID-19.

Socioeconomic Correlates and Key Aspects of Tobacco Surveillance Using Global Adult Tobacco Survey Among College Students of Mangaluru, South India.

Introduction Tobacco use in recent times has been identified to be the single biggest cause of morbidity and mortality. The epidemic of tobacco use has increased among young adults, which has changed the equation of the prevalence. The contribution of tobacco use to socioeconomic inequalities in health is increasing in India. Adolescent's tobacco use may play an important role in increasing social inequalities related to smoking and smokeless tobacco use. The objective of this research was to study the association between socioeconomic status and tobacco use among college students of Mangaluru, South India Methods To analyze the association between the socioeconomic status and tobacco use, the study was conducted among 18 to 24-year-old college students (n = 802) in different colleges of Mangaluru, South India. A subset of key questions from the Global Adult Tobacco Survey (GATS) was used. The socioeconomic status of the participants was recorded using Kuppuswamy socioeconomic scale (for India) to categorize them into upper class and lower class. Descriptive statistics were applied to assess the factors related to tobacco use and socioeconomic status using SPSS ver. 24.0. Results Approximately 29.7% males and 70.3% of females completed the interview. Among 802 subjects, 69.9% belonged to the upper class and 30.04% belonged to the lower class. The current smokers who smoked daily 1.7% were from the upper class and 1.7% were from the lower class; no statistically significant difference was observed as well (p = 0.97). Approximately 3.4% from the upper class smoked less than daily and 3.1% from lower class smoked less than daily (NS). Among the upper class, 1.8% used daily and 2% subjects from the lower class used smokeless tobacco. A statistically significant difference was observed with subjects between the upper and lower class in noticing cigarette promotions in various forms during the last 30 days of interview. Conclusion Socioeconomic disparities on tobacco use need to be explored to ensure the initiation of new tobacco control activities and monitor the existing tobacco control policies. The current study finding demonstrates a significant but varied role of socioeconomic status on current and past tobacco use.

Evaluation of Salivary Parameters and Oral Health Status Among Asthmatic and Nonasthmatic Adult Patients Visiting a Tertiary Care Hospital.

INTRODUCTION: Asthma is a chronic inflammatory disorder of the airways characterized by attacks of bronchoconstriction causing shortness of breath, coughing, and rapid breathing. Patients undergoing inhalation therapy are subjected to a higher risk of dental caries due to the reduced saliva secretion, decreased pH value, increased number of cariogenic bacteria caused by inappropriate oral hygiene, and the use of inhaling medicaments with dry powder. METHODS: The descriptive study was carried out among 200 patients aged (18-45 years) visiting Yenepoya Hospital, Mangalore during the period from May 2018 to October 2018 to evaluate salivary parameters and oral health status in asthmatic and nonasthmatic patients. Data were collected using WHO criteria (2013) and samples of unstimulated saliva were collected for evaluation of salivary flow rate, pH, buffering capacity, and calcium. Statistical analysis was done using SPSS version 21.0 software with the level of significance set at p < 0.05.  Results: A decreased mean score of salivary flow rate, pH, and buffering capacity were found in asthmatic patients compared to nonasthmatic patients (p < 0.001). A higher mean decayed, missing, and filled teeth (DMFT) score and an increased dental erosion score were found in asthmatics compared to nonasthmatics (p < 0.05). Asthmatics had higher gingival bleeding score than nonasthmatics. CONCLUSION:  In order to prevent disease progression in the hard dental tissue and oral cavity of asthmatic patients, it is necessary to apply adequate preventive measures and motivate their continuous application in this caries-risk population.