Universal oral health coverage - Perspectives from a developing country.

Universal Health Coverage (UHC) is where people have access to health services without suffering financial hardship to pay for it, provide equitable health-care services that are appropriate, accessible and affordable for all people, particularly poor and disadvantaged communities. However, optimal intervention in relation to oral disease is not universally available or affordable specifically in developing countries because of limited resources at public sector, escalating costs of treatment and inadequate emphasis on primary prevention of oral diseases. Similar barriers also exist in utilisation of dental services among the Indian population. Integrating oral health into UHC will help improve oral health outcomes and reduce inequalities in access to care. To strengthen the oral health system towards UHC, public sector spending on oral health-care should be equally focused on primary care instead of directing mainly into only tertiary care, which could help reduce the number of complications progress to more expensive and more aggressive treatment.

Effectiveness of a web-based learning module on oral health promotion for nursing and allied health professionals.

Background Nursing and allied health professionals are helping hands for healthcare and are important in the training cascade. We aimed to develop and validate the effectiveness of a web-based learning module on oral health promotion among nursing and allied health professionals. Methods We developed and validated an oral health module focused on prevention and promotion for a web-based intervention among nurses and allied health professionals. Pre- and post-test assessment was conducted to evaluate the effectiveness of the programme. Results Of a total of 347 participants, 170 (48.9%) had a good knowledge score in the pre-test, and after attending the oral health module their number increased to 267 (76.9%). The mean difference between the pre-test and post-test scores was statistically significant (p<0.005). Conclusions Training of nurses and allied health professionals on oral health through a web-based module showed improvement in oral health literacy.

Consensus & Evidence-based INOSA Guidelines 2014 (First edition).

Obstructive sleep apnoea (OSA) and obstructive sleep apnoea syndrome (OSAS) are subsets of sleep-disordered breathing. Awareness about OSA and its consequences amongst the general public as well as the majority of primary care physcians across India is poor. This necessiated the development of the INdian initiative on Obstructive Sleep Apnoea (INOSA) guidelines under the auspices of Department of Health Research, Ministry of Health & Family Welfare, Government of India. OSA is the occurrence of an average five or more episodes of obstructive respiratory events per hour of sleep with either sleep related symptoms or comorbidities or ≥ 15 such episodes without any sleep related symptoms or comorbidities. OSAS is defined as OSA associated with daytime symptoms, most often excessive sleepiness. Patients undergoing routine health check-up with snoring, daytime sleepiness, obesity, hypertension, motor vehicular accidents and high risk cases should undergo a comprehensive sleep evaluation. Medical examiners evaluating drivers, air pilots, railway drivers and heavy machinery workers should be educated about OSA and should comprehensively evaluate applicants for OSA. Those suspected to have OSA on comprehensive sleep evaluation should be referred for a sleep study. Supervised overnight polysomnography (PSG) is the "gold standard" for evaluation of OSA. Positive airway pressure (PAP) therapy is the mainstay of treatment of OSA. Oral appliances are indicated for use in patients with mild to moderate OSA who prefer oral appliances to PAP, or who do not respond to PAP or who fail treatment attempts with PAP or behavioural measures. Surgical treatment is recommended in patients who have failed or are intolerant to PAP therapy.

Consensus & evidence-based INOSA Guidelines 2014 (first edition).

Obstructive sleep apnoea (OSA) and obstructive sleep apnoea syndrome (OSAS) are subsets of sleep-disordered breathing. Awareness about OSA and its consequences amongst the general public as well as the majority of primary care physcians across India is poor. This necessiated the development of the INdian initiative on Obstructive sleep apnoea (INOSA) guidelines under the auspices of Department of Health Research, Ministry of Health & Family Welfare, Government of India. OSA is the occurrence of an average five or more episodes of obstructive respiratory events per hour of sleep with either sleep related symptoms or co-morbidities or ≥ 15 such episodes without any sleep related symptoms or co-morbidities. OSAS is defined as OSA associated with daytime symptoms, most often excessive sleepiness. Patients undergoing routine health check-up with snoring, daytime sleepiness, obesity, hypertension, motor vehicular accidents and high risk cases should undergo a comprehensive sleep evaluation. Medical examiners evaluating drivers, air pilots, railway drivers and heavy machinery workers should be educated about OSA and should comprehensively evaluate applicants for OSA. Those suspected to have OSA on comprehensive sleep evaluation should be referred for a sleep study. Supervised overnight polysomnography (PSG) is the "gold standard" for evaluation of OSA. Positive airway pressure (PAP) therapy is the mainstay of treatment of OSA. Oral appliances are indicated for use in patients with mild to moderate OSA who prefer oral appliances to PAP, or who do not respond to PAP or who fail treatment attempts with PAP or behavioural measures. Surgical treatment is recommended in patients who have failed or are intolerant to PAP therapy.

NTRDC retainer: a novel approach for both retention and habit control--a follow up of 2 years.

Many methods have been used to correct abnormal tongue habits. A mechanical device such as tongue spurs or cribs offers help till they are in the mouth, but the habit often returns when the device is removed. Patients with tongue thrusting habits complain to their clinician, of reopening of spaces, proclination of anteriors and contraction of arch, though the clinician successfully treated the case.

Dewey's Modification for Angle's Class I Malocclusion: Revisited.

Introduction Classification is a crucial communication tool between dental school professors and students, between practitioners, and between practitioners and insurance companies or government bureaucracies. The management of patients is significantly impacted by classification. Once a patient has been categorized, the practitioner will frequently use treatment strategies corresponding to that classification. The classification used by orthodontists most frequently is Dewey's version of Angle's categorization. To date, the shortcomings of Dewey's modification were not mentioned in the literature. Various other malocclusions are still not included in this classification system that was modified by Dewey.  Aim The aim of this study was to re-evaluate and re-establish Dewey's modification for class I malocclusion for the various other types of malocclusions that are not included in the classification system. Material and method An observational study was carried out on a total of 600 patients in the Department of Orthodontics. The study duration was eight months. The photographic method was used for the evaluation of the malocclusion. Photographs were taken and clinical evaluation was done of the selected cases. The type of malocclusion was observed and recorded. Result The results showed that other types of malocclusions other than that of Dewey's modification are observed in the population. A total of 4% of the population was affected with single tooth crossbite and 5% were affected in more than one tooth. A total of 1% of the population was affected with single-tooth scissor bites, and in 2%, more than one tooth was involved. In 9% of the population, single-tooth rotations were present, whereas in 6%, more than one tooth was involved. A total of 35% of the population showed other types of malocclusions. Conclusion To conclude, various other malocclusions are present in the population suggesting a lacuna in Dewey's modification. Hence, there was a need to revisit.

Empowering AYUSH health professionals on oral health promotion in a tertiary care dental hospital in India: An interventional study.

BACKGROUND: The extensive reach of AYUSH health professionals allows them to provide profound quality care to the unreachable. These professionals from the traditional system of medicine form fundamental part of the health care system. If adequately trained on oral health they can play a remarkable role in oral health promotion and prevention of oral diseases. OBJECTIVE: A training strategy was thus chalked out and this study was conducted to assess the knowledge of AYUSH health professionals on oral health and the impact of this training intervention in improving their knowledge. MATERIALS AND METHODS: An interventional study via self structured pre and post questionnaire on 49 participants assessed the knowledge of participants on oral health promotion. The needs assessment revealed that all the AYUSH health practitioners felt the need to participate in oral health promotion training. RESULTS: A significant increase in mean knowledge scores from 12.56 ± 2.26 to 15.26 ± 1.40 of AYUSH professionals was seen after a one day training programme. CONCLUSION: The study concluded that the utilization of AYUSH health professionals for oral health promotion and education can aid as a valuable tool for population based oral health promotion approaches.

Influence of tongue volume, oral cavity volume and their ratio on upper airway: A cone beam computed tomography study.

BACKGROUND: Our study aimed to measure the tongue volume (TV), oral cavity volume (OCV), and their ratio (TV/OCV) and correlate with upper airway using cone-beam computed tomography (CBCT). METHOD: The volume of oral cavity, tongue and upper airway were obtained by the manual process of segmentation of CBCT data of 15 subjects. The mean age of the sample was 21.86 years (range 15-33 years). Segmentation of the upper airway, tongue and oral cavity was performed manually using Mimics 11.0 (Materialise, Leuven, Belgium) software at different thresholds for air and the tongue. The Hounsfield units (HU) for airway volume of the different facial region ranged from -1024 to -500. For tongue volume, Hounsfield units (HU), ranging from -200 to 200 was calculated. RESULTS: A significant negative correlation between TV/OCV and oropharynx (r = - 0.51; P = 0.04), TV/OCV and oral cavity airway volume (r = - 0.74; P = 0.002) was found. There was a significant and a positive correlation with TV/OCV and tongue volume (r = 0.65; P = 0.009). CONCLUSION: A significant negative correlation established between TV/OCV, oropharynx and oral cavity airway volume. This finding indicates an influence tongue volume, oral cavity volume and their ratio on patency of the oropharynx.

Effectiveness of an oral health training program for school teachers in India: An interventional study.

INTRODUCTION: Schools are a valuable platform for promoting oral health through oral health education as the children spend most of their active time in schools. Training school teachers on oral health promotion will help to inculcate healthy oral habits in children during their formative years of life. OBJECTIVES: The objective of this study was to assess the knowledge, attitude, approach, and action change of school teachers toward oral health and the impact of this training intervention in improving their knowledge. MATERIALS AND METHODS: An interventional study was conducted among 50 primary school teachers across the country selected by the Ministry of Human Resource Development. A self-administered, 28-item questionnaire in Google document format was developed to evaluate the knowledge and practice of teachers toward oral hygiene before and after the teachers' training program. The training was done using a validated training manual on oral health promotion for school teachers developed by the Ministry of Health and Family Welfare. Needs assessment for training was conducted 1 week before this training program. STATISTICAL ANALYSIS: Wilcoxon signed-rank test and Mc Nemar tests were used to assess the difference between the scores before and after oral health education. RESULTS: The needs assessment revealed that majority of the teachers felt the need to participate in oral health promotion training. A significant increase (P < 0.001) in mean knowledge scores of school teachers was seen after a 1-day training program. CONCLUSION: The training improved the knowledge of school teachers on oral health which indicates that the adopted method of oral health education was well received by the participants from all over the country.

NOVEL USE OF FLUORESCEIN DYE IN DETECTION OF ORAL DYSPLASIA AND ORAL CANCER.

BACKGROUND: India is now regarded as the country with one of the highest incidence of oral cancer in the world. Considering poor survival in cases with late diagnosis, early detection can reduce morbidity and mortality of cancer patients and may impede malignant transformation in cases of oral potentially malignant disorders (OPMD). Most of the diagnostic aids are expensive and not available for mass screenings in developing countries. There is a need to develop a sensitive and affordable technique for screening of oral cancer, which can be accurate even in hands of health care workers with limited experience. Fluorescein dye has been used for tumour detection in colon, stomach, breast and brain. However, its utility in the diagnosis of oral cancer and OPMD has not yet been explored. METHODS: This is the first study to report the role of fluorescein in the detection of oral cancer and OPMD. The present cross sectional study was conducted at a tertiary care dental centre. It included 100 individuals presenting with 42 OPMDs, 40 oral squamous cell carcinoma (OSCC) and 18 controls. RESULTS: The sensitivity and specificity for the fluorescein detection method for OPMDs and OSCC was found to be 96.6% and 52.4% respectively. The positive predictive value was 73.7% and the negative predictive value was 91.7% for the fluorescein method. The likelihood ratios stood at 2.03 for a positive test and 0.066 for a negative test. CONCLUSION: We conclude that fluorescein staining along with blue light is likely to improve detection of early oral cancers and dysplasia and can play a vital role in mass screening programmes of oral cancer.

mOral Health in India: Current Scenario and Future Perspectives.

Oral diseases affect half of the world's population and found to be the most common and preventable noncommunicable diseases worldwide. The World Health Organization Oral Health Programme work plan 2018-2020 is to prevent the burden of oral diseases using digital technology. With 5 billion mobile phone subscribers in the world, covering over 85% of the world's population, the utilization of technology-based interventions for oral health promotion is no different. In India, numerous medical applications such as eRaktkosh and mDiabetes have been developed for the improvement of general health, whereas few initiatives such as mCessation and National Quitline services for oral health have been undertaken. Digitalization and oral health forms a crucial component in the future of oral health, which should be utilized in ensuring oral health for all.

Oral Health Status and Treatment Needs of Government Employees in New Delhi.

Oral diseases, including dental caries, periodontitis, and edentulism (toothlessness), affect about 3.5 billion people worldwide. A cross-sectional study was conducted to assess the oral health status and treatment needs of government employees employed at an organization in New Delhi. Oral health information was recorded using the standard World Health Organization's (WHO) Oral Health Assessment Tool. A total of 476 employees at various levels of administration were screened at their worksite. Dental caries and periodontal disease were present in more than half of the participants. Around 56% had decayed teeth, 20% had missing teeth, and 16% had filled teeth. Bleeding from gums was seen in 71% and periodontitis in 59% of participants. Preventive treatment and oral health promotion was required in at least 41% of the screened individuals. Annual workplace oral examinations may help in decreasing the oral disease burden and create awareness on the oral health among employees.

Building Oral Health Research Capacity in India: Identifying Barriers and Enablers Using Mixed Methods.

Knowledge Transfer Statement: This article will provide a brief overview of the methods in finding barriers and enablers in doing oral health research in India. This mixed-methods approach can be used by researchers in finding barriers and enablers in doing oral health research in other developing countries and building oral health research capacities.

Synergistic Effect of BDNF and FGF2 in Efficient Generation of Functional Dopaminergic Neurons from human Mesenchymal Stem Cells.

To understand the process of neurogenesis, generation of functional dopaminergic (DAergic) neurons from human mesenchymal stem cells (hMSCs) is important. BDNF has been reported to be responsible for inducing neuronal maturation and functionality. Previously, we have reported the efficient generation of neurons from human bone marrow derived MSCs using FGF2 alone. We hypothesize that hMSCs from various tissues [(bone marrow (BM), adipose tissue (AD) and dental pulp (DP)], if treated with BDNF on 9th day of induction, alongwith FGF2 will generate functional DAergic neurons. Hence, cells were characterized at morphometric, transcription and translational levels for various markers like MAP2, TH, NGN2, PITX3, DAT, synaptophysin, Kv4.2 and SCN5A. Functionality of in vitro generated neurons was studied by calcium ion imaging. Result analysis depicted that BDNF has effect on expression of dopaminergic neuronal markers at gene and protein levels and functionality of neurons. Among these hMSCs, DP-MSC showed significantly better neuronal characteristics in terms of morphology, expression of neuronal markers and foremost, functionality of neurons. From the present study, therefore, we concluded that i) BDNF has additive effect on neuronal characteristics and functionality ii) DP-MSC are better MSC candidate to study DAergic neurogenesis and perform future studies.

Consensus and evidence-based Indian initiative on obstructive sleep apnea guidelines 2014 (first edition).

Obstructive sleep apnea (OSA) and obstructive sleep apnea syndrome (OSAS) are subsets of sleep-disordered breathing. Awareness about OSA and its consequences among the general public as well as the majority of primary care physicians across India is poor. This necessitated the development of the Indian initiative on obstructive sleep apnea (INOSA) guidelines under the auspices of Department of Health Research, Ministry of Health and Family Welfare, Government of India. OSA is the occurrence of an average five or more episodes of obstructive respiratory events per hour of sleep with either sleep-related symptoms or co-morbidities or ≥15 such episodes without any sleep-related symptoms or co-morbidities. OSAS is defined as OSA associated with daytime symptoms, most often excessive sleepiness. Patients undergoing routine health check-up with snoring, daytime sleepiness, obesity, hypertension, motor vehicular accidents, and high-risk cases should undergo a comprehensive sleep evaluation. Medical examiners evaluating drivers, air pilots, railway drivers, and heavy machinery workers should be educated about OSA and should comprehensively evaluate applicants for OSA. Those suspected to have OSA on comprehensive sleep evaluation should be referred for a sleep study. Supervised overnight polysomnography is the "gold standard" for evaluation of OSA. Positive airway pressure (PAP) therapy is the mainstay of treatment of OSA. Oral appliances (OA) are indicated for use in patients with mild to moderate OSA who prefer OA to PAP, or who do not respond to PAP or who fail treatment attempts with PAP or behavioral measures. Surgical treatment is recommended in patients who have failed or are intolerant to PAP therapy.

Role of programmed cell death in dental anomalies associated with cleft lip and palate.

A role of programmed cell death (PCD) is proposed in the production of tooth anomalies occurring in association with cleft lip and palate (Cl + P). Dental anomalies are viewed as a microform of cleft lip and palate, produced by different modulations of the same operating mechanism.

Craniofacial pattern of parents of children having cleft lip and/or cleft palate anomaly.

The craniofacial patterns of 38 sets of parents who had children with cleft lip and/or cleft palate anomalies (experimental group) were compared with the 24 sets of parents of healthy (noncleft) children (control group). Using a computerized program, 248 cephalograms (124 lateral and 124 frontal) were digitized and analyzed. The parents in the experimental group exhibited a distinct craniofacial morphology, including a significant decrease in upper anterior facial height (N-Ans) and total anterior face height (V-Gn). Anterior nasal spine (Ans) and maxillary alveolar process (A) were positioned more anteriorly and superiorly in the experimental group, which contributed to a significant increase in the length of the palate (Ans-Pns) and an anterosuperior rotation of the palatal plane. The cranial base angle in the experimental group was significantly obtuse and the articular angle was smaller than that of the controls. The counterclockwise rotation of the mandible was mitigated by a significant increase in the gonial angle. Parents in the experimental group also tended to have faces which were smaller in both transverse and vertical dimensions.