Vaccine a promising immunotherapy option for head and neck cancer patients.

Head and neck cancer (HNC) is a diversified group of tumors arising from the upper aerodigestive tract, encompassing the oral cavity, larynx, and pharynx. Globally, this particular cancer ranks sixth in prevalence, resulting in an annual mortality rate above 325,000 individuals. Surgery, radiation, and chemotherapy are the primary therapeutic options for HNC, which are frequently used in combination. Despite their extensive use, these treatments are typically unsuccessful and can significantly impair patient quality of life. Therapeutic vaccinations are administered to cancer patients instead of preventative immunizations administered to a healthy population. The efficacy of this modality has considerably transformed the application and success of cancer management by providing an additional and effective therapeutic option for patients. Cancer treatment has been revolutionized by introducing Immune Checkpoint receptors inhibitors (ICR), such as anti-CTLA4, anti-PD-1, and anti-PD-L1.3. ICR have also established immunity against self-generated cancerous cells. Cancer vaccines have shown extraordinary synergistic potential with checkpoint inhibitors to maximize tumor-specific CD8+ expansion and activity, which detects and destroys tumor cells. Personalized neoantigen vaccination therapies can potentially combat the heterogeneity of each patient's tumor. The findings of this review suggest that recent advances in cancer immunology and genetics imply that cancer vaccination can be a promising alternative treatment for head and neck cancer patients. This review conducted a comprehensive literature search to identify relevant studies on immunotherapy options for head and neck cancer patients. The search strategy was designed to capture a wide range of peer-reviewed articles, conference proceedings, and grey literature from 2013 to 2023. The databases searched to ensure comprehensive coverage of the literature included PubMed, Web of Science, and Google Scholar; to include grey literature and articles not indexed in traditional databases.

Malignant transformation in oral submucous fibrosis: Tertiary level evidence: An umbrella review.

OBJECTIVES: An umbrella review is a systematic review of systematic reviews, which provides a tertiary level of evidence. This umbrella review of systematic reviews and meta-analysis (SR-MA) aimed to determine the proportion of oral cancer (OC) development in oral submucous fibrosis (OSF) patients. MATERIALS AND METHODS: We searched electronic databases including PubMed, Scopus, Web of Science, Cochrane and grey literature. Two reviewers independently screened abstracts and assessed for eligible papers. The methodological quality of SR-MA was evaluated using AMSTAR2, and we also checked the quality of evidence of the included papers. RESULTS: Out of 454 papers identified in the primary search, 105 underwent eligibility screening. Inclusion criteria were met by four SR-MA. OC ratios ranged between 4.2% and 6% for OSF. Substantial heterogeneity was observed for this outcome in all four MA (I2 = 71.31% to 86.37%). None of the SRs assessed the quality of evidence, and half of them were judged to be of critically low methodological quality. CONCLUSION: There is lack of quality of evidences and critically low methodological quality among SRs and MA leading to substantial heterogeneity. However, due to potentially malignant nature, OSF patients should be monitored carefully for early detection of OC.

Recurrence of Invasive Cervical Resorption after six years of Nonsurgical and Surgical management by Bioceramic-Material.

Invasive cervical resorption (ICR) is a phenomenon of unknown etiology that results in the loss of hard dental tissue. To have a successful outcome for a tooth affected by ICR, correct diagnosis and management are needed. With the introduction of new biocompatible materials and the advancement of CBCT imaging, these pathologies can be identified and treated with precision, resulting in promising outcomes. This case report aims to present the management of maxillary central incisors diagnosed with external ICR, treated with bioceramic root repair material, and followed-up to six years.

Detection and Management of Giant Submandibular Gland Sialolith.

Sialolithiasis is a disease process involving the formation of conglomerates of calcifications in the ductal system or the parenchyma of the salivary gland. The Submandibular gland is more vulnerable to form sialoliths than the other major salivary glands due to its salivary composition and anatomic factors. The management of sialolithiasis is determined by the dimensions and position of the calculi. Here, we discuss a case of a twenty eight mm submandibular sialolith managed by an intraoral approach.

Knowledge towards COVID-19 among healthcare students in the central region of Saudi Arabia: a cross-sectional observational study.

STUDY PURPOSE: Coronavirus disease 2019 (COVID-19) is an infectious illness of high public concern. Healthcare students are directly or indirectly exposed to this disease. This study aimed to evaluate the knowledge of healthcare students in the central region of Saudi Arabia. STUDY DESIGN: A cross-sectional survey was planned to collect information from healthcare students living in the central region of Saudi Arabia. A questionnaire was formulated to evaluate the healthcare student's knowledge towards COVID-19 pandemic. The collected data were analysed by using frequencies of correct knowledge answers. RESULTS: A total of 612 students were analysed for the study. The overall knowledge score of healthcare students was 65.7%. The regression analysis showed a significant association between academic year and knowledge score p<0.001. CONCLUSIONS: Our analysis demonstrates satisfactory student's knowledge but lacks awareness about background and mode of transmission of this disease; therefore, there is a strong need for further education and training programmes.

Sociodemographic Characteristics as Predictors of Satisfaction in Public and Private Dental Clinics.

OBJECTIVE: This study aimed to investigate influence of multiple sociodemographic characteristics on the patient satisfaction levels in outpatient public and private dental practices of Riyadh, Saudi Arabia. METHODS: Questionnaire-based survey data were collected from 500 patients, 250 each from the public and private dental clinics of Riyadh, Saudi Arabia from September to December, 2017. Questions related to demographic factors and service attributes were included. A Likert scale of 5-points was used to measure satisfaction levels. Data was analyzed to calculate the descriptive and inferential statistics (analysis of variance and multiple regression analysis) to find the statistical difference (p < 0.01). RESULTS: Satisfaction level differed significantly by education level (P< 0.001) and the type of clinic (P<0.001). The multiple regression analysis suggest that all variables influenced satisfaction, except age and marital status. The satisfaction score was higher by 27% for private clinics compared to public clinics. CONCLUSION: This study was exploratory and revealed an effect of individual variables on overall satisfaction score of the services attributes. Future plans for patient care could be developed with the help of this research.

Impact of network aided platforms as educational tools on academic performance and attitude of pharmacology students.

OBJECTIVE: This cross-sectional study aimed to examine the impact of learning management system and WhatsApp application as educational tools on students' academic achievement and attitude. METHODS: The sample population was the students of six medical colleges of Riyadh, Saudi Arabia attending Medical Pharmacology's semester course in Bachelor of Medicine, Bachelor of Surgery (MBBS) program from September 2016 to January 2017. An exploratory approach was adopted based on a comparison between students exposed to only in-class lectures (Group-N), in-class lectures together with WhatsApp platform to disseminate the lecture slides (Group-W) and students group with in-class lectures facility blended with Learning Management System (LMS) and WhatsApp platform (Group-WL). The students' grades were assessed using unified multiple choice questions at the end of the semester. Data were analyzed using descriptive statistics and Pearson correlation (p<0.01). RESULTS: Using learning management system (LMS) and/or WhatsApp messenger tool showed a significant positive correlation in improving students' grades. Additionally, use of WhatsApp enhances students' in-class attendance though statistically insignificant. CONCLUSION: The results are pivotal for a paradigm shift of in-class lectures and discussion to mobile learning (M-learning). M-learning through WhatsApp may be as an alternative, innovative, and collaborative tool in achieving the required goals in medical education.

Influence of mouth rinses on the surface hardness of dental resin nano-composite.

OBJECTIVE: The aim of this research was to assess the effect of mouth rinses with and without alcohol on the hardness of dental nano-filled composite. METHODS: The micro-hardness of fifty circular disk shaped specimens of 7 mm x 2 mm were measured after 14 days. Specimens were immersed into alcohol containing (Listerine and Colgate Perioguard) and alcohol-free (Prodent and Sensodyne Oral antiseptic) mouth rinse solutions. Artificial saliva served as the control. Vickers Micro-hardness was measured with a 30gram load for 30 seconds dwell time by using a diamond indenter. Significant differences were represented by p<0.05, whereas highly significant difference represented by p<0.01. The level of significance (p) was calculated with the help of repeated measure ANOVA. For multiple comparisons, Tukey's multiple comparison test was used. RESULTS: Statistical analysis revealed highly significant difference between specimens immersed in artificial saliva (control) and Listerine (p<0.01). Whereas significant difference were observed between control and Colgate Periogard (p<0.05). However, no significant difference was observed on comparing Prodent and Sensodyne Oral antiseptic mouth rinses with control group(p>0.05). Control specimens depicted highest value of micro-hardness(60.5746 ± 3.2703) compared to the lowest value seen in specimens immersed in Listerine solvent(54.4687 ± 1.0937). CONCLUSION: Alcohol containing mouth rinsing solutions have more deleterious effect on hardness of nano composites as compared to alcohol-free mouth rinses.

Prevalence of oral mucosal alterations in type 2 diabetes mellitus patients attending a diabetic center.

OBJECTIVE: To explore an association between oral mucosal alterations and type 2 Diabetes mellitus. METHODS: This study was conducted at Baqai Institute of Diabetology and Endocrinology and Baqai Medical University from September 2010 to September 2012. A total of 800 individuals' 395 type 2 diabetes mellitus patients and 405 healthy individuals were enrolled in this study. An oral clinical examination was carried out for all participants using a mouth mirror, visible light source and cotton gauze. RESULTS: The prevalence of oral mucosal lesions was high significantly < 0.0001; odd ratio 2.601, CI 1.929-3.509 in type 2 diabetic as compared to non-diabetic. With respect to specific oral mucosal lesions, highly significant association p<0.0001; Odd ratio 4.275, CI 2.798-6.534 was found between coated tongue with type 2 diabetes mellitus. This study did not find any association (p>0.05) between type 2 diabetes mellitus and potentially malignant disorders. CONCLUSION: This study showed that the prevalence of oral mucosal lesions was higher in type 2 diabetic than non-diabetics. This study provides evidence that diabetes has a negative influence on oral health.

Knowledge of Dental Students and Practitioners About Medication-Related Osteonecrosis of the Jaw in the Central Region of Saudi Arabia.

BACKGROUND: Bisphosphonates (BPs) are often used in treating benign and malignant disorders. Medication-related osteonecrosis of the jaw (MRONJ) is a significant problem that arises from the long-term use of BPs. OBJECTIVE: In this study, we assessed the knowledge of students and dentists about MRONJ in the central region of Saudi Arabia. METHODS: A cross-sectional study was conducted to collect information from dental students and practitioners from the central region of Saudi Arabia. A valid, reliable, and structured questionnaire was used to gather data using a non-probability convenient sampling technique. IBM SPSS Statistics for Windows, Version 22.0 (Released 2013; IBM Corp., Armonk, New York, United States) was used to analyse the data. The descriptive data were expressed as frequencies and percentages to evaluate the association between dentists and students concerning overall knowledge related to osteonecrosis of the jaw, and a chi-squared test was applied. RESULTS: In total, 250 individuals completed the questionnaire. The general knowledge of antiresorptive/antiangiogenic medications showed that most dentists (87.5%) and students (68.4%) knew about BP medications. A general lack of understanding about the therapeutic uses of antiangiogenic and antiresorptive medications was demonstrated by the participants. A significant proportion of dentists (58.8%) and students (50.9%) were not convinced that invasive dental procedures can be safely performed on patients receiving intravenous BP therapy. A significant proportion of the participants in the sample were unclear of the principal diseases that antiresorptive and antiangiogenic medications target. A mere 22% of respondents were aware of the accurate definition of medications-related MRONJ. CONCLUSION: There is insufficient knowledge about MRONJ among students and practitioners. Therefore, these findings suggest increased emphasis should be placed on educating dentists and students about this condition to ensure patients receive the best possible care.

Gingival Biotypes and its Relation to Biologic Width, Alveolar Bone Thickness, Dehiscence and Fenestration in Mandibular Anterior Region: A CBCT Analysis Study.

Background: Gingival biotype and its relationship to biologic width and alveolar bone thickness may affect surgical periodontal therapy outcomes. Hence, it is vital to assess the gingival biotype prior to any of these treatments for its success. Aim: The study aims to compare the thick and thin gingival biotype in the mandibular anterior region concerning biologic width, buccal bone thickness, prevalence and distribution of dehiscence, and fenestration in lower anterior teeth. Materials and Methods: A total of 30 patients were selected for the study based on the inclusion and exclusion criteria. The Cone Beam Computed Tomography analysis was performed in the mandibular anterior area to assess gingival thickness (biotype), biologic width, buccal bone thickness, dehiscence, and fenestrations. The data were analyzed using SPSS version 26. An independent t-test was used to assess the relationship between the variables. Results: Our study identified an increased biologic width in the thick gingival biotype, a higher frequency of dehiscence in the thin gingival biotype than in the thick biotype, and a greater mean alveolar bone thickness in the thick biotype group. Conclusion: A statistical difference was not observed between the groups; however, the thick biotype showed better results than the thinner biotype for the periodontal parameters examined.

Mechanical and antibacterial efficacy of photo-sonodynamic therapy via methylene blue-loaded nanoparticles over dental implants for treating peri-implantitis.

AIM: This study aimed to evaluate the mechanical (i.e., flexural modulus [FM], flexural strength [FS], and surface roughness [Ra]) and antibacterial efficacy of photo-sonodynamic therapy via methylene blue-loaded poly(D,L-lactide-co-glycolide) nanoparticles (MB-loaded PLGA NPs) over dental implants for potential treatment of peri-implantitis. METHODS: PLGA NPs were synthesized via a solvent displacement method. After the synthesis and confirmation of MB-loaded PLGA NPs via physical (Scanning Electron Microscope [SEM]) and chemical characterization (Fourier transform infrared spectroscopy [FTIR]), the mature dental biofilm of Porphyromonas gingivalis was produced over the surfaces of dental implants. Then, the bacterial viability assessment of the following five study groups was performed: group-I (diode laser treatment); group-II (PDT/MB-loaded PLGA NPs treatment; group-III (ultrasound treatment); group-IV (ultrasound/PLGA NPs-MB treatment); and group-V: control group included the samples without any treatment. Finally, the FS, FM, and Ra of the samples was assessed. RESULTS: Under the SEM, the NPs were spherical homogeneous particles having round morphology ranging approximately 100 nm in size without aggregation. The FTIR spectra of PLGA NPs and MB-loaded PLGA NPs demonstrated absorption peaks at approximately 1000 cm-1 to 1200 cm-1 and around 1500 cm-1 to 1750 cm-1. The greatest level of P. gingivalis killing was exhibited by ultrasound/MB-loaded PLGA-NPs-treated samples. The FS was statistically significantly greater for control group samples than any other group (i.e., 100.28 MPa; p<0.05). The FM and Ra ranged between 3.31 and 3.58 GPa and between 0.18 and 0.20 µm without any statistically significant difference between the control and experimental groups (p>0.05), respectively. CONCLUSION: Within the limitations of this study, the application of photo-sonodynamic therapy via MB-loaded PLGA NPs demonstrated the greatest antibacterial activity against P. gingivalis without deteriorating the surfaces and compromising the mechanical properties of dental implants.

Effect of the COVID-19 pandemic on dental interns in Saudi Arabia.

BACKGROUND: The coronavirus disease (COVID-19) has emerged as a global pandemic recognized by the World Health Organization. It has a significant impact on Saudi Arabia's educational process, resulting in several universities suspending on-campus teaching, exams, and training. OBJECTIVE: The study aimed to evaluate the effect of COVID-19 on dental students' examination, internship placement, and subsequent impact on preparedness and confidence. METHODS: A cross-sectional study was conducted to gather data from dental interns in Saudi Arabia using a pre-tested online questionnaire. Convenient sampling was applied to collect data from 5th September to 15th September 2020. Data were analyzed using SPSS version 23. Descriptive data were presented as frequency and percentages. The Chi-square test was used to evaluate the relationship between variables. RESULTS: Data of 409 dental interns from 8 dental schools reported that 209 (51%) participants' exams were affected as the format was changed to online examination. 130 (31.8%) dental interns strongly agreed that assistance in hospitals during the outbreak of COVID-19 would complement their learning opportunities. Whereas 115(28.1%) respondents strongly agreed that dental schools' measures to modify their curriculum were necessary.The impact of COVID-19 on dental intern preparedness discovered that the affected exams had a significant effect on final year students' readiness to begin the internship (p = 0.042). Considering students' confidence in starting the training earlier than expected, the student course had a statistically significant impact on their confidence (p = 0.002). CONCLUSION: The current study demonstrates that COVID-19 had disrupted dental interns' preparedness towards clinical rotation and decreased their confidence performing in the clinical setup. Due to being unprepared and having low confidence, most dental interns were not ready to start working in the hospital on time.

COVID-19: Fear and Anxiety among Healthcare Workers in Saudi Arabia. A Cross-Sectional Study.

The novel coronavirus (COVID-19) is an extremely contagious respiratory disease. It poses a serious threat to healthcare workers which may cause substantial degree of psychological distress. This study aimed to evaluate the level of fear and anxiety among healthcare workers. A cross sectional study was designed to collect data from healthcare workers in Saudi Arabia using an online questionnaire. A non-probability convenient sampling technique was used to collect the data from 1st August to 10th August 2020 with the exclusion of non-healthcare worker and general public. A 5-point Likert scale was used to evaluate the level of fear and anxiety. The data was analyzed by using Spss version 23 .The descriptive data were represented as frequencies and percentage. Multinomial logistic regression analysis was applied to control the confounding factors and assess the relationship between variables. Data analyzed 737 participants revealed that 10.7%, 73.5%, and 15.7% of HCWs had a mild, moderate, and severe degree of fear and anxiety respectively. The multinomial logistic regression analysis revealed that gender and specialty of the participants were significantly associated with moderate and severe anxiety level. This study demonstrates that two-third of the healthcare workers had a moderate risk of fear and anxiety. However, females participants found to have elevated fear and anxiety level. Social distancing has a major impact on social well-being therefore its important to address social support through a policy. Further studies are needed to explore the mental health condition of healthcare workers in order to develop evidence based strategies.

Dental health care providers' concerns, perceived impact, and preparedness during the COVID-19 pandemic in Saudi Arabia.

BACKGROUND: Dental health care providers (DHCPs)are at high risk of cross-infection during clinical practice therefore, the aim of the study was to evaluate the DHCPs Covid-19 related concerns, its perceived impact, and their preparedness in Saudi Arabia. METHODS: This cross-sectional study on DHCPs was carried out at five dental teaching hospitals/colleges in four provinces of Saudi Arabia from October to December 2020. A 35-item valid and reliable questionnaire was used to assess the concerns, perceived impact, and preparedness of DHCPs in the COVID-19 pandemic. Chi-square tests and logistic regression were used to compare parameters between the clinical and non-clinical staff. RESULTS: A total of 320 DHCPs participated in this study with proportion of clinical staff (57.5%) surpassing the non-clinical staff (42.5%). The clinical DHCPs felt greater odds of falling ill with COVID-19 than non-clinical workers (OR, 2.61) and willing to look for another job (OR, 3.50). The higher proportion in both groups was worried that people close to them would be at higher exposure risk (96.3%) however, slightly more clinical DHCPs were concerned for their children than a non-clinical worker (OR, 3.57). The clinical DHCPs have greater odds of worrying that people would avoid them and their family members because of their job (OR, 2.75). A higher proportion in both groups (75.0%, 63.2%) felt that they would feel stress at work. More non-clinical DHCPs (94.1%) had received training for infection control than clinical (94.1% vs 63.0%: OR 0.10). Similarly, more DHCPs in the nonclinical group received adequate personal protective equipment training (88.2%; OR, 0.48). Most participants practiced self-preparation such as buying masks and disinfection (94.4%, 96.9%). CONCLUSION: The majority of DHCPs felt concerned about their risk of exposure and falling ill from infection and infecting friends/family. These concerns could potentially affect the working of DHCPs during this pandemic. Measures to improve protection for DHCPs, minimize psychological implications, and potential social stigmatization should be identified at the planning phase before any pandemic.

Evaluating CagA and VacA Oncoproteins of Helicobacter pylori in Oral Potentially Malignant Disorders.

Oral Potentially Malignant Disorders such as leukoplakia, lichenplanus, Oral Submucous Fibrosis are most commonly encountered precancerous lesions in India. Although, usage of smoking tobacco has been decreased yet incidence of oral cancer seems to be in increasing trend. Apart from tobacco many non-tobacco causes are associated with the disease. Helicobacter pylori is a curved, flagellated bacterium that has been declared as group I carcinogen by WHO. They are proven causative agent for gastric carcinoma. They have been shown to harbour oral cavity by many authours. They produce onco-protein that causes DNA damage. CagA and VacA are such proteins that modulate certain oncogenes and tumour suppressor genes. In this study we have identified the organism from sub gingival plaque by PCR and those who harboured the organism were further subjected for identification of oncoproteins CagA and VacA by ELISA. This study shows that presence of organism in Oral leucoplakia, oral lichenplanus and Oral Submucous Fibrosis are statistically significant in comparison to control group (p>0.05). The presence of oncoproteins was also statistically significant in comparison to control group. These proteins are shown to accelerate inflammatory pathway thereby hasten the process of tumorigenesis. H.pylori infection as well the virulent strains can be diagnosed from oral cavity in the most non-invasive way at the earliest.