Comparative effectiveness of verbal instruction versus video-based education (VIVid) among family caregivers for improving the quality of life in advanced head and neck cancer patients receiving palliative care in Eastern India: a randomized controlled trial.

PURPOSE: To determine if video-based educational intervention compared to the standard verbal guidelines, provided to caregivers on home-based palliative care could enhance the quality of life (QoL) in advanced head and neck cancer (HNC) patients. METHODS: The study employed a prospective, two-arm parallel-group, randomized controlled trial design. Investigators prepared a real-world demonstrational video of ten minutes duration regarding home-based care for family caregivers, with voice-over in Odia language (Eastern India). The contents of the video addressed the management of common problems in palliative care among HNC patients. This study included 180 participants, 90 patient & caregiver dyads randomized to interventional (video-based education) or control (verbal instruction) groups. Patients' QoL was measured at baseline and 3 weeks follow-up using EORTC QLQ C30. Data were analyzed descriptively, and the Chi-square, Mann-Whitney U, T-test, spearman correlation, and multiple hierarchical regression analyses were employed for statistical analysis, with a significance level of p < 0.05. RESULTS: Seventy participant dyads completed the planned two assessments: baseline and at the end of 3rd week (Intervention = 37; Control = 33). The intervention group showed a significant improvement in the patient's health-related QoL, physical, emotional, and social functioning. Symptom burden reduction was observed for pain, nausea, and fatigue. A significant increase in the change in QoL with the video-based education group (VBE) compared to the verbal instruction (VI) group after adjusting for age, gender, physical functioning, and pain symptomology (adjusted R2 = 0.402) was noted. CONCLUSION: VBE intervention using smart-phone may offer caregivers a viable means of enhancing self-management while improving patients' QoL within the socio-cultural challenges for home-based palliative care in India. Further research on training caregivers using digital interventions and home-based visits is recommended. TRIAL REGISTRATION NUMBER: CTRI/2021/06/034473 [Registered on: 30/06/2021].

Preparedness toward participation in disaster management: An online survey among dental practitioners in a disaster-prone region of Eastern India.

BACKGROUND: Dentists are often overlooked resources in the workforce for disaster management (DM). To determine the knowledge, attitudes, willingness, and self-perceived effectiveness to participate in DM among general dental practitioners (GDPs) of Eastern India. MATERIALS AND METHODS: A web-based online survey was conducted among 256 Dental Council of India registered GDPs of Cuttack district, Odisha. The 45-item survey comprised closed-ended questions on the demographic data of the participants, years of practice, previous experience in DM, and willingness to participate. Other domains assessed were the participants' objective knowledge of DM, attitude, and self-perceived effectiveness toward participation during disasters. Data were analyzed descriptively, and the Chi-square and Mann-Whitney U tests were used for statistical analysis, with a significance threshold of P < 0.05. RESULT: A total of 154 responses were analyzed, giving a response rate of 60.16%. The average age was ≤35 years, 59.1% were BDS dentists and 78.6% had less than 10 years of practice. Only 18% of them had previous experience with DM, and merely 3.2% were formerly trained; however, 95.5% of the dentists were willing to participate in DM. The mean DM knowledge and attitude scores were 16.12 (CI = 15.4-16.8) and 5.79 (5.45-6.13), respectively. Knowledge and attitude showed a significant correlation. About 56% indicated that they would be able to respond effectively to a disastrous event. Significant associations were observed between age group (P = 0.008), years of clinical practice (P = 0.001), qualification (P = 0.012), previous participation (P = 0.029), and self-perceived effectiveness. CONCLUSION: The knowledge regarding DM among respondents was at an average level. However, the majority of them were found to have a positive attitude toward participation in DM. Thus, including DM in dental curricula and drills for dental professionals might prove beneficial as almost all GDPs were showing greater self-perceived effectiveness and willingness to participate in disasters.

Effect of platelet rich fibrin on stability of dental implants: A systematic review and meta-analysis.

Objective: The aim of the study is to provide a systematic review of the potential evidence for the effect of platelet rich fibrin (PRF) on stability of dental implants. Methods: A systematic review was performed based on the Preferred Reporting Items for Systematic review and Meta-analysis. An extensive and comprehensive electronic search was carried out from January 2000 to March 2021, independently by author in PUBMED, Cochrane Central Register of Controlled Trials, Google Scholar, Scopus, Embase, and Web of Science irrespective of publication status, date, or language. For any registered ongoing or completed but unpublished trial, ClinicalTrials.gov, World Health Organization International Clinical Trials Registry Platform, and Cochrane Oral Health's Trials Register websites were searched. Randomized, controlled, and clinical trials which assessed the stability of implant with and without use of PRF using Osstell device by radiofrequency analysis were selected. Results: The electronic and manual search yielded 630 studies. In all the eight included studies implant stability was measured using same ISQ units by Osstell device. Meta-analysis was carried out in six studies that had similar comparisons and reported the same outcomes at same time interval. Random effect models have shown pooled mean difference of 4.49 (95% CI 1.22-7.76) for 1-week post-insertion, 3.65 (95% CI 2.21-5.09) for 4-week post insertion, 3.25 (95% CI 0.03-6.47) for 8-week post-insertion, and 2.79 with 95% CI of 0.48, 5.10 for 12-week post-insertion. Conclusions: The present systematic review suggests that PRF is effective in improving secondary implant stability with certain limitations and displays possible implication for clinical practice.

Prevalence, Trends, and Associated Risk Factors of Traumatic Dental Injury among Children and Adolescents in India: A Systematic Review and Meta-analysis.

AIM AND OBJECTIVE: Traumatic dental injury (TDI) is a significant public health concern. This study aimed to perform a systematic review on the prevalence, trends, and possible risk factors of dental trauma in permanent teeth among children and adolescents in India. MATERIALS AND METHODS: Literature search was carried out, in PubMed, EMBASE, Web of Science, Cochrane, Google scholar, and Gray literature (MDS dissertation, manuscripts) database up to October 5, 2020, reporting on dental trauma prevalence in India. Meta-analyses were done using random effects model. Pooled estimates were calculated with a confidence interval of 95% (95% CI) both for prevalence and odds ratios (OR). Trend analysis was performed for the included studies. Quality assessment of the included studies was done using the Hoy checklist for prevalence studies. Qualitative synthesis was done for predictors in which meta-analysis could not be performed. RESULTS: This online searching strategy collected and listed 2,491 articles on this topic. After evaluating their titles and abstracts, only 59 were finally selected for complete review and data collection. All studies had been performed in children and adolescents. The pooled prevalence of dental trauma in permanent teeth was 11%. Positive summary association of dental trauma with male gender (pooled OR = 1.52; 95% CI: 1.37-1.70), inadequate lip coverage (pooled OR = 4.76; 95% CI: 3.18-7.11), and increased overjet of >3.5mm (pooled OR = 4.84; 95% CI: 2.86-8.19) and >5.5 mm (pooled OR = 4.93; 95% CI: 4.32-5.63) was observed. Prevalence of dental trauma showed an increasing trend with time. All of the studies were having moderate-high risk of bias. CONCLUSION: Approximately 9-13% of the children and adolescents in India presented some type of TDI in permanent teeth, with an increasing trend. Boys, children, and adolescents presenting inadequate lip coverage, or an increased overjet greater than 3.5 and 5.5 mm are more likely to have traumatic dental injuries. CLINICAL SIGNIFICANCE: Future population-based analytical studies on TDI in India are recommended.

Effectiveness of curcumin mouthwash on radiation-induced oral mucositis among head and neck cancer patients: A triple-blind, pilot randomised controlled trial.

INTRODUCTION: Radiation-induced oral mucositis (RIOM) is considered the most severe non-haematological complication affecting almost every head and neck cancer patient during the course of radiotherapy (RT). Curcumin, a herbal agent present in Indian spice 'Turmeric' has anti-inflammatory, immunomodulation and wound healing properties. The objective of this pilot randomised controlled clinical trial was to compare the effectiveness and safety of 0.1% curcumin (freshly prepared using nanoparticles) and 0.15% benzydamine mouthwash on RIOM among 74 head and neck cancer patients scheduled to receive RT. MATERIALS AND METHODS: Assessment of RIOM was carried out using WHO criteria once in a week for 6 weeks. Both modified intention to treat (MIT) and per protocol (PP) analysis were carried out to test the null hypothesis of equal effectiveness on prevention and severity of RIOM. RESULTS: As far as the onset of RIOM is concerned, MIT analysis showed that the instantaneous risk of getting the onset of RIOM was 50% lower (hazard ratio 0.5) in curcumin. Onset of RIOM was also significantly delayed (mean = 19.56, median = 21) in the test group by 2 weeks. But in 'PP' analysis, no significant difference was observed between two preparations and almost all patients experienced the onset. Both the mouthwashes were equally effective in preventing the occurrence of severe form of RIOM in PP analysis after dichotomisation of severity score (≥3 and ≤2). CONCLUSION: Though both the mouthwashes were not able to completely prevent the onset of RIOM and reduce the severity of RIOM, use of 0.1% curcumin mouthwash was able to significantly delay the onset of RIOM (Clinical trial registration no. CTRI/2018/04/013362).

Exploring determinants of care-seeking behaviour of oral cancer patients in India: A qualitative content analysis.

BACKGROUND: A major public health concern in India is the high morbidity and mortality rates of oral cancer because of late diagnosis. Among the several determinants of this late diagnosis, the most important is the healthcare-seeking behaviour of the oral cancer patients. The aim of this study was to explore the care-seeking behaviour and its determinants among oral cancer patients. METHODS: A face-to-face in-depth interview was conducted among 70 oral cancer patients using a semi-structured questionnaire, and qualitative content analysis of the results was performed. RESULTS: All the patients had squamous-cell carcinoma and none had attended any screening programme. The most common site affected was the buccal mucosa with a non-healing wound. Most of the patients contacted a doctor available nearby; only 7% of patients consulted a dentist. Only one patient approached a traditional healer. The median patient delay was 30 (4-365) days and the professional delay was 40 (4-650) days. Enablers included determinants such as increasing symptoms (80%), influence of the society (74%), fear (10%), and social media (3%). The main barriers were lack of awareness (97%), hope that the lesion will heal spontaneously (90%), lack of perception of seriousness (64%), financial constraints (55%), provider switching (47%), and missed diagnosis (44%). CONCLUSION: The care-seeking path among oral cancer patients is complex, customised, and influenced by multiple patient-related and system-related factors.

Knowledge, attitude and practices of institution-based dentists toward nicotine replacement therapy.

BACKGROUND: Dental institutions provide very good platform to educate budding dentists to inculcate the habit of tobacco cessation counseling, including nicotine replacement therapy (NRT). AIMS: The aim of this study is to assess and compare the knowledge, attitude, and practice of institutionally attached postgraduate students and faculty members of the dental profession toward NRT. METHODS: For a cross-sectional survey among 201 participants from four dental colleges in Odisha, India, a 28-item questionnaire was developed, subdivided into four categories: demographic details, assessment of NRT knowledge (21-item), assessment of attitude (5-item), practice (1-item with 4 subgroup questions), and 1-item assessing barriers. STATISTICAL ANALYSIS USED: Data were analyzed using descriptive statistics, Chi-square test, and multiple logistic regression. RESULTS: Only one-third of participants were aware of the dosage, mechanism of action, pharmacology, duration of the prescription, brand name, side effects, contraindications, and availability. Around two-third of participants who claimed to practice NRT, agreed to follow up the patients whom they prescribed NRT. Half of the study participants reported that they do not keep a record of these patients. Around 10% of respondents practicing NRT were confident enough to practice it without facing any problem. Major barriers for practicing NRT was found to be a lack of awareness (54.22%) followed by availability and bitter taste. The total knowledge score was found to be the strongest predictor of practicing NRT in multiple logistic regression. CONCLUSION: Lack of detailed knowledge regarding NRT reduces the chance of practicing inspite of having a positive attitude among institutionally attached dentists.

Assessment of Demirjian's 8-teeth technique of age estimation and Indian-specific formulas in an East Indian population: A cross-sectional study.

BACKGROUND: The age of an individual can be assessed by a plethora of widely available tooth-based techniques, among which radiological methods prevail. The Demirjian's technique of age assessment based on tooth development stages has been extensively investigated in different populations of the world. AIM: The present study is to assess the applicability of Demirjian's modified 8-teeth technique in age estimation of population of East India (Odisha), utilizing Acharya's Indian-specific cubic functions. MATERIALS AND METHODS: One hundred and six pretreatment orthodontic radiographs of patients in an age group of 7-23 years with representation from both genders were assessed for eight left mandibular teeth and scored as per the Demirjian's 9-stage criteria for teeth development stages. Age was calculated on the basis of Acharya's Indian formula. Statistical analysis was performed to compare the estimated and actual age. All data were analyzed using SPSS 20.0 (SPSS Inc., Chicago, Illinois, USA) and MS Excel Package. RESULTS: The results revealed that the mean absolute error (MAE) in age estimation of the entire sample was 1.3 years with 50% of the cases having an error rate within ± 1 year. The MAE in males and females (7-16 years) was 1.8 and 1.5, respectively. Likewise, the MAE in males and females (16.1-23 years) was 1.1 and 1.3, respectively. CONCLUSION: The low error rate in estimating age justifies the application of this modified technique and Acharya's Indian formulas in the present East Indian population.