Trabecular bone microstructure parameters as predictors for chronological age: a systematic review.

Estimating chronological age is crucial in forensic identification. The increased application of medical imaging in age analysis has facilitated the development of new quantitative methods for the macroscopic evaluation of bones. This study aimed to determine the association of age-related changes in the trabecular microstructure with chronological age for age estimation in forensic science through different non-invasive imaging techniques. This systematic review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. An electronic search was performed with PubMed/MEDLINE, Scopus, and Cochrane databases as well as with a Google Scholar search. Qualitative synthesis was performed using the Anatomical Quality Assessment tool. A detailed literature search yielded 3467 articles. A total of 14 articles were ultimately included in the study. A narrative approach was employed to synthesize the data. Microcomputed tomography, high-resolution peripheral quantitative computed tomography, and cone beam computed tomography have been used for the quantitative estimation of age. These imaging techniques aid in identifying the trabecular bone microarchitectural parameters for chronological age estimation. Age-related changes in trabecular bone included a decrease in the bone volume fraction, trabecular number, and connectivity density and an increase in trabecular separation. This study also revealed that morphometric indices vary with age and anatomical site. This study is registered with the International Prospective Register of Systematic Reviews (PROSPERO) with the registration number CDRD42023391873.

Perspectives of smokers, smokeless tobacco users and cessation practitioners in India: A qualitative study.

INTRODUCTION: India is the second largest consumer of tobacco in the world and accounts for 70% of global deaths due to smokeless tobacco (SLT) use. AIM: The aim of this study is to understand the perspectives of tobacco users (smokers and SLT users) and practitioners in India to inform cessation interventions. METHOD: Semi-structured in-depth interviews with tobacco users (smoked and smokeless; n=23), and healthcare practitioners (n=13). Perspectives were triangulated using thematic analysis to examine convergence, divergence and complementarity of findings. RESULTS: We present the results in a socio-ecological framework to highlight reasons for initiation and continuation of tobacco and motives to quit at the individual, interpersonal, occupational, societal and policy levels. SLT is seen as culturally acceptable compared to smoked forms of tobacco. Emotionally framed messages highlighting negative effects of tobacco on loved ones were perceived to be a better motivator than other types of cessation messages. DISCUSSION: Nuanced differences exist between smokers and SLT user perspectives which have implications for cessation programs. Our findings supplement similar studies with other South Asian populations. IMPLICATIONS FOR PRACTICE: Our study provides useful insights to tailor cessation interventions to the type of tobacco consumed in order to enhance their acceptability and effectiveness.

Exploring the perceived sociocultural factors in the initiation of smokeless tobacco among adolescents: a qualitative systematic review protocol.

OBJECTIVE: The objective of the review is to identify and explore the perceived sociocultural factors leading to smokeless tobacco initiation among the adolescent population. INTRODUCTION: Smokeless tobacco use is associated with oral cancer and premalignant lesions. The initiation of smokeless tobacco often occurs in adolescence, with multiple sociocultural factors facilitating the commencement of this habit. An in-depth understanding of the factors influencing smokeless tobacco uptake can assist policymakers and tobacco-control units in establishing global policies and implementing control strategies to prevent adolescents' taking up smokeless tobacco. INCLUSION CRITERIA: This review will consider qualitative studies conducted within the last 20 years on adolescent smokeless tobacco users, focusing on sociocultural factors influencing smokeless tobacco initiation. Studies involving cigarette smoking, other alternative forms of smoking, and any form of tobacco cessation intervention will be excluded. METHODS: A systematic search will be conducted in MEDLINE, Scopus, CINAHL, Embase, PsycINFO, and the Cochrane CENTRAL databases, using a 3-step search process. ProQuest Dissertations and Theses, OAIster, and Google will be searched for unpublished studies. Only studies published from January 2002 until the present and in English will be considered. Study screening, extraction, and critical appraisal will be performed by 2 independent reviewers using the standardized JBI qualitative appraisal and data extraction tools. Data synthesis will involve aggregation of the review findings to generate a set of statements based on similarity of meaning. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42021240588.

Cognizance towards implementation and adherence of Cigarette and other Tobacco Products Act (COTPA) directives - A descriptive cross-sectional study among security guards in Goa.

Objective: The use of tobacco has proven to be one of the leading cause of preventable premature deaths and diseases across the globe. The World Health Organization (WHO) claims that tobacco consumption alone kills more people annually as compared to Acquired Immunodeficiency Syndrome (AIDS), alcohol, and other addictions (drugs, etc.) put together. Although the Cigarettes and Other Tobacco Products Act (COTPA) is a powerful Indian national law to curb the tobacco epidemic, the effectiveness of its implementation remains disputed. The current study aims to examine the role of the security guards in the implementation of the COTPA by assessing their awareness. Method: A cross-sectional questionnaire-based study was conducted among 258 security guards in Goa to ascertain the knowledge regarding the tobacco legislation in the country. A self-administered 20-item close-ended questionnaire was used to collect information regarding the demographic variables, tobacco use, and knowledge regarding COTPA. Data analysis was done using SPSS version 22.0. Results: The mean age of the study participants was 29.93 ± 6.93 years. Overall, 68.6% of the study participants were aware of any tobacco control law in India. It was observed that 71% of the subjects had adequate knowledge of the COTPA. The participants with higher secondary educational levels had significantly higher knowledge scores. Conclusion: The overall awareness of the security guard was good but there is a need to provide in-depth knowledge on certain key aspects of the COTPA. Efforts should be made to train the security personnel to increase their awareness of the act.

Comparative evaluation of color stability of three commercially available provisional restorative materials: An in vitro study.

Aim: Esthetics of the provisional restorations is of prime importance to the patients especially in long term in the esthetic zone. Discolouration of these restorations may result in patient dissatisfaction and an additional expense for their replacement. LuxaCrown provisional material being new in market and claimed to be semi-permanent by the company needs to be evaluated for its colour stability. This in vitro study was aimed to evaluate and compare the colour stability of three provisional restorations using three pigmented solutions. Setting and Design: In vitro - comparative study. Materials and Methods: LuxaCrown, Protemp4, Heat cure PMMA were evaluated. 40 specimens of each material were divided into four groups of ten specimens each. Each group was stored in three staining solutions and artificial saliva. Colour values of each specimen were measured before immersion, after one day, one week, one month, three months and six months with a spectrophotometer. Stastistical Analysis Used: One way ANOVA, Post Hoc Tukey Test, Bonferonni Test. Results: Least colour change was seen in Heat Cure PMMA followed by Protemp4 and highest colour change was seen in LuxaCrown when immersed in artificial saliva, tea and coffee. Whereas in turmeric, Heat Cure PMMA showed the least colour change followed by LuxaCrown and highest colour change was seen in Protemp4 at all time intervals except day one, where LuxaCrown was higher than Protemp4. Conclusion: Heat cure showed the best results as compared to Protemp4 and LuxaCrown in terms of colour stability at all time periods.

A bio-behavioral intervention combining task analysis with skill-based training to train toothbrushing among children with intellectual disability.

AIMS: Individuals with intellectual disability (ID) have special health care needs. Teaching self-care behaviors like toothbrushing helps reduce their dependence on adult caregivers. We present a bio-behavioral intervention combining task analysis with skill-based teaching of toothbrushing behavior aimed to promote autonomy in children with various types of ID. METHODS: One hundred twenty children with ID enrolled at a special school in the State were included in the study. After baseline measurements using task analysis, four methods were used to train the children - instruction, three-phase modeling, physical guidance, and descriptive praise. The caregiver was trained and given instructional videos for reinforcement. After 4 weeks, the children were asked to brush their teeth and performance was evaluated. RESULTS: There was increased independence in the performance of toothbrushing behavior, the mild and moderate ID groups showing the most improvement. Steps like oral manipulation of the toothbrush showed the greatest improvement in these groups. The severe ID group showed improvement in certain skills, while requiring assistance for others that demanded dexterity. CONCLUSION: This intervention can be implemented by special schools and special care dentistry centers to foster autonomy in oral self-care skills in the mild and moderate ID children, and complemented with other methods for severe ID children.

The Covid-19 uncertainty and ethical dilemmas in dental practice.

The Covid-19 pandemic has affected dental practice globally. Proximity with patients and predominance of aerosol-generating procedures has raised concerns regarding the safety of dentists and patients alike. The near-total, yet inevitable, suspension of dental practice has raised several ethical issues.

Efficiency of simplified versus traditional denture fabrication methods: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: Conventional techniques (CTs) for complete denture fabrication involve a series of clinical and laboratory steps. A simplification of this process has been advocated, but whether simplified techniques result in acceptable treatment outcomes is unclear. PURPOSE: The purpose of this systematic review and meta-analysis was to evaluate the efficiency of simplified denture fabrication techniques in comparison with CTs. MATERIAL AND METHODS: The standard methodological procedures prescribed by the Cochrane Collaboration for systematic review and meta-analysis were used. An electronic search (MEDLINE through PubMed, Cochrane trial registry, and Scopus) and a manual search up to February 2020 were made to identify studies. Only randomized controlled trials involving edentulous adults requiring complete denture treatment were included. RESULTS: Nineteen studies met the inclusion criteria. The pooled estimate of the included studies for patient satisfaction at 6 months marginally favored the simplified method of denture fabrication (standardized mean difference=0.02 [95% confidence interval {CI} -0.22 to 0.27]). The pooled estimate of the included studies for clinical time and cost of fabrication favored the simplified method (mean difference=-77.34 [95% CI -122.45 to -32.24] and mean difference=-85.89 [95% CI -170.02 to -1.77] respectively). CONCLUSIONS: Simplified techniques were cost effective and less time consuming than the CT, with no significant difference in patient satisfaction or oral health-related quality of life. The high risk of bias and heterogeneity among studies requires that the results be considered cautiously.

Effect of LASER therapy Vs conventional techniques on clinical and radiographic outcomes of deciduous molar pulpotomy: A systematic review and meta-analysis.

BACKGROUND: To systematically review the effectiveness primary molar pulpotomy based on the clinical and radiographic outcomes using lasers over the conventional therapies. MATERIAL AND METHODS: This systematic review and meta-analysis included Randomized or Quasi-randomized trials comparing LASER with conventional pulpotomy therapies (formocresol, ferric sulphate, MTA or calcium hydroxide) with atleast 6-month follow-up period was included. Risk of bias of included studies was assessed and metanalysis was done using RevMan software. RESULTS: Of the 1383 articles that were searched, only 14 studies were included for qualitative synthesis and 10 for meta- analysis. There was no statistically significant difference in clinical success rate [OR 0.99, 95%CI (0.19,5.22)] or radiographic success rate [OR 0.77, 95%CI (0.31,1.87)] of LASER therapy compared to Formocresol in primary molar pulpotomy for 6 months. No statistically significant difference were found in clinical success rate [OR 1.04, 95%CI (0.35,3.07)] and radiographic success rate [OR 0.71, 95%CI (0.37,1.35)] at 12 month follow-up also. Comparison of LASER with Ferric Sulphate also did not show a statistically significant difference. CONCLUSIONS: Meta-analysis showed no statistically significant difference in clinical and radiographic outcomes of LASER pulpotomy with conventional pulpotomy (formocresol and ferric sulphate) at 6 and 12 months follow-up. However, there was considerable risk of bias in the included studies. Key words:Pulp therapy, Laser, formocresol.

The Ominous beginning" Perceptions of Smokeless Tobacco Initiation among the Paniya Tribes of Wayanad: A qualitative Study.

BACKGROUND: The prevalence of tobacco chewing, and related oral mucosal lesions is alarmingly high amongst the Paniya tribes of Wayanad. A deeper understanding of their socio-cultural factors, beliefs, attitudes and behaviours would shed greater insights into the indiscriminate use of smokeless tobacco and related products in this community. METHODS: Ethnography was the theoretical framework adopted with network and convenience sampling. Fifteen in-depth interviews and two focus group discussions were conducted among the key informants from within the tribal colonies of Cheepram and Madikkunnu. The data was audio recorded and converted into verbatim transcripts. Thematic content analysis was done using an inductive approach performed using computer-assisted qualitative data analysis software (NVivo). RESULTS: This study is suggestive of parental influence and peer pressure as the key factors for smokeless tobacco initiation amongst the adolescent. There was a greater predisposition for women to be chewers of tobacco, particularly after marriage. The key factors influencing initiation of the habit amongst men include peer pressure and availability of tobacco at workplace. The role of contextual factors such as enculturation, marginalization and perceived health benefits also play a substantial role in development of this habit. CONCLUSION: Targeted strategies for effective tobacco control can be developed through an understanding of the socio-cultural factors leading to initiation of smokeless tobacco use among disadvantaged communities.

Intergenerational Transfer of Tobacco Use Behaviour from Parent to Child: A Case Control Study.

BACKGROUND: Parental influence may be a strong modifiable risk factor in the initiation of Tobacco habits among young adults. Parenting style may modify the risk of initiation of Tobacco use. OBJECTIVE: To examine the intergenerational transfer of Tobacco habits amongst the urban and tribal populations in Kerala. METHODOLOGY: A hospital based unmatched case control study was undertaken in urban and tribal health centres in Kerala, India. 239 cases (19-30 years of age using any form of Tobacco, 64.10% males) and 256 controls (35.90% males) were enrolled. Parental Tobacco exposure ascertainment was done by conducting in depth interviews using a validated structured questionnaire, parent bonding instrument and life grid technique. Multiple logistic regressions were performed. RESULTS: The odds of a case initiating the habit of Tobacco use was nearly four times more when the parent was a Tobacco user [adjusted OR 4.26 (95% CI 2.39 - 7.58)] as opposed to controls. Among other covariates examined, low parental bonding with subject (especially father- warmth/care) was a strong risk factor for Tobacco usage [OR 2.17 (95% 1.11 - 4.23)]. The cases had nearly four times the probability of Tobacco uptake compared to controls if the mothers had no formal schooling [adjusted OR of 3.93 (95% CI, 2.12 - 7.26)]. CONCLUSION: Parental use of Tobacco influences the uptake of Tobacco habits in their children, with the father's parenting (low paternal warmth) being a strong risk factor.

Effectiveness of school-based dental screening in increasing dental care utilization: A systematic review and meta-analysis.

BACKGROUND: School based dental screening has been a popular public health intervention. However, literature provides contrasting evidence regarding effectiveness of such programs on the utilization of dental services. OBJECTIVES: We designed this review to understand the differences in dental attendance rates of children below 15 years of age, receiving a school based dental screening versus those not receiving it. MATERIAL AND METHODS: The standard methodological procedures prescribed by The Cochrane Collaboration for Systematic review and meta-analysis was employed. An electronic (MEDLINE via PUBMED, Cochrane trial registry, and Google scholar) and a manual search (2016) were made to identify studies. RESULTS: Five studies met the inclusion criteria, covering a population of 28208 school children of which 21447 were included in the meta-analysis. The review concludes that school based dental screening marginally increases the dental attendance by 16 percent as opposed to a non-screening group (RR 1.16 (95% CI 1.11, 1.21). The quality of evidence was found to be low. CONCLUSIONS: There is evidence of marginally increased dental attendance rate of 16 % following screening. As the quality of evidence was found to be low, the results of this review may be used with caution.

Comparison of Plaque Removal Efficacy of Tooth Powder and Toothpaste in Young Adults in India: A Randomized Controlled Clinical Trial.

OBJECTIVE: A clinical equipoise exists between the plaque reducing efficacies of two of the most commonly used dentifrices in India. This study compared the plaque removal efficacy of a commercially available tooth powder with commercially available toothpaste in young adults. METHODS: This was an investigator-blinded randomized controlled clinical trial with crossover design conducted among 89 young adults aged 18 to 25 years. Interventions were a commercially available tooth powder and toothpaste. Plaque scores were measured at baseline, after 24 hours and seven days. RESULTS: At baseline, the mean plaque scores were 0.97 ± 0.30 and 0.93 ± 0.34 for the toothpaste and tooth powder groups, respectively. After 24 hours without any oral hygiene activity, the scores increased to 2.41 ± 0.54 and 2.42 ± 0.52, respectively. After seven days of using the intervention, the mean plaque scores were 2.12 ± 0.53 in the toothpaste group and 2.11 ± 0.56 in the tooth powder group. There was no signifi cant difference between the groups at baseline and follow-up visits. Within each group, there was a signifi cant difference in the plaque scores between the follow-up visits. CONCLUSIONS: The present study suggests comparable plaque removal efficacy of tooth powders and toothpastes.

Political priority of oral health in India: analysis of the reasons for neglect.

OBJECTIVES: To examine the political priority of oral health in India and to understand the underlying reasons for the political support oral health receives. METHODS: The analysis is based on the political power framework developed by Shiffman and Smith and modified by Benzian et al. to examine the factors that contribute to the political priority of oral health in India. The framework comprises four main analysis categories, further subdivided into 11 dimensions. Based on the set of criteria, each dimension was analyzed and rated by assigning a score to assess to what extend the criteria were met. RESULTS: There is a good understanding on what defines an oral health problem, however, there is no consolidated and comprehensive approach to address oral diseases. Despite India's efforts to improve oral health-related research, its poor utilization in terms of public health and population-based approaches is apparent. The absence of a national surveillance system for oral health masks the severity and extent of the oral disease burden and limits the basis for advocacy on improving oral health to health decision makers. The fragmentation of actors and institutions and the absence of leaders uniting various actors in oral public health impede changes toward improving the oral health status of the population. CONCLUSIONS: Limited accessibility to oral health care, poor portrayals of the severity and extent of the burden, and inertia to address-related challenges are important factors contributing to the low political priority of oral health.