Heterogeneity of outcome measures in the clinical trials of treatment for oral submucous fibrosis-Systematic review.

OBJECTIVE: This systematic review was performed to evaluate the range of outcome measures used in interventional trials for oral submucous fibrosis (OSF). MATERIALS AND METHODS: PubMed, Scopus, and Cochrane databases were searched to identify randomized controlled trials (RCTs) published from 2004 to 2018 about OSF treatment. All the outcome measures and measurement methods mentioned in the trials were extracted and analyzed. RESULTS: Out of 120 published papers, 12 RCTs that met the inclusion criteria were included. A total of 38 single outcome measures and 29 composite outcome measures were considered under four different outcome domains, of which clinical symptoms and clinical response were the most commonly used. The linear measurement of mouth opening (11 trials; 91.66%) and Visual Analogue Scale (10 trials, 83.33%) were the predominant measurement methods. CONCLUSIONS: This systematic review highlights the high heterogeneity in outcome measures in therapeutic RCTs of OSF. This lack of widely agreed standard outcome measures in OSF is a great concern as it prevents the comparison of studies and meta-analyses to gather evidence. There is a dire need of establishing a core outcome set for reporting in the future clinical trials that may help facilitate treatment choice for OSF to improve life quality of patients.

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.

A bibliometric analysis of the 100 most cited articles on early childhood caries.

BACKGROUND: Bibliometric analysis aids to quantify the research prolificacy. The citation count acquired by a scientific article is one of the measures of its influence within a field. AIM: To employ bibliometrics to offer a quantitative-qualitative analysis of publications on early childhood caries (ECC) published between 1950 and 2019. DESIGN: Two researchers independently read all the titles and abstracts of articles retrieved from Scopus database on 16 October 2019. The articles were categorized according to citation and study characteristics. Collaboration network amongst authors, countries, and keywords were generated using VOSviewer software. RESULTS: Amongst a total of 10 578 articles published on ECC, 100 most cited articles were sorted. The top-cited articles appeared in 34 journals, with Community Dentistry and Oral Epidemiology journal (n = 18) contributing maximum number of articles. The papers originated from 25 countries, with the United States (n = 54) accounting for largest number. Amid the papers with high levels of evidence, 11 were systematic reviews and 8 were randomized clinical trials. The topic most commonly addressed was aetiology/associated factors (63%). Amongst a total of 990 keywords, 'dental caries' appeared 89 times. CONCLUSION: The findings of this paper will help researchers, academicians, and students for appropriate article referrals for evidence-based clinical decision-making.

Angiotensin-converting Enzyme 2 Specific Cell Subset Identification in Oral Tissues: A Need of the Hour in COVID-19 Research.

It is well known that angiotensin-converting enzyme 2 (ACE2) is an important host factor responsible for the attachment of severe acute respiratory syndrome coronavirus clad 2 (SARS-CoV-2). ACE2 has been predominantly reported to be present in lungs and nasal mucosa, which is the most common site for the initiation of COVID-19.1 Apart from lungs, ACE2 is also expressed in heart, blood vessels, kidneys, brain, intestines, etc.2 Recently various locations of the oral cavity have been found to be associated with differential expression of ACE2 protein, with the tongue being the most common site.3 Moreover, the salivary glands have also been regarded as a potential source of SARS-CoV-2 infection due to the presence of the ACE2 receptor.4 However, till date there is no strong scientific evidence that has proved the existence and interaction of ACE2 protein and spike receptor of SARS-CoV-2 on oral mucosal and salivary gland epithelial cells.

Transverse Ridge of Premolars and Oblique Ridge of Maxillary Molars are in Divine Golden Ratio.

AIMS: In premolars and molars, transverse ridge (TR) and oblique ridge (OR) play major roles in providing strength and stability to the cusps in particular and tooth as a whole. Hence, they could be divided at the central groove or the transverse groove in a divine golden ratio. MATERIALS AND METHODS: Twenty pairs of maxillary and mandibular casts were retrieved from the Department of Orthodontics. The lengths of buccal triangular ridge (BTR), lingual triangular ridge (LTR) and TR of maxillary and mandibular first and second premolars were measured. Similarly, lengths of distal cuspal ridge of mesiopalatal cusp, triangular ridge of distobuccal cusp (DBTR) and OR of the maxillary first and second molars were measured using a brass wire and a Vernier caliper. The TR:BTR, BTR:LTR, OR:distal ridge of mesiopalatal cusp (MPDR), and MPDR:DBTR ratios were calculated to find out the possibility of golden ratio. RESULTS: Transverse ridges of the premolars and OR of the maxillary first and second molars were divided at the central groove in a divine golden ratio. The mean TR/BTR ratio for maxillary first premolar was 1.61 ± 0.007, whereas the mean BTR/LTR ratio was 1.63 ± 0.02. The mean TR/BTR ratio for maxillary second premolar was 1.61 ± 0.01, whereas the mean BTR/LTR ratio was 1.62 ± 0.04. The TR/BTR and BTR/LTR ratios for mandibular first premolar were 1.6 ± 0.008 and 1.64 ± 0.02, respectively. Similarly, the mean TR/BTR ratio for mandibular second premolar was 1.61 ± 0.01, whereas the mean BTR/LTR ratio was 1.63 ± 0.02. CONCLUSION: The ORs of maxillary first molar ridge and TR of maxillary and mandibular premolars are divided into two parts at transverse and central grooves, respectively, in a divine ratio. CLINICAL RELEVANCE: The ORs of maxillary first molar ridge and TR of maxillary and mandibular premolars are divided into two parts at transverse and central grooves, respectively, in a divine ratio. This signifies the strength and stability of the occlusal table in the posterior teeth, as the golden ratio is the mark of functional excellence. Golden ratio should be taken into consideration while restoration or fabrication of the posterior teeth.

Impact of socioeconomic inequalities on quality of life in oral submucous fibrosis patients.

AIM: The purpose of this study was to analyze the impact of socioeconomic characteristics on oral health-related quality of life (OHRQoL) in patients with oral submucous fibrosis (OSF). METHODS:  A total of 300 OSF patients' quality of life (QoL) data were obtained using OHRQoL-OSF and global self ratings of oral health and overall wellbeing. The socioeconomic status (SES) of participants was analyzed by using modified Kuppuswamy scale. RESULTS: OSF patients with lower SES had worse OHRQoL as compared with those with middle and upper SES (p < 0.001). The household income of the family was found to be strongly associated with poor OHRQoL. CONCLUSION: Socioeconomic characteristics should be considered in the holistic management of OSF as it has been strongly associated with the OHRQoL of these patients.

Comparison of generic and condition-specific oral health-related quality of life instruments in patients with oral submucous fibrosis.

PURPOSE: With the growing interest in health economics, there is a demand for best valid instrument to assess quality of life (QoL) in patients with oral submucous fibrosis (OSF). The objective of this study was to compare the convergent and discriminative properties of the condition-specific OHRQoL-OSF and generic OHIP-14 in OSF patients. METHODS: The OHRQoL-OSF and OHIP-14 instruments were administered concurrently to 300 clinically diagnosed OSF patients. Analysis of both the instruments was carried out by using descriptive statistics. The internal consistency and reproducibility of the instruments were assessed using Cronbach's alpha and intra-class correlation coefficient respectively. The convergent and discriminative validity were then determined and compared. RESULTS: The OHRQoL-OSF and OHIP-14 exhibited good psychometric properties for internal consistency (Cronbach's alpha > 0.88) and reproducibility (ICC > 0.85). A positive associations were observed between both the instruments, but a high prevalence of patients with no impact was noted using the OHIP-14. Both the instruments were able to discriminate between patients with different clinical stages of OSF, but OHRQoL-OSF was more responsive in the early stages of OSF. The OHRQoL-OSF demonstrated greater sensitivity for 'discomfort and functional impairment'. CONCLUSIONS: The condition-specific OHRQoL-OSF identified OSF patients with impaired oral health-related QoL more easily with greater discriminative properties. To better understand patient reported experiences in OSF, these results may guide the choice of instrument in future researches and surveys.

Similarity Index Analysis of the Manuscript: A Viewpoint.

Fabrication, falsification, and plagiarism have been considered the major academic/scientific misconduct in writing the research.1 In recent decades, plagiarism detection has become relatively easy with the evolution of newer software.2,3 Undoubtedly, many scientific journals evaluate the received manuscripts for plagiarism/similarity index and strictly refuse to consider manuscripts with higher similarity index for further publication process. In addition, if plagiarism is reported in the published articles, authors may pose various academic, professional, and legal consequences. This is definitely fruitful in producing originality of the articles with newer ideas/concepts in research design.

A Critical Appraisal on the "Level-of-evidence" Classification Systems.

Evidence-based medicine is about analyzing the evidence and then utilizing the same analysis in making clinical decisions. The key element of evidence-based medicine is the hierarchical system of categorizing evidence. This hierarchy is known as the "levels of evidence".1 Clinicians use this classification to identify the highest level of evidence to answer clinical questions. Various types of research studies answer the different kinds of clinical questions.1.

Histomorphological Evidence of Cellular Cannibalism in Ameloblastoma.

AIM: To study the cellular cannibalism (CC) in the tumor cells of ameloblastoma. MATERIALS AND METHODS: Hematoxylin and eosin (HE)-stained sections of ameloblastoma cases (50) were retrieved from the archived specimens and screened for cellular cannibalism (CC) by stellate reticulum-like cells. Further characterization of CC was performed using CD68 and lysozyme antibodies. RESULTS: CC was observed in 15 (30%) cases [follicular 10 (66.66%), unicystic 3 (20%), and acanthomatous 2 (13.33%)]. In acanthomatous ameloblastoma, the CC was observed in the central metaplastic squamous cells, while in 3 cases of unicystic ameloblastoma, CC was seen in stellate reticulum-like cells of intraluminal (2) and mural proliferations (1). All the 15 cases of ameloblastoma showed a negative expression of CD68 as well as lysozyme. CONCLUSION: CC is a new addition to the pathogenesis of ameloblastoma.

Prosthetic Rehabilitation of Microstomia Patients: A Systematic Review of Published Case Reports and Case Series.

STATEMENT OF PROBLEM: Prosthetic techniques commonly employed for the rehabilitation of edentulous patients might not be adequate in the treatment of patients with microstomia. PURPOSE: The purpose of this paper is to systematically review all the prosthetic techniques that have been used in the oral rehabilitation of patients with microstomia. MATERIALS AND METHODS: Data sources, including PubMed, Google Scholar, SCOPUS and Web of Science, were searched for case reports and case series published through September 2017. Three investigators reviewed and verified the extracted data. Only case reports and case series on prosthetic rehabilitation in microstomia patients published in the English language were considered eligible. RESULTS: A total of 212 records were identified from the database search. Forty duplicate records were removed. The remaining 172 articles were assessed for eligibility, and 139 articles were removed because they did not satisfy the inclusion criteria. A total of 34 cases (including 32 case reports and 1 case series) were finally included in the qualitative analysis. The review revealed the use of a modified impression technique with flexible and sectional trays to record impressions in patients with microstomia. Modified forms of oral prostheses ranging from sectional, flexible, collapsible and hinged dentures to implant-supported prosthesis were fabricated to overcome the limited mouth opening. The success of the prosthetic technique primarily depended on the extent of the microstomia and the nature of the cause of the microstomia. CONCLUSION: Even though the patient acceptance of the prosthetic techniques summarized in the systematic review were high, long-term success rates for each option could not be assessed because of the short follow-up time in most of the included case reports and series.

Bibliometric analysis of 100 most cited articles on oral submucous fibrosis.

BACKGROUND: Citation analysis reflects the scientific recognition and influential performance of an article in the scientific community. The objective of this study was to identify and characterize the 100 most cited articles on oral submucous fibrosis (OSF). METHODS: A list of 100 most cited articles related to OSF was retrieved from the Science Citation Index-Expanded tool of Scopus database in May 2018. The articles were further reviewed, and basic information was recorded including the number of citations, citation density, journals, with its impact factor, category and quartile, publication year, authors, institution and country of origin, article type and level of evidence. Descriptive statistics were used to summarize the results. RESULTS: The most frequently cited article received 780 citations, while the least frequently cited article received 49 (mean 107.5 citations per article). There were 38 different journals with Journal of Oral Pathology and Medicine having the most citations (n = 22). The 100 most cited articles were published from 1966 to 2013, with 81% published after 1990. Thirteen authors listed 5 or more articles in the top 100 list, and India was found to be the most prolific country with 38 articles. In terms of article type, there were 72 research articles and 28 review articles. CONCLUSIONS: This first citation analysis of the 100 most cited articles renders a historical perspective on the progress of research in the field of OSF and enables the comprehensive identification and recognition of the most important and relevant research topics concerned.

Impact of oral potentially malignant disorders on quality of life: a systematic review.

Although oral potentially malignant disorders (OPMDs) are relatively common and potentially debilitating, literature on quality of life (QoL) in these patients is scanty. The purpose of this paper is to systematically review the literature on QoL in patients with OPMDs. A total of 210 titles were retrieved from electronic and manual databases searched from 1960 until September 2017. Out of these, 25 met our strict inclusion criteria as per the preferred reporting items for systematic reviews and meta-analyses guidelines. Most studies have assessed QoL in patients with oral lichen planus, reports of which cannot be generalized to all patients with OPMD. The findings of the studies differ but, overall, do not provide evidence that OPMD patients have a poorer QoL than healthy subjects.

Impact of oral submucous fibrosis on oral health-related quality of life: A condition-specific OHRQoL-OSF instrument analysis.

OBJECTIVE: Oral submucous fibrosis (OSF) could have a significant impact on daily life activities of affected individuals. The objective of this study was to investigate the impacts of OSF on oral health-related quality of life (OHRQoL). MATERIALS AND METHODS: A total of 206 clinically diagnosed OSF patients were recruited and subjected to the condition-specific OHRQoL-OSF instrument and global self-ratings of oral health and overall well-being. RESULTS: "Discomfort and functional impairment" dimension was highly prevalent among patients with all stages (p < 0.001). OSF also has impacts on other domains, namely "psychological wellness" (82.35%) and "social wellness" (61.16%). Stage IV OSF (25.94 ± 4.05) patients reported higher OHRQoL-OSF scores as compared to stage III (16.20 ± 2.58) and stage II OSF (7.26 ± 1.70) patients. However, stage I OSF patients reported significantly better OHRQoL (p < 0.001). A significant trend demonstrating overall OHRQoL-OSF scores increasing with advancing stages of OSF was observed. The majority of the participants rated their overall oral health status "fair" (34.95%) to "very poor" (26.21%), whereas overall well-being was rated as moderate (33.00%) to good (31.55%). CONCLUSION: OSF has a significant impact on OHRQoL. Increasing severity of OSF is associated with the worsening QoL.

Quality of Life-related "Patient-reported Outcome Measures" in Oral Submucous Fibrosis Patients.

AIM: The aim of this study was to explore the patients' perspectives about the impact of oral submucous fibrosis (OSF) on life quality. MATERIALS AND METHODS: Thirty clinically diagnosed OSF patients with a wide degree of disease severity and diverse range of sociodemographic profile were included in this study. Fourteen participants were interviewed and four focus group discussions were conducted in nonclinical settings. The audio recordings were anonymized, transcribed, and translated in English from Marathi language. Data were analyzed using an in-depth narrative thematic analysis method. RESULTS: Four main themes evolved from the interviews: (1) discomfort and functional impairment; (2) psychological wellness; (3) physical wellness, and (4) social wellness. Majority of the participants discussed about discomfort and functional impairment. Participants also reported greater impact of OSF on psychological and social wellness. CONCLUSION: This study demonstrated the impact of OSF on different aspects of participant's life. "Discomfort and functional impairment" was noticed to be the most recognized theme by our participants. However, OSF also has impacts on other important domains, namely psychological, social, and physical wellness. CLINICAL SIGNIFICANCE: The patient-reported outcome (PRO) measure (PROM) reflects an integral aspect of general health and well-being and thus can be used to elucidate the impact of OSF on the quality of life (QoL) of affected individuals. These patients' perspectives should be taken into consideration along with thorough clinical examination to decide and effectively manage the overall health care needs of the OSF patients.

"Mind" in Betel-quid Use and Related Disorders.

Oral squamous cell carcinoma is characterized by a unique predisposing state called oral potentially malignant disorders (OPMDs). Wide variety of carcinogenic insult in the form of detrimental habits can contribute to the causation of variety of OPMDs.1,2.

Scope of Mathematical Biology in Cancer Research.

Mathematical biology involves the use of mathematical models derived from biological data to predict the course or outcome of a biological event. In oncology, mathematics plays a vital role in determining the tumor behavior and the optimal treatment strategy including the right combination of treatment modality to be used, and the timing and duration of the treatment. The major limiting factor in mathematical oncology is the inability to obtain accurate biological data to formulate appropriate mathematical models.1 Development of molecular biology has enabled us to overcome these limitations.

Analyses of the Erosive Potential of Various Soft Drinks and Packaged Fruit Juices on Teeth.

AIM: This study aimed to evaluate the erosive potential of twenty beverages (8 carbonated drinks and 12 packaged fruit juices). MATERIALS AND METHODS: Twenty-one sound permanent freshly extracted teeth were segmented into small enamel slices and stored in normal saline. The titratable acidity of each experimental drink was measured as the amount of 0.1 N sodium hydroxide (NaOH) required to raise pH to 5.5 and 7. The enamel specimens were incubated in freshly collected human saliva for 3 hours. One enamel slice was immersed in each beverage and percentage weight loss in the enamel slice was calculated after 6 and 24 hours intervals. RESULTS: The titratable acidity values of the experimental drinks ranged from 0.2 to 5.6. The mean titratable acidity values of the packaged fruit juices were higher than carbonated drinks. A significant difference (p < 0.0 5) was found in the percentage weight loss of enamel specimens after 6 and 24 hours immersion in the carbonated drinks than packaged fruit juices. Apple juice followed by thumps up were found to be the most erosive drinks with the least effects of Miranda and Guava juice. CONCLUSION: Most of the beverages tested in this study showed erosive potential. The carbonated drinks caused significant dental erosion. CLINICAL SIGNIFICANCE: Individuals at risk for beverages-associated erosion, particularly those with high intakes or decreased salivary flow, should be provided preventive guidance regarding habits of beverages intake. Specific dietary recommendations for the prevention of dental erosion may now be developed based on the patient's history of beverage consumption.

Oral Manifestations in Diabetic and Nondiabetic Chronic Renal Failure Patients receiving Hemodialysis.

Aim: To assess the prevalence of oral findings in diabetic and nondiabetic chronic renal failure (CRF) patients receiving hemodialysis (HD). Materials and methods: This study was conducted on 144 CRF patients undergoing HD therapy. They were further classified into diabetic and nondiabetic groups and also according to the duration of CRF. An oral examination was performed, searching for CRF-associated oral findings, along with due considerations to duration of CRF. Results: The oral manifestations were found to be higher in diabetic CRF patients (97.14%) relative to nondiabetic CRF patients (89.18%). The diabetic group exhibited a significantly higher number of patients with poor oral hygiene index (p = 000), uremic fetor (p = 0.005), unpleasant taste (p = 0.009), dry-fissured lips (p = 0.002), and pale mucosa (p = 0.019) than the nondiabetic group. The oral manifestations were significantly higher in CRF patients of more than 24 months' duration. Conclusion: The CRF HD patients with diabetes mellitus exhibited a higher risk of oral uremic manifestations including uremic fetor, unpleasant taste, pale mucosa, and dry-fissured lips than nondiabetics. The oral health status of CRF HD patients becomes worse with the increase in the duration of CRF. Clinical significance: Oral health status is often a neglected aspect in CRF patients. It should be given prime importance for CRF patients receiving HD to improve the quality of life. Keywords: Chronic renal failure, Diabetes, Hemodialysis, Oral manifestations.

Quality of Life Assessment should be Part of Oral Health Evaluations in Day-to-day Practice.

According to the World Health Organization (WHO), "Health is a state of complete physical, mental, and social wellbeing and not merely the absence of disease and infirmity."1 Quality of Life (QoL) is a crucial and often required measure of an individual's general well-being. The QoL is an established term incorporating different facets of life like physical, psychological, social, economical, spiritual, cognitional, and sexual dimensions.