Salivary and imaging-based biomarkers of radiation therapy-induced xerostomia.

Biomarkers are anatomical characteristics or naturally occurring measurable molecules indicating physiological or pathological state of an individual. These biomarkers have the potential to detect or predict diseases at an early stage, which is particularly beneficial in timely management of common complications of radiation therapy done in head and neck cancer treatment regime. Xerostomia is one of the most common oral complaints of radiation therapy. Saliva has an abundance of protein biomarkers; however, those related to post-radiation therapy xerostomia need to be explored further. Textural and imaging-based biomarkers are helpful in predicting xerostomia in such patients. This narrative review provides an account of salivary protein and imaging-based biomarkers of radiation therapy-induced xerostomia in head and neck cancer patients.

Comparison of perceived stress and oral health status using perceived stress scale and DMFT index between healthy, undiagnosed hypertensive, and known hypertensive dental patients.

Subtle and asymptomatic nature of high blood pressure results in increase in mortality and morbidity. Dentists may play a vital role in identifying patients with suspected hypertension who are not yet diagnosed to refer them timely to physicians for diagnosis and management of the condition. The aim of this study was to compare the oral health status using decayed, missing, filled teeth (DMFT) index and perceived stress score using perceived stress scale (PSS-10) between systemically healthy dental patients, and patients with undiagnosed and known hypertension attending dental out-patient department of Combined Military Hospital (CMH) Lahore Medical College & Institute of Dentistry, Lahore, Pakistan. It is a cross-sectional descriptive study in which 108 patients participated selected through purposive sampling method, 36 in each group. According to Kruskal Wallis H test, there were significant associations seen among the three groups with age (p < 0.001), DMFT (p < 0.001), and PSS-10 scores (p = 0.003). According to Spearman's matrix correlations, moderate positive correlations were observed between mean arterial pressure (MAP) and DMFT (r = 0.46, p < 0.001), and MAP and age (r = 0.38, p = 0.001), DMFT and PSS-10 (r = 0.47, p < 0.001), and DMFT and age (r = 0.33, p = 0.004) in healthy and patients with undiagnosed hypertension. It may be concluded that patients with raised blood pressure have higher perceived stress and deteriorated oral health.

Leadership competencies for dentists: What do undergraduate students think?

Dentists face difficult situations and challenges every day, but undergraduate dental students in Pakistan are not formally taught leadership skills or assessed for these skills. This study aims to explore the perception of undergraduate dental students on various leadership competencies. A multi-institutional cross-sectional observational study was conducted on undergraduate students in five institutions by using universal sampling technique. Students were asked to self-assess various leadership competencies for dentists based on 15 competencies using a validated questionnaire utilizing Likert scale response format. Responses to these items were presented as frequency and percentage. The overall scores were presented in mean and standard deviation and median and interquartile range. The differences in median scores of all items of the questionnaire between male and female students were determined with Mann Whitney U tests. The year-wise differences in the median of all response items of the questionnaire were determined using Kruskal Wallis H test. A total of 750 students, of which 570 (76%) were females and 180 (24%) were males, participated in the study. Most of the students (n = 708, 94.4%) did not attended any leadership course or workshop in the last five years. Majority of the students perceived that their leadership competencies were fair to excellent. Empathy was perceived as 'excellent' by the majority of the students (n = 294, 39.2%). Majority of the students (n = 319, 42.5%) perceived that their 'authenticity' skills were 'good'. Statistically significant differences were reported between male and female students in most of the leadership skills including 'compassion', 'advocacy skills', 'inquiry skills', 'empathy', 'integrity', 'ability to build trust with others', 'managing conflict', 'leading groups/teams', 'dealing with difficult personalities', and 'likelihood to exercise leadership during a crisis' (p < 0.05). There were also significant differences in the median item scores in 13 out of 15 leadership domains and the year of study (p < 0.05). The study identified the perceptions of students regarding different leadership competencies. It gives indications that which leadership competencies need to be incorporated, promoted, and enhanced in leadership curriculum to make them effective dental practitioners and leaders in future. Incorporating these targeted leadership courses into the curriculum can provide participants with the opportunity to refine their existing leadership strengths and develop a well-rounded set of competencies essential for making a significant contribution in their chosen fields.

Comparison of virtual clinical scenario and role play in learning oral pathology among dental students.

In oral pathology, virtual clinical scenario illustrating dentist-patient interactions can be utilized by both students and health professionals to deliver/gain knowledge and make clinical diagnosis of oral lesions. Role play is also an educational technique which is designed to engage and motivate students in classrooms. This study aimed to compare usefulness of virtual clinical scenario and role play in learning oral pathology among second-year dental students. The students were randomly divided to one of the two groups: virtual clinical scenario group (n = 50) and role play group (n = 50). Virtual clinical scenario group was provided with virtual clinical cases of oral lesions through Google Forms whereas role play group was exposed to virtual clinical cases of oral lesions through role playing activity. Both groups underwent assessments before and after the intervention. Students' perceptions on usefulness of both techniques in terms of diagnosis, visual parameters and impact on learning were evaluated by feedback questionnaire. Data were analyzed using Statistical Package for the Social Sciences version 27.0. Wilcoxon signed-rank test was used to compare pre-test and post-test scores. Additionally, the scores and students' responses from both groups were compared using the Mann-Whitney U test. A P-value of < 0.05 was set as statistically significant. Students in both groups showed significantly higher post-test scores compared to their pre-test scores (P < 0.001). However, the role play group outperformed the virtual clinical scenario group, with a significantly higher post-test score (P = 0.04). Furthermore, feedback concerning role play was significantly higher than that for the virtual clinical scenario across multiple aspects (P < 0.05). Our findings suggest that role play emerges as the preferred method, significantly enhancing dental students' learning experiences in oral pathology.

Comparison of light microscopy and digital microscopy for learning oral pathology practicals among second year dental students.

Background/purpose: Previous studies have shown that digital microscopy is an indispensable tool for teaching oral pathology laboratory course. Despite this, our institute relies solely on recommended/reference book images for oral pathology practicals, neglecting both light and digital microscopy methods. Gathering students' feedback on these methods is essential before considering digital microscopy as part of the oral pathology curriculum. Therefore, this study aimed to compare the usefulness of light and digital microscopy among second-year dental students. Materials and methods: The study was conducted from December 6 to December 7, 2023, in the Department of Oral Pathology, Dr. Ishrat-ul-Ibad Khan Institute of Oral Health Sciences, Dow University of Health Sciences. The study involved the selection of five cases from the oral pathology course, followed by feedback on students' diagnostic skills, learning impact and acceptance rate of light and digital microscopy using an online questionnaire. Mann-Whitney U test was used to compare students' responses and P-value < 0.05 was set as statistically significant. Results: There was a statistically significant difference in diagnostic scores between light microscopy and digital microscopy (P < 0.05). Statistically significant differences favoring digital microscopy were observed in various aspects, including interpreting variations, diagnosis, time efficiency, and image clarity. Conclusion: Although diagnostic scores were lower, digital microscopy was perceived as a useful method for enhancing diagnostic skills among dental students. Both light microscopy and digital microscopy are viable options for oral pathology practicals, however, digital microscopy was preferred by students due to its time efficiency and clear image quality.

Salivary aquaporin-3 as a screening biomarker for xerostomia in patients with periodontal disease and the effects of xerostomia on oral health-related quality of life.

Xerostomia is a subjective condition of dryness of the oral cavity that may lead to several oral problems deteriorating oral health-related quality of life. This study aimed to (1) determine the prevalence of xerostomia, (2) compare the general health status, unstimulated salivary flow rate, and oral health-related quality of life in xerostomics and non-xerostomics, and (3) investigate the potential of salivary aquaporin-3 (AQP-3) as a screening biomarker for xerostomia in patients with periodontal disease. Demographics and systemic health data were collected from 109 healthy participants, 20 to 55 years old, with Community Periodontal Index (CPI) score ≥ 3. For subjective assessment of xerostomia, Shortened Xerostomia Inventory (SXI) was used. For objective assessment of xerostomia, unstimulated salivary flow rate was measured. Shortened Oral Health Impact Profile (S-OHIP) was utilized for oral health-related quality of life assessment. The collected saliva samples were processed and stored at -80°C. Quantification of salivary AQP-3 protein was done with enzyme-linked immunosorbent assay. Xerostomia was reported in 78% of the subjects based on SXI score. Median concentration of AQP-3 was significantly higher in xerostomics compared to non-xerostomics, p = 0.001. Moreover, oral health-related quality of life was significantly poor in xerostomics compared to non-xerostomics, p = 0.002. Furthermore, there were significant correlations between AQP-3 and SXI (r = 0.21, p = 0.025), AQP-3 and S-OHIP (r = 0.2, p = 0.042), S-OHIP and SXI (r = 0.37, p < 0.001), unstimulated salivary flow rate and random blood glucose level (r = 0.32, p = 0.001), and body mass index and mean arterial pressure (r = 0.44, p < 0.001). Regression analysis showed that body mass index, CPI score 3, and salivary AQP-3 were suitable predictors for presence of xerostomia. AQP-3 could be a potential screening biomarker for xerostomia in patients with periodontal disease for its early identification may help improve oral health-related quality of life of the individuals.

From text to e-text: perceptions of medical, dental and allied students about e-learning.

Objective: More than a year ago, Pakistan like the rest of the word, was hit by a global pandemic, due to which students of higher education had to accept the new era and adapt to the electronic learning environment for the very first time. This study aims to analyze the perceptions of medical, dental, and allied health students about e-learning in Pakistan. Methods: A descriptive, cross-sectional study was conducted throughout the country. A pre-validated, anonymous online questionnaire regarding demographics, past-experience of e-learning, advantages disadvantages of e-learning, and general perception of students towards e-learning was distributed. Descriptive statistics were computed for all demographics. Chi-square test was used to compare the differences of perceptions between pre-clinical year and clinical years students. Chi-square was used to compare overall category-wise positive and negative responses of students. The association between participant demographics and their perception towards e-learning was also calculated using chi square. Results: A total of 1200 students participated in the study of which 797 (66.4%) were from pre-clinical years and 403 (33.6%) were from clinical years. The major advantage identified by all students was the 'comfortable environment' (70%) and 'technical problems with IT equipment' was listed as the biggest disadvantage (89%) of e-learning. For preclinical year students, 'anxiety due to social isolation' was selected as the biggest issue (p < 0.05) whereas, for clinical year students, it was 'lack of patient interaction' (p < 0.05). Overall, 72% of students had a negative perception of e-learning. Conclusion: After more than a year of online studying, medical and allied students of Pakistan have expressed dissatisfaction towards e-learning. Student-teacher training, student counselling sessions, and innovative techniques need to be introduced to enhance student engagement and reduce pandemic stress.

Determining the relationship among stress, xerostomia, salivary flow rate, and the quality of life of undergraduate dental students.

OBJECTIVE: Xerostomia may result in several oral conditions, which ultimately affect oral health-related quality of life (OHRQOL). This study aims to evaluate the relationship of stress, xerostomia, salivary flow rate, and OHRQOL among young adults. METHOD: We invited 72 participants to complete three validated questionnaires including the Perceived Stress Scale-10 (PSS-10), a shortened version of the Xerostomia Inventory (SXI), and the shortened Oral Health Impact Profile (S-OHIP). Unstimulated saliva was collected, and flow rate was determined. Based on the SXI scores and hyposalivation, the participants were categorised into four groups: subjective xerostomia, subjective and objective xerostomia, objective xerostomia, and true non-xerostomia. Based on the median PSS score, participants were categorised into high stress and low stress groups. Data were analysed using the Mann-Whitney U test, Kruskal-Wallis H test, and Spearman's correlation coefficient. A p value of 0.05 was set for all tests. RESULTS: A significant difference was observed in the unstimulated salivary flow rate (χ2(3) = 26.677, p < 0.001) and PSS scores (X2(3) = 8.552, p = 0.036) between xerostomia groups, while OHIP scores were not statistically different (X2(3) = 5.488, p = 0.139). A significant correlation was observed between SXI and S-OHIP scores (r = 0.348, p = 0.003) and unstimulated salivary flow rate and PSS (r = -0.259, p = 0.028). CONCLUSION: This study shows that perceived stress can influence salivary flow rate. Among the xerostomia groups, stress scores and salivary flow rates varied significantly. Additionally, subjective xerostomia has an impact on OHRQOL.