Diagnostic accuracy of tele-dentistry in screening children for dental caries by community health workers in a lower-middle-income country.

BACKGROUND: Tele-dentistry can be useful for dental caries screening of children, especially in lower-middle-income countries (LMICs). AIM: To evaluate the diagnostic accuracy of mobile phone photographs taken by a community health worker (CHW) for caries detection in Iran. DESIGN: Children aged 6-12 years were visually examined by a paediatric dentist. Following dental examinations, intraoral photographs were taken by a trained CHW. Two remote dentists assessed intraoral photographs for dental caries. Diagnostic accuracy of tele-dentistry for caries detection was evaluated. In addition, the questionnaire about oral health and parents' views towards tele-dentistry was prepared. RESULTS: One hundred thirty-one children aged 8.74 ± 1.62 years participated. The caries prevalence was 30% for the whole dentition. Tele-dentistry demonstrated high accuracy, with a sensitivity exceeding 80% and specificity exceeding 90%. The inter-rater reliability for remote dentists' assessments to the gold standard dental examination ranged from substantial to almost perfect (kappa: 75%-93%). Additionally, 80% of parents whose children participated in this study had positive views towards tele-dentistry. CONCLUSION: Tele-dentistry was shown to be an alternative approach to clinical examinations for caries detection among school children. Employing non-dental care professionals in tele-dentistry has been emerged as a reliable and cost-effective approach, especially in LMICs.

The feasibility of a digital health approach to facilitate remote dental screening among preschool children during COVID-19 and social restrictions.

BACKGROUND: Tele-dentistry can be useful to facilitate screening of children, especially those living in rural and remote communities, and during the COVID-19 pandemic. AIM: This study evaluated the feasibility of tele-dental screening for the identification of early childhood caries (ECC) in preschoolers using an app operated by their parents with remote review by oral-health therapists. DESIGN: This cross-sectional study was a sub-project nested in ORIGINS Project, a longitudinal birth cohort study in Western Australia. Initially, children were visually examined by a paediatric dentist (gold standard). Subsequently, dental photographs were taken by parents using a smartphone camera. Two trained oral health professionals asynchronously evaluated dental photographs. The presence of dental caries was recorded as per the International Caries Detection and Assessment System-II classification. The diagnostic accuracy and reliability of the tele-dental screening and the gold standard dental examinations were then compared. RESULTS: Forty-two children aged <4 years were enrolled in the study. Twenty-five per cent of examined children had dental caries (mean dmfs = 0.7). A total of 370 dental photographs were obtained. Parents were able to take good-quality photographs, with 90% of photographs rated as good to fair quality. Tele-dental screening demonstrated high specificity (>=95.5%) for both reviewers compared to the gold standard dental examination. However, the sensitivity scores for the two reviewers varied, ranging from 44% to 88.4%. CONCLUSION: Tele-dental screening for ECC was shown to be a feasible approach following a brief training for primary caregivers. This approach can offer a potential low-cost and sustainable alternative for visual dental examinations for young children, particularly in times of COVID-19-related restrictions.

Disparities in Oral Cancer Awareness: a Population Survey in Tehran, Iran.

Oral cancer is a life-threatening disease with low survival rates, especially when diagnosed in an advanced stage. Lack of awareness about this cancer among the population is proposed as a possible reason for this diagnostic delay. The aim of this study was to evaluate oral cancer awareness, as well as the association of this with sociodemographic status in Tehran. In this cross-sectional population-based survey, 1800 self-administered questionnaires (collecting sociodemographic data, questions regarding oral cancer awareness and the source of information) were distributed through multistage stratified random sampling. Scores for questions ranged from 0 to 4, and totals were summed. The outcome of question responses was also analyzed separately. In total, 1312 questionnaires were available for analysis, from 788 females and 489 males (37.8 ± 9.02 years). Only 30% of the respondents were aware of oral cancer. The average score for awareness was 1.09 ± 1.6 with no significant differences between age groups and genders. Almost 6.5% of participants had complete awareness about oral cancer. A significant difference was found between mean scores in different levels of education and occupation (p = 0.0001). From 585 responses to the "source of information" question, "public media" was the most important source (almost 50%). Only 2% mentioned "dentists" as a source of information. This study indicated an alarming lack of oral cancer awareness and literacy in Tehran, Iran. Dentists should be obliged to practice their pivotal role in informing the public about oral cancer.

Relationship Between Mothers' Knowledge and Attitude Towards the Importance of Oral Health and Dental Status of their Young Children.

PURPOSE: To examine the relationship between mothers' knowledge, attitude and dental caries status and their young children's dental caries status. MATERIALS AND METHODS: In this cross-sectional study, 153 2- to 6-year old children old and their mothers were dentally examined. Mothers' decayed, missing or filled teeth (DMFT) and children's decayed, missing or filled teeth (dmft) were recorded. A validated questionnaire was used to examine maternal knowledge and attitudes regarding the importance for the oral health of their children. RESULTS: The average age of children and mothers were 5.1 and 31 years, respectively. The mothers' and children's mean DMFT and dmft were 12 and 6, respectively. The mean level of mothers' knowledge was 31.5 out of 40, while the mean attitude was 24.5 out of 30 points. There was a statistically significant inverse correlation between mothers' knowledge and their DMFT (r = -0.7), and between mothers' knowledge and children's dmft (r = -0.6). Also, there was an inverse correlation between mothers' attitude and DMFT (r = -0.8), and between mothers' attitude and dmft (r = -0.7). A direct correlation between mothers' DMFT and children's dmft (r = +0.6) was observed. CONCLUSION: Attempts at improving the knowledge and attitude in parents have a substantial impact on improving the oral health of next generation.

Patterns and predictors of dental hospitalizations in patients with acquired brain injury from pre-injury to acute and post-acute injury.

BACKGROUND: Acquired brain injury (ABI) can cause long-term disability and functional impairment. OBJECTIVE: This study aims to determine the prevalence of dental hospitalizations in an ABI cohort across different phases of injury and identify factors associated with such hospitalizations. METHODS: The cohort comprises patients with ABI (n = 683), traumatic (n = 282) and non-traumatic (n = 401) who were admitted to a neurorehabilitation service in Western Australia between 1991 and 2016. De-identified patient data were linked to the Hospital Morbidity Data Collection. The incidence of dental hospitalizations was calculated per 1,000 person-years (PY), and associated factors were investigated using multilevel mixed-effects logistic regression. RESULTS: Dental hospitalizations significantly increased from pre-injury (3.35/1,000PY) to acute injury (302.65, Δ+299.3) and remained elevated in the post-acute phase (23.98, Δ+20.63). Dental caries had the highest incidence rate among all diagnoses in the pre-injury and post-acute phases (0.68 and 8.93, respectively), followed by gingivitis and periodontal diseases (3.60) in the post-acute phase. Tooth extractions were performed more often than restorative and preventive treatment in the pre-and post-injury phase, p < 0.001. Dental hospitalizations were associated with the type of ABI, age at injury, remoteness, and history of pre-injury hospitalization. CONCLUSION: Implementing comprehensive preventive dental care can reduce potentially preventable dental hospitalization among ABI patients.

Experience of primary caregivers in utilising an mHealth application for remote dental screening in preschool children.

Objectives This study aimed to address the acceptance of mHealth applications for a dental screening app that facilitates patient information entry and captures dental photos remotely to assist in caries diagnosis in preschool children in Australia. Methods All participants were recruited through the ORIGINS Project, a community-based interventional birth cohort study in Western Australia. Forty-two primary caregivers, who were the users of a teledental screening app, were given a questionnaire with 17 questions; these were constructed based on the theme of the Technology Acceptance Model: perceived ease of use (PE), perceived usefulness (PU), behavioural intention to adopt (BI), anxiety (ANX), attitude toward a behaviour (ATB), and self-efficacy (SE). Cronbach's alpha was estimated to determine internal consistency. Path analysis was employed to quantify the relationship between each theme. Results The mean values for most themes indicated high satisfaction with the intervention among caregivers (scores out of 5): PE (4.54 ± 0.55), PU (4.65 ± 0.49), BI (4.40 ± 0.65), ATB (4.23 ± 0.70), SE (4.36 ± 0.64). Results indicated high consistency in response in the PE, PU, ATB, and SE (α = 0.74-0.84) and moderate consistency was observed in ANX and BI (α = 0.50-0.62). The overall intention of using the dental screening app was significantly related to both PU and ATB (P Conclusion The perceived usefulness and attitude toward behaviours influenced the overall behavioural intention of the participants to use the telehealth model in dental screening. Recognising these relationships indicates community readiness for implementing the telehealth application in the dental program and enables identification of areas for improving its diffusion.

Malignant and non-malignant oral lesions classification and diagnosis with deep neural networks.

OBJECTIVES: Given the increasing incidence of oral cancer, it is essential to provide high-risk communities, especially in remote regions, with an affordable, user-friendly tool for visual lesion diagnosis. This proof-of-concept study explored the utility and feasibility of a smartphone application that can photograph and diagnose oral lesions. METHODS: The images of oral lesions with confirmed diagnoses were sourced from oral and maxillofacial textbooks. In total, 342 images were extracted, encompassing lesions from various regions of the oral cavity such as the gingiva, palate, and labial mucosa. The lesions were segregated into three categories: Class 1 represented non-neoplastic lesions, Class 2 included benign neoplasms, and Class 3 contained premalignant/malignant lesions. The images were analysed using MobileNetV3 and EfficientNetV2 models, with the process producing an accuracy curve, confusion matrix, and receiver operating characteristic (ROC) curve. RESULTS: The EfficientNetV2 model showed a steep increase in validation accuracy early in the iterations, plateauing at a score of 0.71. According to the confusion matrix, this model's testing accuracy for diagnosing non-neoplastic and premalignant/malignant lesions was 64% and 80% respectively. Conversely, the MobileNetV3 model exhibited a more gradual increase, reaching a plateau at a validation accuracy of 0.70. The MobileNetV3 model's testing accuracy for diagnosing non-neoplastic and premalignant/malignant lesions, according to the confusion matrix, was 64% and 82% respectively. CONCLUSIONS: Our proof-of-concept study effectively demonstrated the potential accuracy of AI software in distinguishing malignant lesions. This could play a vital role in remote screenings for populations with limited access to dental practitioners. However, the discrepancies between the classification of images and the results of "non-malignant lesions" calls for further refinement of the models and the classification system used. CLINICAL SIGNIFICANCE: The findings of this study indicate that AI software has the potential to aid in the identification or screening of malignant oral lesions. Further improvements are required to enhance accuracy in classifying non-malignant lesions.

Factors associated with dental hospitalisations in children with intellectual disability or autism spectrum disorder: a Western Australian population-based retrospective cohort study.

PURPOSE: This study investigated dental hospitalisations in Western Australian (WA) children with intellectual disability (ID) and/or autism spectrum disorder (ASD) aged up to 18 years. METHODS: Data on WA live births from 1983 to 2004 from the WA Midwives Notification System were linked to the Intellectual Disability Exploring Answers database, the WA Hospital Morbidity Data System, and the Western Australian Birth Defects Registry databases. Children were followed from birth to 2010 and the data grouped into three age-groups. Primary and secondary admissions for relevant dental diagnoses were identified and factors associated with having a dental hospitalisation investigated. RESULTS: There were 1366, 1596, and 780 dental hospitalisations amongst 1122, 1154, and 609 children with ID and/or ASD in the 0-6, >6-12, and >12-18 year age groups, respectively. Children with severe ID were much more likely to be hospitalised than those with mild/moderate ID. More socioeconomically disadvantaged children were less likely to be hospitalised than children whose parents were socially advantaged. CONCLUSIONS: There is concern that more vulnerable children in the WA community with ID or ASD are receiving an inadequate level of dental services compared with other groups resulting in potentially preventable hospitalisations, a situation in need of urgent remediation.Implications for rehabilitationLittle is known about why some children with intellectual disability (ID) or autism are being hospitalised for their dental care and others are not.Children with disability whose families are socioeconomically disadvantaged should have equivalent opportunity to receive optimal dental care.Dental practitioners at all levels need training and confidence in treating children with ID.

Herbs in dentistry.

Herbs have been used for centuries to prevent and control disease. Herbal extracts are effective because they interact with specific chemical receptors within the body and are in a pharmacodynamic sense, drugs themselves. By using herbal medicines, patients have averted the many side effects that generally come with traditional medicines, but this does not mean that side effects do not occur. Only knowledgeable practitioners can prescribe the right herb and its proper dosage. Herbal medicines had been considered in every culture, however, pharmaceutical companies overturned this type of thinking. Now, pharmaceuticals are called traditional and herbs are libeled as the 'alternative'. The biggest challenge and problem is lack of information about the effect of herbs in oral tissues, mechanism of effect, and side effects. Several popular conventional drugs on the market are derived from herbs. These include aspirin (from white willow bark), digitalis (from foxglove), and sudafed (modelled after a component in the plant ephedra). Herbal products can vary in their potency. Therefore, care must be taken in selecting herbs, even so, herbal medicines have dramatically fewer side effects and are safer to use than conventional medications. The herbs described in this article are Bloodroot, Caraway, Chamomile, Echinacea, Myrrh, Peppermint, Rosemary, Sage, Thyme, Aloe Vera, Propolis, and a summary of other herbs that are useful in dentistry. Herbs may be good alternatives to current treatments for oral health problems but it is clear that we need more research.

Comparison of superoxide dismutase activity in saliva of smokers and nonsmokers.

BACKGROUND: Considering the role of superoxide dismutase (SOD) as one of the most important salivary antioxidant enzymes, this study was performed to compare the level of this enzyme in smokers and nonsmokers. METHODS: Unstimulated saliva of 60 volunteers (30 smokers and 30 nonsmokers) was collected. The activity of salivary SOD was measured in each group and compared. RESULTS: The mean value of superoxide dismutase activity was significantly higher in the smoking group (P < 0.001), while no detectable activity level was found in nonsmokers. CONCLUSION: Cigarette smoke leads to an elevation in salivary superoxide dismutase activity.

The accuracy of a 3-D laser scanner for crown width measurements.

BACKGROUND: Virtual dental casts have been recently introduced to orthodontics. The problem of capturing the shapes of teeth on study casts may be complicated by the presence of undercut areas and deep grooves. AIMS: This study aimed to develop a 3-D laser scanner and associated software, and to evaluate the reproducibility and validity of mesiodistal crown width measurements based on slice distinction. METHODS: To evaluate reproducibility: a cube was scanned with readily available equipment and the digital measurements compared to caliper measurements of the cube; and the mesiodistal widths of artificial upper teeth were measured, set-up in a dental model, scanned, measured on the virtual study models and compared with the reference measurements. Custom software was used to capture and process the resulting images. To determine validity artificial teeth were measured with calipers, set-up in 20 different malocclusions, duplicated and scanned. The caliper measurements of groups of teeth (incisors, canines, premolars, molars) were compared with digital measurements of the same teeth. In the second method to determine validity, 10 dental casts were scanned and measured by two examiners and the mesio-distal widths compared with the reference values, and with each other. RESULTS: The digital measurements of the cube fell within 0.1 mm of the reference value. The absolute error in repeated measures of the dental model was 0.32 +/- 0.25 mm. The overall correlation between 3-D images of the teeth and the reference values, using the intraclass correlation coefficient (ICC), was 0.84. The most and least valid results for groups of teeth were the premolars and canines, respectively. The inter-observer ICC was 0.60, and each examiner's ICC versus the reference values were 0.833 and 0.855. CONCLUSIONS: The mesiodistal widths of teeth and groups of teeth can be reliably and validly measured on virtual study models using the scanner and software developed for this purpose. Inaccuracy in the canine region may be overcome by using a smaller rotational angle during scanning.

Knowledge of Oral Precancerous Lesions Considering Years Since Graduation Among Dentists in the Capital City of Iran: a Pathway to Early Oral Cancer Diagnosis and Referral?

Background: Late diagnosis and improper treatment lead to many avoidable deaths in patients suffering from oral cancer. This study evaluated the knowledge and perceptions of general dentists regarding oral precancerous lesions and oral cancer risk factors with reference to early diagnosis and referral. Materials and Methods: In this descriptive study, 200 private general dental practitioners were randomly selected in Tehran, Iran. Demographic information and years since graduation were recorded; knowledge levels were evaluated with a standardized questionnaire consisting of 15 closed-response item questions about precancerous lesions and oral cavity cancer. Each correct answer got one point. Results: Out of 200 selected dentists, 153 returned completed questionnaires. The average age of participants was 36 and the average achieved score was 7.96 out of 15 (Min 3, Max 13). Most (64.7%) of participants were in the group that graduated within the previous 10 years, 23.5% between 10 and 20 years since graduation, and 11.8% more than 20 years previously. There was a statistically significant difference between the most recently graduated group (< 10 years) and the other two groups. The dentists' awareness was also significantly dependent on age. There was no statistically significant difference in awareness between male and female dentists. Conclusion: As professional oral health care providers, dentists should be aware of all aspects regarding precancerous lesions in order to optimize early diagnosis and referral of oral cancer patients. Training courses and continuing education seem to be an essential strategy to increase and maintain knowledge of this group.

Does green tea consumption improve the salivary antioxidant status of smokers?

OBJECTIVE: Considering the higher rate of oral cancer, and reduction in salivary antioxidants in smokers as indicated in previous studies, antioxidant- containing nutrients such as green tea, seem to be beneficial in counteracting against oxidative stress in this group. This study assessed the salivary total antioxidant alteration in smokers compared to nonsmokers, after short-tem (7days) and long-term (3 weeks), green tea drinking. DESIGN: In this experimental study, 20 volunteer moderate-to-heavy male smokers, and 20 matched healthy non-smokers were selected to participate, according to the inclusion criteria. Participants were instructed to drink two cups of green tea per day, by dissolving 2g of green tea in 150ml of hot water for each cup. After saliva collection, antioxidant capacity of saliva was measured at baseline, after 7days, and after 21days. Statistical evaluation was done by SPSS 21, using paired samplet tests, one-way ANOVA and Bonferroni tests. RESULTS: At day zero nonsmokers had a higher antioxidant capacity than smokers (686.6±62.22 vs. 338.8±59.9) mM/50µl, P<0.001. There was also a significant difference between two groups in salivary total antioxidant capacity after one week and three weeks of green tea consumption (P<0.001). However, there was an upward trend in both smokers and non-smokers over the study period (after tea drinking). In addition, a significant difference was found in total antioxidant capacity alteration in smokers compared to non-smokers from baseline to day 21. CONCLUSIONS: Results support the effectiveness of green tea consumption in salivary antioxidants enhancement in smokers, in both the short- and long term.

Giant Cell Fibroma of the Buccal Mucosa with Laser Excision: Report of Unusual Case.

Giant Cell Fibroma (GCF) was described as a new entity of fibrous hyperplastic soft tissue. It seems that stimulus from an unexplained origin can have a role in its etiology. Histopathologically GCF is consisted of multinucleated fibroblasts that have oval shape nuclei within the eosinophilic cytoplasm. Surgical excision is the treatment of choice and recurrence is very rare. Here we report a case of relatively large GCF in a 54-year-old man. Gingiva is the common location of GCF. As in our case, it may be mistaken as irritation fibroma especially if it is on the buccal mucosa, the most common location for fibroma. Correct diagnosis is based on biopsy and clinical examination to see surface texture roughness. To minimize bleeding because of its large size an excisional biopsy with Diod laser was performed under local anesthesia for this patient.

Diode Laser in Minor Oral Surgery: A Case Series of Laser Removal of Different Benign Exophytic Lesions.

INTRODUCTION: The role of laser in conservative management of oral disease is well established. Laser procedures are common in the fields of oral surgery, implant dentistry, endodontic, and periodontic therapy. CASE: This case series describes the use of diode laser for the excision of oral exophytic lesions. All the patients attended the oral medicine department of Shahid Beheshti University of Medical Sciences, Tehran, Iran. Criteria in patient selection were accessibility to lesions, patient fear from blade surgery, aesthetics, and probability of bleeding. An informed consent was filled by every patient. All of the lesions were completely excised under local anaesthesia by diode laser with 300 µm-fibre tip, 808 nm continuous wavelength and 3-3.5 W power for 3×60 seconds (Dr Smile, Italia). During surgery, the fibre tip was in contact with lesions. No analgesics were prescribed to the patients. The patients were followed for the first, second, and forth week after treatment. CONCLUSION: The lesions could be excised using the diode laser. This procedure was a quick clinical technique without bleeding.

Frequency of gingival pregnancy tumor in iran (confirmed by biopsy).

BACKGROUND: Pregnancy tumor histologically coincides with oral pyogenic granuloma. It is a reactive hemorrhagic swelling that mostly occurs in gingiva of pregnant women and can cause some complications. Considering the lack of knowledge regarding its prevalence, this study aimed to determine the frequency and characteristics of pyogenic granuloma in pregnant women presenting to Tehran/Iran Medical Centers in 2013. MATERIALS AND METHODS: In this descriptive cross-sectional study, a total of 923 pregnant women with a mean age of 27.7 ± 4.7 years were selected among those presenting to Tehran Medical Centers using consecutive sampling and clinical examination. Data were collected through interview and filling out a data form. Related variables were evaluated, and if the lesion was present, its clinical and histological characteristics were recorded. Data were analyzed and reported using relative and absolute frequency indices. RESULTS: Of 923 pregnant women presenting only 2 (0.22%) had clinical and histological signs and symptoms of pyogenic granuloma. Both lesions had a firm consistency and were seen on maxillary gingiva. The lesions were not ulcerative, but both had bleeding. CONCLUSION: Considering the frequency of pyogenic granuloma in previous studies, it can be concluded that the prevalence of this lesion in pregnant women presenting to Tehran Medical Centers in 2013 is lower than previous studies.

Correlation between Burning Mouth Syndrome and Anxiety in the Elderly Inmates of Sanitaria in Tehran.

BACKGROUND AND AIMS: Burning mouth syndrome (BMS) is a chronic pain disorder characterized by a chief complaint of oral burning/pain with no clinically observable oral mucosal lesions. The prevalence of BMS has been reported to be 2.5-5.1% in the general population and several psychological disorders have been reported as associated or predisposing factors for BMS. The aim of this study was to determine the correlation between BMS and anxiety in the elderly residents of sani-taria in Tehran, Iran. MATERIALS AND METHODS: In a cross-sectional analytical study, 50 patients with BMS were included along with 50 healthy individuals as controls. Inclusion criteria were: age over 60 years, burning sensation in the mouth, normal oral mu-cosa, absence of diabetes, satisfactory prosthesis, absence of iron deficiency and other nutrients, and no heavy smoking habits. Similar inclusion criteria were considered for the control group without any oral complaints. Burning/pain severity was assessed by a 100-mm visual analog scale and the severity of anxiety (state, trait, and total) was determined by Cattell's Anxiety Scale. Data was analyzed by t-test and Pearson's correlation coefficient. RESULTS: Individuals with BMS assessed their burning/pain severity to be 27.4 mm (95% CI=25.2 - 29.6 mm). Standard-ized total anxiety scale in individuals with and without BMS (±SE for mean) was 5.9±0.2 and 4.6±0.3 with significant dif-ferences (p=0.001). Similar significant differences were observed in state and trait anxiety between the two groups. CONCLUSION: It seems that both state and trait anxiety are associated with burning mouth syndrome.